Linkage to care after HIV diagnosis among men who have sex with men and transgender women in Lima, Peru

ABSTRACT

In Lima, Perú, HIV prevalence is estimated to be 15% among men who have sex with men (MSM) and 30% among transgender women (TW). We investigated timely linkage of MSM and TW to HIV care, as linkage to antiretroviral therapy (ART) is critical to protect the health of those living with HIV and to prevent onward transmission. We investigated linkage within 90 days of HIV diagnosis by matching data from two studies conducted in Lima between 2013 and 2015 to national ART program records. We used generalized linear modeling to assess predictors of timely linkage and late presentation to care. Of 487 newly-diagnosed MSM and TW, only 44% presented for care at an HIV clinic within 90 days. Timely linkage was less common among TW (aPR 0.7, 95% CI 0.5–1.0), those younger than 24 (aPR 0.8, 95% CI 0.6–1.0), and those reporting a history of sex work (aPR 0.7, 95% CI 0.6–0.9). Proximity to an ART program clinic was not associated with linkage; most participants linked to clinics offering “LGBTQ-friendly” care. The pattern of clinics selected by participants suggests the importance of concerns about confidentiality and stigma in decision-making about where to link to care.

KEYWORDS:

• HIV care
• HIV diagnosis
• linkage to care
• men who have sex with men
• transgender women

Acknowledgements

The authors thank the staff of Epicentro, Vía Libre, Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Perú, and Asociación Civil Impacta Salud y Educación for their commitment to the success of this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Funding for Sabes study was provided by the National Institutes of Health/National Institute on Drug Abuse via the R01 grant R01DA032106 (AD). We acknowledge Gilead Sciences and Merck, Sharp & Dohme Corp. for ART donation.