1 / 45

in + care Campaign Meet the Author November 12, 2013

in + care Campaign Meet the Author November 12, 2013. Ground Rules for Webinar Participation. Actively participate and write your questions into the chat area during the presentation(s) Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6)

thai
Download Presentation

in + care Campaign Meet the Author November 12, 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. in+care CampaignMeet the Author November 12, 2013

  2. Ground Rules for Webinar Participation Actively participate and write your questions into the chat area during the presentation(s) Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6) Slides and other resources are available on our website at incareCampaign.org All webinars are being recorded

  3. Welcome & Introductions • Welcome & Introductions, 5min • BalighYehia, MD, MPP, MSHP, 30min • Q & A Session, 20min • Updates, Reminders & Evaluation, 5min In the chat room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency Michael Hager, MPH MA NQC Manager, in+care Campaign Manager New York, NY

  4. Retention in Care and Health Outcomes of Transgender Persons Living with HIV Clin Infect Dis. 2013 Sep; 57(5):744-6 Baligh R. Yehia, MD, MPP, MSHP Assistant Professor of Medicine University of Pennsylvania Perelman School of Medicine

  5. No Disclosures or Conflicts of Interests.

  6. Outline Background Transgender Individuals & HIV Barriers to Care Literature Review/Past Studies Study Summary Research Methods Results & Conclusions Limitations & Future Directions Discussion/Q & A Baligh R. Yehia, MD, MPP, MSHP

  7. Transgender-Specific Research is Needed • LGBT individuals have unique health experiences and needs, but as a nation, we do not know exactly what these experiences and needs are. • Focus Areas: • Demographic Research • Social Influences • Health Care Inequities • Intervention Research • Transgender-specific Health Needs Baligh R. Yehia, MD, MPP, MSHP

  8. HIV Prevalence Among Transgender Individuals Meta-analysis of 29 studies conducted between 1990-2003 in the U.S. and Puerto Rico to estimate HIV prevalence and risk behaviors among MTF transgender women. Herbst, et al., AIDS Behav2008 Baligh R. Yehia, MD, MPP, MSHP

  9. HIV Prevalence Among Transgender Individuals Meta-analysis of 29 studies conducted between 1990-2003 in the U.S. and Puerto Rico to estimate HIV prevalence and risk behaviors among MTF transgender women. Herbst, et al., AIDS Behav2008 Baligh R. Yehia, MD, MPP, MSHP

  10. HIV Prevalence Among Transgender Individuals Meta-analysis of 29 studies conducted between 1990-2003 in the U.S. and Puerto Rico to estimate HIV prevalence and risk behaviors among MTF transgender women. Limited data on FTM transgender men, but estimated to be ~3%. Herbst, et al., AIDS Behav2008 Baligh R. Yehia, MD, MPP, MSHP

  11. HIV Incidence Among Transgender Individuals Based on 2009 data from the CDC, the incidence of HIV was 2.6% among transgender persons compared to 0.9% among cisgender males and 0.3% among cisgender females. Highest among: Blacks (4.4%) and Hispanics (2.5%) transgender persons. CDC, 2009 Baligh R. Yehia, MD, MPP, MSHP

  12. Limited Access to and Delays in HIV Care • Discrimination • Stigma • Social Isolation • Past negative experiences • Prioritization of gender-related health care • Concern about adverse interactions between ART and hormone therapy Sevelius et al., Women’s Health Issues 2011 Baligh R. Yehia, MD, MPP, MSHP

  13. Discrimination by Medical Provider for Transgender People Baligh R. Yehia, MD, MPP, MSHP

  14. Postponement of Care Due to Discrimination Baligh R. Yehia, MD, MPP, MSHP

  15. Literature Review- Study 1: Decreased ART Use Objective: Examine whether MTF transgender persons with HIV face greater difficulties accessing health services than cisgender people with HIV. Methods: Adults in the Healthy Living Project, a trial designed to reduce sexual risk behaviors among HIV-infected persons. - 59 MTF transgender persons - 300 matched cisgender person. Melendez et al., AJPH 2006 Baligh R. Yehia, MD, MPP, MSHP

  16. Literature Review - Study 1: Decreased ART Use Melendez et al., AJPH 2006 Baligh R. Yehia, MD, MPP, MSHP

  17. Literature Review - Study 1: Decreased ART Use Melendez et al., AJPH 2006 Baligh R. Yehia, MD, MPP, MSHP

  18. Literature Review - Study 1: Decreased ART Use Limitations: Convenience Sample & Self-Reported Data Melendez et al., AJPH 2006 Baligh R. Yehia, MD, MPP, MSHP

  19. Literature Review - Study 2: Decreased ART Adherence Objective: Examine rates of self-reported ART adherence among transgender women compared to cisgender people with HIV. Methods: Adults in the Healthy Living Project, a trial designed to reduce sexual risk behaviors among HIV-infected persons. - 35 transgender women on ART - 2,770cisgender persons on ART Sevelius et al., JANAC 2010 Baligh R. Yehia, MD, MPP, MSHP

