Medication adherence among transgender women living with HIV

Abstract

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the U.S. report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p=.028) and were less likely to achieve viral suppression (p=.039). Within the transgender group, Black/African Americans reported better adherence than participants who were Whites/Caucasian or other races (p=.009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population’s continuum of care in HIV therapies.

Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

“…The levels of engagement in care and viral suppression reported in this sample of TF youth is similar to that of TF adults sampled in San Francisco [29], yet suboptimal relative UNAIDS 90-90-90 targets [75]. Consistent with research conducted in TG adults [28, 42, 76], medication adherence and retention in care were also suboptimal as only 55.0% of those currently taking medications had been adherent in the past 7 days and 33.9% had missed one or more HIV care appointment in the past 6 months. Additionally, in multivariable models, medical gender affirmation was associated with reduced odds of virological suppression and with increased odds of missing appointments.…”

Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices

“…also showed disparities with ART at one clinical site, with fewer TGW (59%) than non-transgender people (82%) taking ART [24]. Even when receiving ART, TGW have been shown to be significantly less likely to report optimal adherence [25]. A study examining community viral load in San Francisco demonstrated that TGW had a higher community viral load, almost three times compared to non-transgender persons, consistent with low rates of ART [26].…”

“…A recent substudy of the iPrEx trial revealed that TGW were less likely to have detectable drug levels compared to non-transgender MSM [30]. Furthermore, TGW may have concerns about potential interactions between feminizing hormone regimens and PrEP that reduce the likelihood of PrEP uptake among HIV-negative TGW [25]. …”

Adherence to Antiretroviral Therapy Among Transgender and Gender Nonconforming People Living with HIV: Findings from the 2015 U.S. Trans Survey

“…A few smaller community samples (N = 22 to N = 181) report lower ART adherence rates spanning from 55% to 68% among predominantly transgender women samples, although measurement of adherence varies across studies. 12,[16][17][18][19][20] Community studies of transgender populations report adherence barriers such as negative health care experiences 16 and transphobia. 12 The National HIV/AIDS Strategy for the United States calls for improving health outcomes and decreasing health disparities among transgender people.…”

“…12 The National HIV/AIDS Strategy for the United States calls for improving health outcomes and decreasing health disparities among transgender people. 21 Meeting these goals necessitates better understanding of HIV adherence among this population, 18 although existing national community samples are few. 12 In this study we use the U.S. Transgender Survey (USTS) to explore factors associated with ART adherence among TGNC PLWH based on both the adherence literature and availability of variables in the USTS, including 22 demographics, health and health care indicators, substance use, and recent negative experiences of discrimination and sexual assault.…”