Evidence map›Paper›PMID 36868260›Full record

ArticleThe lancet. HIV2023

HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study.

Andrea L Wirtz, Elizabeth Humes, Keri N Althoff, Tonia C Poteat, Asa Radix, Kenneth H Mayer, Jason S Schneider, J Sonya Haw, Andrew J Wawrzyniak, Christopher M Cannon and 9 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. HIV, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  15. Exploring Willingness to Use Long-Acting Injectable PrEP Among Sexual and Gender Minoritized People Accessing Pharmacies.AIDS education and prevention : official publication of the International Society for AIDS Education · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

Andrea L WirtzDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: awirtz1@jhu.edu.
Elizabeth HumesDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
Keri N AlthoffDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
Tonia C PoteatCenter for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Asa RadixCallen-Lorde Community Health Center, New York, NY, USA.
Kenneth H MayerBeth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
Jason S SchneiderDepartment of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
J Sonya HawDepartment of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Andrew J WawrzyniakDepartment of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
Christopher M CannonWhitman-Walker Institute, Washington, DC, USA.
Meg StevensonDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA.
Erin E CooneyDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
Dee AdamsDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA.
James CaseJohns Hopkins Bloomberg School of Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
Chris BeyrerDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
Oliver LaeyendeckerDepartment of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Allan E RodriguezDivision of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA.
Sari L ReisnerDepartment of Medicine, Harvard University, Boston, MA, USA; Harvard Medical School and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Endocrinology, Diabetes, and Hypertension, Brigham Women's Hospital, Boston, MA, USA.
American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group

Funding

The impact of HIV viral diversity and cellular immunity on HIV pathogenesisP30AI060354 · NIAID · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI ARTHUR Y KIM · 2004 to 2026
$94.4M
Virology and Molecular Biomarkers CoreP30AI050409 · NIAID · EMORY UNIVERSITY · PI Ann M Chahroudi, Colleen F Kelley · 2002 to 2026
$74.0M
Vaccine Response and Immunotherapeutics SWGP30AI094189 · NIAID · JOHNS HOPKINS UNIVERSITY · PI Anna Palmer Durbin · 2012 to 2026
$67.0M
University of Miami Developmental Center for AIDS Research (D-CFAR)P30AI073961 · NIAID · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI Savita Pahwa · 2007 to 2026
$33.8M
SWG 2: Cure Research Scientific Working GroupP30AI117970 · NIAID · GEORGE WASHINGTON UNIVERSITY · PI Italo Mocchetti · 2015 to 2026
$29.6M
International Center for Excellence in Research (ICER) in Uganda: Impact of ARVsZIAAI001040 · NIAID · NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES · PI REYNOLDS, STEVEN · 2009 to 2025
$23.5M
International Studies of the Acquired Immune Deficiency Syndrome (AIDS)ZIAAI000361 · NIAID · NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES · PI REDD, ANDREW · 2009 to 2025
$15.8M
Research Services CoreP2CHD050924 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI KAREN B GUZZO · 2015 to 2026
$9.6M
LITE CONNECT: Addressing testing gaps and epidemiologic disparities of COVID-19 amongtransgender people in the United StatesUH3AI133669 · NIAID · JOHNS HOPKINS UNIVERSITY · PI REISNER, SARI, WIRTZ, ANDREA L · 2019 to 2022
$6.9M
American Cohort to Study HIV Acquisition among Transgender Women in High Risk AreasUG3AI133669 · NIAID · JOHNS HOPKINS UNIVERSITY · PI REISNER, SARI, WIRTZ, ANDREA L · 2017 to 2018
$3.5M
PrEP Engagement Trajectories Among Transgender Women in the United StatesF31MH124582 · NIMH · JOHNS HOPKINS UNIVERSITY · PI COONEY, ERIN EILEEN · 2020 to 2022
$138k
NIAID NIH HHS P30 AI050409NIAID NIH HHS P30 AI060354NIAID NIH HHS P30 AI073961NIAID NIH HHS P30 AI094189NIAID NIH HHS P30 AI117970NIAID NIH HHS UG3 AI133669NIAID NIH HHS UH3 AI133669NICHD NIH HHS P2C HD050924NIMH NIH HHS F31 MH124582
6 · The paper itself

Abstract

backgroundEpidemiological monitoring of HIV among transgender women is minimal despite prioritisation of this group in the US National HIV/AIDS Strategy (2022-2025). We aimed to estimate HIV incidence in a multisite cohort of transgender women in the eastern and southern USA. Participant deaths were identified during follow-up; thus, we felt it was an ethical imperative to report mortality alongside HIV incidence.

methodsIn this study, we established a multisite cohort across two modes: a site-based, technology-enhanced mode in six cities (Atlanta, Baltimore, Boston, Miami, New York City, and Washington, DC) and an exclusively digital mode that spanned 72 eastern and southern US cities that matched the six site-based cities based on population size and demographics. Trans feminine adults (≥18 years) who were not living with HIV were eligible and followed up for at least 24 months. Participants completed surveys and oral fluid HIV testing with clinical confirmation. We ascertained deaths through community and clinical sources. We estimated HIV incidence and mortality using the number of HIV seroconversions and deaths, respectively, divided by person-years accumulated from enrolment. Logistic regression models were used to identify predictors of HIV seroconversion (primary outcome) or death.

findingsBetween March 22, 2018, and Aug 31, 2020, we enrolled 1312 participants with 734 (56%) in site-based and 578 (44%) in digital modes. At the 24-month assessment, 633 (59%) of 1076 eligible participants consented to extending participation. 1084 (83%) of 1312 participants were retained at this analysis based on the study definition of loss to follow-up. As of May 25, 2022, the cohort participants had contributed 2730 accumulated person-years to the analytical dataset. Overall HIV incidence was 5·5 (95% CI 2·7-8·3) per 1000 person-years and incidence was higher among Black participants and those living in the south. Nine participants died during the study. The overall mortality rate was 3·3 (95% CI 1·5-6·3) per 1000 person-years, and the rate was higher among Latinx participants. Identical predictors of HIV seroconversion and death included residence in southern cities, sexual partnerships with cisgender men, and use of stimulants. Participation in the digital cohort and seeking care for gender transition were inversely associated with both outcomes.

interpretationAs HIV research and interventions are increasingly delivered online, differences by mode highlight the need for continued community and location-based efforts to reach the most marginalised transgender women. Our findings underscore community calls for interventions that address social and structural contexts that affect survival and other health concerns alongside HIV prevention.

fundingNational Institutes of Health. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Indexed as

Acquired Immunodeficiency SyndromeHIV InfectionsHIV SeropositivityTransgender PersonsAdultCohort StudiesFemaleHumansIncidenceMale

Identifiers

PMID36868260
PMCPMC10164681

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