  20. Literature Review - Study 2: Decreased ART Adherence Sevelius et al., JANAC 2010 Baligh R. Yehia, MD, MPP, MSHP

  21. Literature Review - Study 2: Decreased ART Adherence Sevelius et al., JANAC 2010 Baligh R. Yehia, MD, MPP, MSHP

  22. Literature Review - Study 2: Decreased ART Adherence Sevelius et al., JANAC 2010 Baligh R. Yehia, MD, MPP, MSHP

  23. Literature Review - Study 2: Decreased ART Adherence Limitations: Convenience Sample & Self-Reported Data Sevelius et al., JANAC 2010 Baligh R. Yehia, MD, MPP, MSHP

  24. Outline Background Transgender Individuals & HIV Barriers to Care Past Studies Study Summary Research Methods Results & Conclusions Limitations & Future Directions Discussion/Q & A Baligh R. Yehia, MD, MPP, MSHP

  25. Study Objective and Design Objective: Examine whether retention in care, use of ART, and HIV viral suppression differed between cisgender and transgender people living with HIV. Design: A retrospective cohort of HIV-infected adults enrolled in care at 13 US HIV clinics between 2001 and 2011. Baligh R. Yehia, MD, MPP, MSHP

  26. Study Outcomes Retention in Care Jan 1 Dec 31 ≥ 90 days Use of ART Jan 1 Dec 31 at any point Viral Suppression Jan 1 Dec 31 median

  27. Analyses We compared demographics for each cisgender group to the transgender group using the χ2 test of independence. CD4 count and HIV viral load at enrollment were compared using the Kruskal-Wallis test due to their non-normal distribution. Multivariate logistic regression examined demographic (age, gender, race/ethnicity, HIV transmission risk, insurance coverage) and clinical factors (CD4 count) associated with each of the three outcomes, adjusting for calendar year and site of care. Baligh R. Yehia, MD, MPP, MSHP

  28. Results - Demographics Baligh R. Yehia, MD, MPP, MSHP

  29. Results - Demographics Baligh R. Yehia, MD, MPP, MSHP

  30. Results - Demographics Baligh R. Yehia, MD, MPP, MSHP

  31. Results - Demographics Baligh R. Yehia, MD, MPP, MSHP

  32. Results - Demographics Baligh R. Yehia, MD, MPP, MSHP

  33. Results - Demographics Baligh R. Yehia, MD, MPP, MSHP

  34. Results - Outcomes 82% 81% 80% 77% 76% 74% 69% 69% Baligh R. Yehia, MD, MPP, MSHP

  35. Results – Multivariate Analyses Baligh R. Yehia, MD, MPP, MSHP

  36. Conclusions Reducing HIV-related disparities is a major goal of Healthy People 2020 and the National HIV/AIDS Strategy for the United States. Compared to prior studies, these results reflect improvements in health equity for transgender patients infected with HIV. Advances in HIV therapy and management have occurred since these studies were conducted, including expansion of available antiretroviral drugs, simplified dosing, greater tolerability, and improvements in evidence-based guidelines. Baligh R. Yehia, MD, MPP, MSHP

  37. Limitations • Retrospective nature • Focus on patients engaged in care • Relative small number of transgender people with HIV • Generalizability • Unable to assess variations in health outcomes by subgroups (MTF, FTM, gender expression, sexual orientation) Baligh R. Yehia, MD, MPP, MSHP

  38. Future Directions • Estimate the proportion of HIV-infected transgender persons out of care. • Develop interventions designed to improve access and linkage to care for transgender individuals. Baligh R. Yehia, MD, MPP, MSHP

  39. Outline Background Transgender Individuals & HIV Barriers to Care Past Studies Study Summary Research Methods Results & Conclusions Limitations & Future Directions Discussion/Q & A Baligh R. Yehia, MD, MPP, MSHP

  40. Discussion/Q & A

  41. Campaign Update 41

  42. in+care Campaign in 2014 • Campaign database running through 2018! • Campaign website running through 2018! • Partners in+care Facebook maintained indefinitely • Campaign Newsletter moves to quarterly • Campaign Webinars move to quarterly • Partners in+care Webinars move to quarterly • Campaign Coaching integrates into NQC Continuous TA Portfolios • Local Retention Groups that wish to continue meeting should do so – NQC will support where possible 42

  43. 43

  44. Upcoming Events and Deadlines • Upcoming Webinars: • Partners in+care Webinar | Retaining New Patients in+careThursday, November 14, 2013 | 2pm ET • in+care Campaign Webinar | The Transgender Experience and Retention in HIV CareWednesday, November 20, 2013 | 1pm ET • in+care Campaign Webinar | State-Level Efforts to Retain New Patients in HIV CareWednesday, December 4, 2013 | 2pm ET • Data Collection Submission Deadline: December 2, 2013 • Improvement Update Submission Deadline: November 15, 2013

  45. Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floor New York, NY 10007Phone 212-417-4730 incare@NationalQualityCenter.orgincareCampaign.org youtube.com/incareCampaign

More Related