Uptake of Primary Care Services and HIV and Syphilis Infection among Transgender Women attending the Tangerine Community Health Clinic, Bangkok, Thailand, 2016 – 2019

Abstract

Introduction Transgender women (TGW) need a specific package of primary care services usually not available in the publicly funded healthcare system. In addition, little is known about HIV and syphilis prevalence and incidence in clinic‐based samples of TGW. Here we evaluate the uptake of a transgender‐specific package of primary care services by TGW in Bangkok, Thailand and assess HIV and syphilis prevalence and incidence among them. Methods Open cohort study of TGW attending services at the Tangerine Community Health Clinic from 2016 to 2019. Cross‐sectional and longitudinal analysis of routinely collected clinic data was performed to study trends in the number of clients, clinic visits and HIV and syphilis prevalence and incidence. Results During the study period, 2947 TGW clients made a total of 5227 visits to Tangerine. The number of clients significantly increased from 446 in 2016 to 1050 in 2019 (p < 0.001) and the number of visits from 616 to 2198 during the same period (p < 0.001). Prevalence of HIV at first visit was 10.8% and of syphilis 9.8%. HIV incidence was 1.03 per 100 person years (PY) and of syphilis 2.06 per 100 PY of follow‐up. From 2016 to 2019, significant decreases occurred in the annual prevalence of HIV from 14.6% to 9.9% (p < 0.01). The annual prevalence of syphilis significantly increased from 6.6% in 2016 to 14.6% in 2018, and then decreased to 7.3% in 2019 (p < 0.001). The annual HIV incidence decreased during 2016 to 2019, from 1.68 to 1.28 per 100 PY, but this reduction was not statistically significant. The annual incidence of treponemal test seroconversion significantly increased from zero in 2016 to 4.55 per 100 PY in 2019 (p < 0.001). Conclusions The increasing uptake of a transgender‐specific package of services, including co‐located gender affirmative hormone therapy, suggests this may be an effective model in engaging and retaining TGW in primary care. The decrease in HIV prevalence and low HIV incidence across calendar years point at a possible reduction of HIV acquisition among the TGW population served by Tangerine. The increasing prevalence of syphilis suggests ongoing high‐risk sexual behaviour and underscores the need for screening and treatment for this infection at the time of delivery of HIV services.

Self-Testing as a Hope to Reduce HIV in Transgender Women—Literature Review

“…Syphilis infection can be asymptomatic and remain unnoticed for several years until symptomatic. Therefore, screening and treatment for syphilis and other sexually transmitted diseases with concurrent HIV testing, treatment, and prophylaxis are recommended [ 24 ].…”

“…Attempts are made around the world to combat the HIV epidemic through increased emphasis on the prevalence of HIV testing, especially among high-risk populations [ 23 ]. U.S. Centers for Disease Control and Prevention and WHO guidelines recommend that people at increased risk for AIDS be tested for HIV infection at least once a year, and in some situations every three to six months [ 12 , 24 , 25 , 26 ]. There are several ways to test for HIV infection, such as traditional testing performed at a clinic, self-testing without visiting a physician or clinic, and HIV testing and counseling for couples [ 27 ].…”

“…For example, in one of the studies it was observed that a small number of participants in a study conducted in Bangkok who tested HIV-positive were aware of their HIV infection. This finding highlights the need for greater access and more frequent HIV testing, especially in key populations such as TGW [ 24 ]. However, a global review of the latest literature shows that there is still a lack of European evidence on transgender people and their HIVST [ 29 ].…”

HIV prevalence and incidence among men who have sex with men and transgender women in Bangkok, 2014–2018: Outcomes of a consensus development initiative

“…The number of TGW who were repeatedly tested for HIV infection at Tangerine increased from 98 in 2016 to 407 in 2018. The HIV incidence density in these women increased from zero (0/36) in 2016 and 2.3 (2/87) in 2017 to 3.3 (6/182) per 100 PY in 2018 [43].…”

“…The Tangerine Clinic is a dedicated health service for transgender people at TRCAC since 2016. The number of TGW clients per year was 466 in 2016, 488 in 2017 and 999 in 2018 [43]. HIV prevalence among these women was 14.6% (66/446) in 2016, 8.0% (36/488) in 2017 and 11.4% (114/999) in 2018 [43].…”