The HIV Care Cascade Among Transgender Women with HIV in Canada: A Mixed-Methods Study
The HIV Care Cascade Among Transgender Women with HIV in Canada: A Mixed-Methods Study
复制标题
DOI：
10.1089/apc.2019.0013
复制
发表时间：
2019-07-01
影响因子：
4.9
通讯作者：
Loutfy, Mona
中科院分区：
文献类型：
--
作者：
Lacombe-Duncan, Ashley;Bauer, Greta R.;Loutfy, Mona
很少有研究探讨跨性别（跨性别）感染艾滋病毒的妇女（WLWH）在艾滋病毒护理级联中的参与，特别是在像加拿大这样的全民医疗保健环境中。这项趋同平行、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个跨WLWH的横断面定量数据和来自11名参与者的定性半结构化访谈数据。描述性分析用于描述艾滋病毒护理级联的五个步骤中跨WLWH的比例，双变量分析用于确定假设的障碍/促进因素与艾滋病毒护理级联结果之间的关联。框架分析用于描述艾滋病毒护理参与的障碍和促进因素。然后对定量和定性数据进行比较和对比。虽然有目的抽样的使用，包括通过艾滋病服务组织和艾滋病毒诊所进行招募，可能导致对已经获得护理的跨性别WLWH进行了过度抽样，但在抗逆转录病毒治疗（ART）结果方面仍然存在差距（目前ART使用率：78%；>= 95%，目前正在接受ART的患者依从性：67%）。感染艾滋病毒的年数与艾滋病毒护理级联参与呈正相关。与低参与度相关的因素包括：较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、与艾滋病毒相关的耻辱和住房不安全。定性研究结果集中并扩展了身体健康、社会和结构边缘化如何影响跨性别妇女保健工作者参与艾滋病毒护理的问题。定性研究结果详细阐述了art相关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-药物相互作用的担忧。混合方法的研究结果揭示了跨性别WLWH如何经历与其他艾滋病毒感染者共同的障碍，以及由于跨性别和艾滋病毒经历而经历的独特障碍。
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.