ArticleJournal of the International AIDS Society2022
Reaching transgender populations in Zambia for HIV prevention and linkage to treatment using community-based service delivery.
Article in Journal of the International AIDS Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 14 citations in OpenAlex.
- Epidemiological impacts and cost-effectiveness of daily and on-demand oral pre-exposure prophylaxis among key HIV populations in China: An economic evaluation.Epidemiology and infection · 2025Article
- Community-Partnered Development of Behavioral Economic Incentives in a Pre-exposure Prophylaxis Intervention for Transgender and Nonbinary Clients in Los Angeles.Research square · 2025Article
- HIV pre-exposure prophylaxis initiation in community safe spaces increases PrEP access among key populations in Zambia.Journal of the International AIDS Society · 2025Article
- Review
- Global Legal Environment for LGBTQ+ Sexuality and Public Health.The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics · 2025Article
- Programme science in action: lessons from an observational study of HIV prevention programming for key populations in Lusaka, Zambia.Journal of the International AIDS Society · 2024Observational
- Peer-based interventions to support transgender and gender diverse people's health and healthcare access: A scoping review.International journal of transgender health · 2024Article
- HIV Testing by Gender Identity Among Sexually Active Transgender-, Intersex-, and Hijra Individuals Reached Online in India.AIDS and behavior · 2023Article
- De-medicalized and decentralized HIV testing: a strategy to test hard-to-reach men who have sex with men in Cameroon.Frontiers in public health · 2023Article
- Low engagement of key populations in HIV health services in Tanzania: analysis of community, legal and policy factors.The Pan African medical journal · 2023Review
- Improving the HIV response for transgender populations: evidence to inform action.Journal of the International AIDS Society · 2022Article
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Authors and funding
21 authors at 5 institutions in 3 countries.
Funding
Abstract
introductionTransgender and gender-diverse communities in Zambia are highly vulnerable and experience healthcare differently than cisgender persons. The University of Maryland, Baltimore (UMB) supports projects in Zambia to improve HIV case-finding, linkage and antiretroviral treatment (ART) for Zambia's transgender community. We describe programme strategies and outcomes for HIV prevention, testing and ART linkage among transgender communities.
methodsUMB utilizes a differentiated service delivery model whereby community health workers (CHWs) recruited from key populations (KPs) reach community members through a peer-to-peer approach, with the support of local transgender civil society organizations (CSOs) and community gatekeepers. Peer CHWs are trained and certified as HIV testers and psychosocial counsellors to offer counselling with HIV testing and prevention services in identified safe spaces. HIV-negative people at risk of HIV infection are offered pre-exposure prophylaxis (PrEP), while those who test positive for HIV are linked to ART services. CHWs collect data using the standardized facility and community tools and a dedicated DHIS2 database system. We conducted a descriptive analysis examining HIV testing and prevention outcomes using proportions and comparisons by time period and geographic strata.
resultsFrom October 2020 to June 2021, across Eastern, Lusaka, Western and Southern Provinces, 1860 transgender persons were reached with HIV prevention messages and services. Of these, 424 (23%) were tested for HIV and 78 (18%) tested positive. Of the 346 HIV-negative persons, 268 (78%) eligible transgender individuals were initiated on PrEP. ART linkage was 97%, with 76 out of the 78 transgender individuals living with HIV initiating treatment. Programme strategies that supported testing and linkage included peer CHWs, social network strategy testing, same-day ART initiation and local KP CSO support. Challenges included non-transgender-friendly environments, stigma and discrimination, the high transiency of the transgender community and the non-availability of transgender-specific health services, such as hormonal therapy.
conclusionsPeer KP CHWs were able to reach many members of the transgender community, providing safe HIV testing, PrEP services and linkage to care. Focusing on community gatekeepers and CSOs to disburse health messages and employ welcoming strategies supported high linkage to both PrEP and ART for transgender people in Zambia.
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