1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
2 Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada.
AIDS Patient Care STDS. 2019 Jul;33(7):308-322. doi: 10.1089/apc.2019.0013. Epub 2019 Jun 12.
Scant research has explored the engagement of transgender (trans) women living with HIV (WLWH) in the HIV care cascade, particularly in universal health care settings like Canada. This convergent parallel, mixed-methods study drew on cross-sectional quantitative data from 50 trans WLWH in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) and qualitative semistructured interview data from a subsample of 11 participants. Descriptive analyses were used to describe proportions of trans WLWH at five steps of the HIV care cascade and bivariate analyses to determine associations between hypothesized barriers/facilitators and HIV care cascade outcomes. Framework analysis was used to describe barriers and facilitators to HIV care engagement. Quantitative and qualitative data were then compared and contrasted. While use of purposive sampling, including recruitment through AIDS Service Organizations and HIV clinics, may have led to oversampling of trans WLWH who already had access to care, gaps were still seen in antiretroviral therapy (ART) outcomes (current ART use: 78%; ≥95% adherence among those currently taking ART: 67%). The number of years living with HIV was positively associated with HIV care cascade engagement. Factors associated with lower engagement included: higher health-related quality of life, depressive and post-traumatic stress disorder symptoms, barriers to access to care, transphobia, HIV-related stigma, and housing insecurity. Qualitative findings converged and expanded on how physical health, and social and structural marginalization, influence trans WLWH's engagement in HIV care. Qualitative findings elaborated on the importance of ART-related factors in impeding or facilitating engagement, including concerns about feminizing hormone-ART drug-drug interactions. Mixed-methods findings reveal how trans WLWH experience barriers common to other people living with HIV, and also experience unique barriers as a result of trans and HIV experiences.
针对感染艾滋病毒的跨性别（跨性别）女性（简称 trans WLWH）参与艾滋病护理链的研究甚少，特别是在加拿大等全民医疗保健环境中。这项汇聚平行、混合方法的研究利用了加拿大艾滋病毒妇女性健康和生殖健康队列研究（CHIWOS）中 50 名跨性别 WLWH 的横断面定量数据，以及 11 名参与者中一个亚组的定性半结构访谈数据。描述性分析用于描述 HIV 护理链五个步骤中的 trans WLWH 的比例，双变量分析用于确定假设的障碍/促进因素与 HIV 护理链结果之间的关联。框架分析用于描述 HIV 护理参与的障碍和促进因素。然后比较和对比定量和定性数据。尽管采用了包括通过艾滋病服务组织和艾滋病毒诊所进行招募的有目的抽样，可能导致已经获得护理的跨性别 WLWH 过度抽样，但在抗逆转录病毒治疗（ART）结果中仍存在差距（目前正在使用 ART：78%；正在服用 ART 的人中，至少 95%的人具有依从性：67%）。感染艾滋病毒的年限与 HIV 护理链的参与呈正相关。与较低参与度相关的因素包括：更高的健康相关生活质量、抑郁和创伤后应激障碍症状、获得护理的障碍、跨性别恐惧症、艾滋病毒相关耻辱感和住房不安全。定性研究结果与如何影响 trans WLWH 参与 HIV 护理的身体健康以及社会和结构性边缘化趋同并扩大。定性研究结果阐述了与 ART 相关的因素在阻碍或促进参与方面的重要性，包括对女性化激素-ART 药物相互作用的担忧。混合方法研究结果揭示了 trans WLWH 如何经历与其他艾滋病毒感染者共同的障碍，并且由于跨性别和艾滋病毒的经历而经历独特的障碍。
