Prevalence of and Factors Associated with Genital and Extragenital Chlamydia and Gonorrhea among Transgender Women in HIV Care in the United States; 2005-2016.

BACKGROUND Data on testing rates and prevalence of and factors associated with of genital and extragenital chlamydia and gonorrhea among transgender women with HIV in the United States are limited. METHODS This retrospective cohort analysis included transgender women living with HIV enrolled in the U.S. Centers for AIDS Research Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with chlamydia or gonorrhea testing performed in HIV clinic. The primary outcome was a positive test for chlamydia or gonorrhea at urogenital or extragenital (rectal/pharyngeal) sites. Factors associated with infection were examined using logistic regression and generalized estimating equations to account for multiple tests per woman. RESULTS Among 312 transgender women in HIV care, 252 (81%) were tested for chlamydia or gonorrhea at least once. Annual testing rates were low: 23%-53% at genital sites and 24%-47% at extragenital sites. A total of 88 infections were detected and 22% of women (55/252) had at least one positive test. Most infections occurred at extragenital sites (80% of chlamydia and 82% of gonorrhea positive tests). Factors associated with infection in an adjusted model were: age 18-29 years compared to ≥50 years (aOR 7.6; 95% CI 1.8-31.2), CD4 count >350 compared to CD4 <200 (aOR 5.5; 95% CI 1.2-25.1) and higher engagement in HIV care (aOR 2.2; 95% CI 1.0-4.5). CONCLUSIONS Among transgender women living with HIV, testing rates for chlamydia and gonorrhea are inadequate, particularly at extragenital sites where most infections occur.