HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study

Introduction Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to ch...

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Veröffentlicht in:Journal of the International AIDS Society 2020-10, Vol.23 (S6), p.e25604-n/a
Hauptverfasser: Twahirwa Rwema, Jean Olivier, Lyons, Carrie E, Herbst, Sara, Liestman, Benjamin, Nyombayire, Julien, Ketende, Sosthenes, Mazzei, Amelia, Olawore, Oluwasolape, Nsanzimana, Sabin, Mugwaneza, Placidie, Kagaba, Aflodis, Sullivan, Patrick S, Allen, Susan, Karita, Etienne, Baral, Stefan D
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container_issue S6
container_start_page e25604
container_title Journal of the International AIDS Society
container_volume 23
creator Twahirwa Rwema, Jean Olivier
Lyons, Carrie E
Herbst, Sara
Liestman, Benjamin
Nyombayire, Julien
Ketende, Sosthenes
Mazzei, Amelia
Olawore, Oluwasolape
Nsanzimana, Sabin
Mugwaneza, Placidie
Kagaba, Aflodis
Sullivan, Patrick S
Allen, Susan
Karita, Etienne
Baral, Stefan D
description Introduction Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. Methods MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. Results A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p 
doi_str_mv 10.1002/jia2.25604
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Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. Methods MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. Results A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p &lt; 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of &lt;200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. Conclusions These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.</description><identifier>ISSN: 1758-2652</identifier><identifier>EISSN: 1758-2652</identifier><identifier>DOI: 10.1002/jia2.25604</identifier><identifier>PMID: 33000912</identifier><language>eng</language><publisher>Switzerland: International AIDS Society</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; Aged ; AIDS ; Care and treatment ; Chlamydia trachomatis ; Community ; Continuity of Patient Care ; Cross-Sectional Studies ; Diagnosis ; Disease prevention ; Evaluation ; Female ; Gender identity ; Gonorrhea - epidemiology ; Health aspects ; HIV ; HIV care continuum ; HIV infections ; HIV Infections - epidemiology ; HIV Infections - prevention &amp; control ; HIV Infections - therapy ; Homosexuality, Male ; Human immunodeficiency virus ; Humans ; Infections ; Kigali ; Laboratories ; Male ; Mass Screening ; Medical care quality ; men who have sex with men ; Middle Aged ; MSM (Men who have sex with men) ; Neisseria gonorrhoeae ; Prevalence ; Questionnaires ; Rwanda ; Rwanda - epidemiology ; Sexual and Gender Minorities ; Sexual Behavior ; Sexually Transmitted Diseases - epidemiology ; Sexually Transmitted Diseases - therapy ; structural determinants ; Supplement ; Supplement: s ; Syphilis - epidemiology ; Transgender people ; Transgender Persons ; Viral Load ; Women ; Young Adult</subject><ispartof>Journal of the International AIDS Society, 2020-10, Vol.23 (S6), p.e25604-n/a</ispartof><rights>2020 The Authors. Journal of the International AIDS Society published by John Wiley &amp; Sons Ltd on behalf of the International AIDS Society.</rights><rights>COPYRIGHT 2020 International AIDS Society</rights><rights>2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</citedby><cites>FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</cites><orcidid>0000-0001-8127-0704 ; 0000-0002-7954-1736 ; 0000-0002-8954-6426 ; 0000-0002-7728-0587 ; 0000-0002-5482-2419</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527755/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527755/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,1416,11561,27923,27924,45573,45574,46051,46475,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33000912$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Twahirwa Rwema, Jean Olivier</creatorcontrib><creatorcontrib>Lyons, Carrie E</creatorcontrib><creatorcontrib>Herbst, Sara</creatorcontrib><creatorcontrib>Liestman, Benjamin</creatorcontrib><creatorcontrib>Nyombayire, Julien</creatorcontrib><creatorcontrib>Ketende, Sosthenes</creatorcontrib><creatorcontrib>Mazzei, Amelia</creatorcontrib><creatorcontrib>Olawore, Oluwasolape</creatorcontrib><creatorcontrib>Nsanzimana, Sabin</creatorcontrib><creatorcontrib>Mugwaneza, Placidie</creatorcontrib><creatorcontrib>Kagaba, Aflodis</creatorcontrib><creatorcontrib>Sullivan, Patrick S</creatorcontrib><creatorcontrib>Allen, Susan</creatorcontrib><creatorcontrib>Karita, Etienne</creatorcontrib><creatorcontrib>Baral, Stefan