HIV cascade of care and viral load suppression in trans-women and men who have sex with men populations in the Dominican Republic [abstract]

Abstract

Introduction: The overall rate of new HIV infections appears to be in decline worldwide; however, among key populations, men who have sex with men (MSM) and trans-women (TGW), new HIV infections continue growing [1]. Since the introduction of highly active antiretroviral therapy (HAART), people living with HIV live longer than ever before. The HIV cascade of care is a comprehensive monitoring tool to evaluate the HIV continuum of care and to evaluate “leakage points” along the points of attention [2]. The objective of this study was to evaluate the HIV cascade along the services in MSM and TGW and compare this with the general HIV population in an outpatient clinic in Santo Domingo, Dominican Republic. Materials and methods: We used a retrospective database of one outpatient clinic for HIV patients to assess our population-based cascade. Paper-based data were collected from clinical files. Characterization of target populations was based on past clinical history or self-identification as exclusively MSM or TGW and compared with the HIV-positive with unknown risk (+WUR). Treatment access and administration of HIV drugs was based according with the Dominican Republic Ministry of Health criteria (<350 cell/µL) and viral suppression below 20 copies/mL. Results: We identified 405 HIV diagnosed individuals during the study period; 60% were male. Of these, 25.18% (n=102) were MSM and TGW. Overall, 64.44% in the +WUR was retained in care versus 65.68% in MSM/TGW (Figure 1). HAART access in +WUR was 56.04%, while in MSM/TGW 38.29%. Viral suppression in +WUR was 43.70% and in MSM/TGW 24.50%. Conclusions: We found a significant difference between access to HAART and viral suppression in both groups. It is necessary to note that higher viral loads among these groups will be of significant influence for HIV persistence in social and sexual networks. Drops in the proportion to be achieved in each step may be a reflection of challenges specific to MSM/TGW access to care. It is necessary to evaluate the potential role of antiretroviral and hormone replacement therapy interactions.