ArticleThe Lancet regional health. Europe2026
The HIV care continuum and determinants of antiretroviral therapy initiation among transgender women in France (1997-2023): a longitudinal cohort study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Studies on transgender women living with HIV (TWH) are scarce in Europe. We aimed to describe TWH and their care continuum during years 1997-2023 in France, focusing on determinants of time to antiretroviral therapy (ART) initiation. Methods: In this longitudinal cohort study, we included treatment-naïve TWH with immuno-virological data from the ANRS CO4 French Hospital Database on HIV (FHDH). HIV care continuum outcomes, ART and viral suppression rates, and time intervals between HIV diagnosis, ART initiation, and viral suppression, were analyzed across three calendar periods (1997-2004, 2005-2012, and 2013-2023). Factors associated with time to ART initiation were assessed for each period using Cox models adjusted for age, geographic origin, year and region of enrollment, time between diagnosis and enrollment, and baseline immuno-virological status. Findings: 801 TWH entered care between January 1, 1997 and December 31, 2023, mostly originating from Latin America (65%, 522/801), with a median age of 31 years [IQR, 27-36]. Between 1997-2004 and 2013-2023, time to ART initiation after entering care decreased from 3.9 [0-31] to 0.5 [0.2-1.2] months. More advanced HIV disease was associated with faster ART initiation until 2012 (hazard ratio [HR]: 3.17, 95% CI 2.14-4.68 for CD4 <200/mm Interpretation: Despite major improvements in the HIV care continuum for TWH in France, including faster ART initiation and viral suppression reaching UNAIDS 95% targets in 2013-2023, disparities by geographic origin have emerged, showing a delay in ART initiation among foreign-born TWH. Given that most TWH are foreign-born, targeted strategies and policies are needed to ensure equitable and timely access to HIV care. Funding: ANRS-MIE and INSERM.
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