D</creatorcontrib><title>HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study</title><title>Journal of the International AIDS Society</title><addtitle>J Int AIDS Soc</addtitle><description>Introduction Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. Methods MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. Results A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p &lt; 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of &lt;200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. Conclusions These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>AIDS</subject><subject>Care and treatment</subject><subject>Chlamydia trachomatis</subject><subject>Community</subject><subject>Continuity of Patient Care</subject><subject>Cross-Sectional Studies</subject><subject>Diagnosis</subject><subject>Disease prevention</subject><subject>Evaluation</subject><subject>Female</subject><subject>Gender identity</subject><subject>Gonorrhea - epidemiology</subject><subject>Health aspects</subject><subject>HIV</subject><subject>HIV care continuum</subject><subject>HIV infections</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention &amp; control</subject><subject>HIV Infections - therapy</subject><subject>Homosexuality, Male</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Kigali</subject><subject>Laboratories</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Medical care quality</subject><subject>men who have sex with men</subject><subject>Middle Aged</subject><subject>MSM (Men who have sex with men)</subject><subject>Neisseria gonorrhoeae</subject><subject>Prevalence</subject><subject>Questionnaires</subject><subject>Rwanda</subject><subject>Rwanda - epidemiology</subject><subject>Sexual and Gender Minorities</subject><subject>Sexual Behavior</subject><subject>Sexually Transmitted Diseases - epidemiology</subject><subject>Sexually Transmitted Diseases - therapy</subject><subject>structural determinants</subject><subject>Supplement</subject><subject>Supplement: s</subject><subject>Syphilis - epidemiology</subject><subject>Transgender people</subject><subject>Transgender Persons</subject><subject>Viral Load</subject><subject>Women</subject><subject>Young Adult</subject><issn>1758-2652</issn><issn>1758-2652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kt2K1DAUx4so7ofe-AASEGQRZ2zSj7ReCMOi7uiCIOptOE1O2wxtsjbtjnPnIwi-oU9iOl3XGRkk0JRzfvnn5H9OEDyi4ZyGIXux0sDmLEnD-E5wTHmSzViasLs7_0fBiXOrMExZFuf3g6MoCsMwp-w4-Hmx_EK0KVH22hoCRhE0FVTYoul9gox5CR36j5OgkEBrTUV8mqxrS2q4RuLwG1nrvt5GR4m-A-MqNAo7srZj1Cu91xU0-jn5uPYIvCRAZGed-_X9h5tuh4a4flCbB8G9EhqHD2_20-Dzm9efzi9mlx_eLs8XlzOZZHE8y2KloCxizEuusCiZSgsVpcCiXFHFIUsURyppiYVMWR4lWKYxzQAjb0mBGJ0Grybdq6FoUUn_4g4acdXpFrqNsKDFfsboWlT2WvCEcZ4kXuDsRqCzXwd0vWi1k9g0YNAOTrA45lmU5pR79Mk_6MoOnX_yRMVpmnP6l_JOofBtsf5eOYqKha894qlfnpodoLzd6Iu0Bkvtw3v8_AAPYzdbLQ8eeLpzoEZo-trZZhib5PbBZxO47WSH5a15NBTjbIpxNsV2Nj38eNfuW_TPMHqATsDa17P5j5R4t1ywSfQ37v7u5g</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Twahirwa Rwema, Jean Olivier</creator><creator>Lyons, Carrie E</creator><creator>Herbst, Sara</creator><creator>Liestman, Benjamin</creator><creator>Nyombayire, Julien</creator><creator>Ketende, Sosthenes</creator><creator>Mazzei, Amelia</creator><creator>Olawore, Oluwasolape</creator><creator>Nsanzimana, Sabin</creator><creator>Mugwaneza, Placidie</creator><creator>Kagaba, Aflodis</creator><creator>Sullivan, Patrick S</creator><creator>Allen, Susan</creator><creator>Karita, Etienne</creator><creator>Baral, Stefan D</creator><general>International AIDS Society</general><general>John Wiley &amp; 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Lyons, Carrie E ; Herbst, Sara ; Liestman, Benjamin ; Nyombayire, Julien ; Ketende, Sosthenes ; Mazzei, Amelia ; Olawore, Oluwasolape ; Nsanzimana, Sabin ; Mugwaneza, Placidie ; Kagaba, Aflodis ; Sullivan, Patrick S ; Allen, Susan ; Karita, Etienne ; Baral, Stefan D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5844-84ddafb4e9f7debf2d6bd36a239d1d7a85d7e1c1febc62935ef6418ae3265bee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>AIDS</topic><topic>Care and treatment</topic><topic>Chlamydia trachomatis</topic><topic>Community</topic><topic>Continuity of Patient Care</topic><topic>Cross-Sectional Studies</topic><topic>Diagnosis</topic><topic>Disease prevention</topic><topic>Evaluation</topic><topic>Female</topic><topic>Gender identity</topic><topic>Gonorrhea - epidemiology</topic><topic>Health aspects</topic><topic>HIV</topic><topic>HIV care continuum</topic><topic>HIV infections</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - prevention &amp; control</topic><topic>HIV Infections - therapy</topic><topic>Homosexuality, Male</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infections</topic><topic>Kigali</topic><topic>Laboratories</topic><topic>Male</topic><topic>Mass Screening</topic><topic>Medical care quality</topic><topic>men who have sex with men</topic><topic>Middle Aged</topic><topic>MSM (Men who have sex with men)</topic><topic>Neisseria gonorrhoeae</topic><topic>Prevalence</topic><topic>Questionnaires</topic><topic>Rwanda</topic><topic>Rwanda - epidemiology</topic><topic>Sexual and Gender Minorities</topic><topic>Sexual Behavior</topic><topic>Sexually Transmitted Diseases - epidemiology</topic><topic>Sexually Transmitted Diseases - therapy</topic><topic>structural determinants</topic><topic>Supplement</topic><topic>Supplement: s</topic><topic>Syphilis - epidemiology</topic><topic>Transgender people</topic><topic>Transgender Persons</topic><topic>Viral Load</topic><topic>Women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Twahirwa Rwema, Jean Olivier</creatorcontrib><creatorcontrib>Lyons, Carrie E</creatorcontrib><creatorcontrib>Herbst, Sara</creatorcontrib><creatorcontrib>Liestman, Benjamin</creatorcontrib><creatorcontrib>Nyombayire, Julien</creatorcontrib><creatorcontrib>Ketende, Sosthenes</creatorcontrib><creatorcontrib>Mazzei, Amelia</creatorcontrib><creatorcontrib>Olawore, Oluwasolape</creatorcontrib><creatorcontrib>Nsanzimana, Sabin</creatorcontrib><creatorcontrib>Mugwaneza, Placidie</creatorcontrib><creatorcontrib>Kagaba, Aflodis</creatorcontrib><creatorcontrib>Sullivan, Patrick S</creatorcontrib><creatorcontrib>Allen, Susan</creatorcontrib><creatorcontrib>Karita, Etienne</creatorcontrib><creatorcontrib>Baral, Stefan D</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the International AIDS Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Twahirwa Rwema, Jean Olivier</au><au>Lyons, Carrie E</au><au>Herbst, Sara</au><au>Liestman, Benjamin</au><au>Nyombayire, Julien</au><au>Ketende, Sosthenes</au><au>Mazzei, Amelia</au><au>Olawore, Oluwasolape</au><au>Nsanzimana, Sabin</au><au>Mugwaneza, Placidie</au><au>Kagaba, Aflodis</au><au>Sullivan, Patrick S</au><au>Allen, Susan</au><au>Karita, Etienne</au><au>Baral, Stefan D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study</atitle><jtitle>Journal of the International AIDS Society</jtitle><addtitle>J Int AIDS Soc</addtitle><date>2020-10</date><risdate>2020</risdate><volume>23</volume><issue>S6</issue><spage>e25604</spage><epage>n/a</epage><pages>e25604-n/a</pages><issn>1758-2652</issn><eissn>1758-2652</eissn><abstract>Introduction Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. Methods MSM and TGW ≥ 18 years were recruited using respondent‐driven sampling (RDS) from March–August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. Results A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS‐adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p &lt; 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV‐positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cut‐off of &lt;200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. Conclusions These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV‐related outcomes for MSM in Rwanda.</abstract><cop>Switzerland</cop><pub>International AIDS Society</pub><pmid>33000912</pmid><doi>10.1002/jia2.25604</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-8127-0704</orcidid><orcidid>https://orcid.org/0000-0002-7954-1736</orcidid><orcidid>https://orcid.org/0000-0002-8954-6426</orcidid><orcidid>https://orcid.org/0000-0002-7728-0587</orcidid><orcidid>https://orcid.org/0000-0002-5482-2419</orcidid><oa>free_for_read</oa></addata></record>
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subjects Acquired immune deficiency syndrome
Adolescent
Adult
Aged
AIDS
Care and treatment
Chlamydia trachomatis
Community
Continuity of Patient Care
Cross-Sectional Studies
Diagnosis
Disease prevention
Evaluation
Female
Gender identity
Gonorrhea - epidemiology
Health aspects
HIV
HIV care continuum
HIV infections
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV Infections - therapy
Homosexuality, Male
Human immunodeficiency virus
Humans
Infections
Kigali
Laboratories
Male
Mass Screening
Medical care quality
men who have sex with men
Middle Aged
MSM (Men who have sex with men)
Neisseria gonorrhoeae
Prevalence
Questionnaires
Rwanda
Rwanda - epidemiology
Sexual and Gender Minorities
Sexual Behavior
Sexually Transmitted Diseases - epidemiology
Sexually Transmitted Diseases - therapy
structural determinants
Supplement
Supplement: s
Syphilis - epidemiology
Transgender people
Transgender Persons
Viral Load
Women
Young Adult
title HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study
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