1 in+care Campaign Meet the Author November 12, 2013.
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Transcript of 1 in+care Campaign Meet the Author November 12, 2013.
1
in+care CampaignMeet the Author
November 12, 2013
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Ground Rules for Webinar Participation
Actively participate and write your questions into the chat area during the presentation(s)
Do not put us on holdMute 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.orgAll webinars are being recorded
3
Welcome & IntroductionsWelcome & Introductions, 5minBaligh Yehia, MD, MPP, MSHP, 30minQ & A Session, 20minUpdates, Reminders & Evaluation, 5minIn 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 ManagerNew York, NY
Penn Medicine
Retention in Care and Health Outcomes of Transgender Persons Living with HIV
Baligh R. Yehia, MD, MPP, MSHPAssistant Professor of Medicine
University of Pennsylvania Perelman School of Medicine
Clin Infect Dis. 2013 Sep; 57(5):744-6
Penn Medicine
No Disclosures or Conflicts of Interests.
Penn Medicine
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 6
Penn Medicine
Transgender-Specific Research is Needed
Baligh R. Yehia, MD, MPP, MSHP 7
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
Penn Medicine
HIV Prevalence Among Transgender Individuals
Baligh R. Yehia, MD, MPP, MSHP 8
Herbst, et al., AIDS Behav 2008
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.
Penn Medicine
HIV Prevalence Among Transgender Individuals
Baligh R. Yehia, MD, MPP, MSHP 9
Herbst, et al., AIDS Behav 2008
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.
Penn Medicine
HIV Prevalence Among Transgender Individuals
Baligh R. Yehia, MD, MPP, MSHP 10
Herbst, et al., AIDS Behav 2008
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%.
Penn Medicine
HIV Incidence Among Transgender Individuals
Baligh R. Yehia, MD, MPP, MSHP 11
CDC, 2009
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.
Penn Medicine
Limited Access to and Delays in HIV Care
Baligh R. Yehia, MD, MPP, MSHP 12
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
Penn Medicine
Discrimination by Medical Provider for Transgender People
Baligh R. Yehia, MD, MPP, MSHP 13
Penn Medicine
Postponement of Care Due to Discrimination
Baligh R. Yehia, MD, MPP, MSHP 14
Penn Medicine
Literature Review - Study 1: Decreased ART Use
Baligh R. Yehia, MD, MPP, MSHP 15
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
Penn Medicine
Literature Review - Study 1: Decreased ART Use
Baligh R. Yehia, MD, MPP, MSHP 16
Melendez et al., AJPH 2006
Penn Medicine
Literature Review - Study 1: Decreased ART Use
Baligh R. Yehia, MD, MPP, MSHP 17
Melendez et al., AJPH 2006
Penn Medicine
Literature Review - Study 1: Decreased ART Use
Baligh R. Yehia, MD, MPP, MSHP 18
Limitations: Convenience Sample & Self-Reported Data
Melendez et al., AJPH 2006
Penn Medicine
Literature Review - Study 2: Decreased ART Adherence
Baligh R. Yehia, MD, MPP, MSHP 19
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- 2,770 cisgender persons on ART
Sevelius et al., JANAC 2010
Penn Medicine
Literature Review - Study 2: Decreased ART Adherence
Baligh R. Yehia, MD, MPP, MSHP 20
Sevelius et al., JANAC 2010
Penn Medicine
Literature Review - Study 2: Decreased ART Adherence
Baligh R. Yehia, MD, MPP, MSHP 21
Sevelius et al., JANAC 2010
Penn Medicine
Literature Review - Study 2: Decreased ART Adherence
Baligh R. Yehia, MD, MPP, MSHP 22
Sevelius et al., JANAC 2010
Penn Medicine
Literature Review - Study 2: Decreased ART Adherence
Baligh R. Yehia, MD, MPP, MSHP 23
Sevelius et al., JANAC 2010
Limitations: Convenience Sample & Self-Reported Data
Penn Medicine
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 24
Penn Medicine
Study Objective and Design
Baligh R. Yehia, MD, MPP, MSHP 25
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.
Penn Medicine
Study Outcomes
Retention in CareJan 1 Dec 31
≥ 90 days
Jan 1 Dec 31
at any point
Use of ART
Jan 1 Dec 31
median
Viral Suppression
Penn Medicine
Analyses
Baligh R. Yehia, MD, MPP, MSHP 27
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.
Penn Medicine
Results - Demographics
Baligh R. Yehia, MD, MPP, MSHP 28
Penn Medicine
Results - Demographics
Baligh R. Yehia, MD, MPP, MSHP 29
Penn Medicine
Results - Demographics
Baligh R. Yehia, MD, MPP, MSHP 30
Penn Medicine
Results - Demographics
Baligh R. Yehia, MD, MPP, MSHP 31
Penn Medicine
Results - Demographics
Baligh R. Yehia, MD, MPP, MSHP 32
Penn Medicine
Results - Demographics
Baligh R. Yehia, MD, MPP, MSHP 33
Penn Medicine
Results - Outcomes
Baligh R. Yehia, MD, MPP, MSHP 34
Retention in Care Use of ART Viral Suppression0%
20%
40%
60%
80%
100%
Cisgender Men Cissgender Women Transgender Persons
63%
80%76%
69%
82% 81% 77%74%
69%
Penn Medicine
Results – Multivariate Analyses
Baligh R. Yehia, MD, MPP, MSHP 35
Retention Use of ART Suppression
GenderTransgender personsCisgender men Cisgender women
1 [Reference]1.15 (0.94-1.42)1.32 (1.08-1.64)
1 [Reference]0.98 (0.78-1.23)0.81 (0.64-1.02)
1 [Reference]1.11 (0.89-1.39)1.13 (0.90-1.42)
Penn Medicine
Conclusions
Baligh R. Yehia, MD, MPP, MSHP 36
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.
Penn Medicine
Limitations
Baligh R. Yehia, MD, MPP, MSHP 37
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)
Penn Medicine
Future Directions
Baligh R. Yehia, MD, MPP, MSHP 38
Estimate the proportion of HIV-infected transgender
persons out of care.
Develop interventions designed to improve access
and linkage to care for transgender individuals.
Penn Medicine
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 39
Penn Medicine
Discussion/Q & A
41
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Campaign Update
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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
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2013-2014 in+care Campaign Activities
2013 2014
Activities JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
1-Campaign Webinar
2-Journal Club Webinar
3-Campaign Data Reporting Cycle by Participants
4-Availability of Database Benchmark Function
5-Improvement Strategy Cycle
6-in+care Website and Posting of Updates
7-Campaign Newsletter
8-Partners Webinar
9-Partners in+care Facebook
10-Campaign Coaching Availability
11-Local Retention Group Availability
12-Case Study Drafting
13-Final Report Drafting
14-Communications with participants around transition
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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
Upcoming Events and Deadlines
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Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone [email protected]
incareCampaign.orgyoutube.com/incareCampaign