(198) Comparative outcomes for transgender patients: Gaps in HIV pre-exposure prophylaxis (PrEP) adoption between transgender and cisgender individuals.
PearlDiver Technologies Colorado Springs, Colorado, United States
Background: : Health challenges facing the transgender population differ from those of the cisgender population. There has been minimal research using large national claims databases to investigate such health disparities.
Objective: : Using a large, national, all-payer database, a study was designed to investigat gaps in the adoption of PrEP among the transgender community in relation to adoption rates with the cisgender population.
Methods: : Utilizing the Mariner170 all-payer national claims database, the transgender cohort was defined as patients with ≥1 claim of gender identity disorder occurring between January 2010 and April 2023 using ICD-9 and ICD-10 codes. Propensity score matching was performed against a control group. T-tests and chi-square tests were used to compare the transgender cohort to the cisgender cohort across 32 comorbidities. Patients must have ≥ 2 outpatient claims or ≥1 inpatient claim of each respective comorbidity to be considered a member of the comorbidity cohort. Patient age at first appearance in the database was used.
Results: : Within the database, 71,741 individuals with ≥1 ICD9 or ICD10 diagnosis for gender identity disorder (ICD9 302.50:302.53, 302.6, 302.85, ICD10 F64.0:F64.9, Z87.890) as a method of identifying transgender individuals. The highest risk ratio among attributes studied was HIV (12.4) followed by self-inflicted injuries (10.3), schizophrenia (5.1), and mood disorders (4.3) for the transgender population.
The rate of transgender patients with no HIV diagnosis having ≥ 1 claim for PrEP is 5.2% (3,567/68,725). This is significantly lower than national estimates of 35-45% adoption among the high-risk group of gay males. An analysis of the cisgender adopters of PrEP was performed to identify key indicators of PrEP adoption. A logistic regression was performed to identify contributing factors to adopting PrEP. Age was confirmed to be a significant factor, with a t-test confirming significance in difference of mean age between the groups (31.4, 40.3).
Conclusions: : The adoption rate of PrEP in the transgender community aged ≥16 without a diagnosis for HIV (3,058/45,024) is significantly lower than rates among other high-risk populations. It is recommended further research be conducted concerning this gap in treatment and that targeted programs be implemented to increase PrEP adoption rates in the transgender community.
