Africa SW Meta-analysis - AIDS 2012_1_ by hcj

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									GLOBAL BURDEN OF HIV INFECTION AMONG TRANSGENDER
   WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS




                             BY
 STEFAN BARAL, TONIA POTEAT, ANDREA L WIRTZ, THOMAS
    GUADAMUZ, SUSANNE STROMDAHL, CHRIS BEYRER

           Center for Public Health and Human Rights
           Johns Hopkins School of Public Health
Background
 Transgender people exist on every continent.
 Epidemiologic studies have generally included
  Male to Female Transgenders (TG) as a
  subpopulation of men who have sex with men
  (MSM) in HIV research
     Some  biological risk factors are shared between
      TG women and MSM
     There is a limited understanding of the burden of
      HIV among TG
Systematic Review Protocol
   Inclusion Criteria
       Published January 1, 2000 to November 30, 2011 in English, French, Spanish
       PubMed, EMBASE, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL
        (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine
           Following search terms
                 medical subject headings (MeSH) terms for HIV or AIDS, and terms associated with transgender (
                  transgender* OR “travesty” OR “koti” OR “hijra” OR “MTF” or “male to female transgender” OR
                  transsexual* OR transvest* OR “mahuvahine” OR “mahu” OR “waria” OR katoey OR “cross dresser” OR
                  “bantut” OR “nadleehi” OR “mahu” OR “berdache” OR “xanith”).

   Title search
       Completed by two reviewers with a third acting as tie-breaker
       Duplicate titles removed and excluding non-scientific journals. These were retained for
        abstract review.
   Abstract review
       Completed by two reviewers with a third acting as tie-breaker
   Full text review and Data Abstraction
       Completed by two abstractors with a third acting as tie-breaker
    Methods
   Meta-Analysis
       Characterize the increased odds of living with HIV for male-to-
        female transgender as compared to other people in each country
           TG HIV Prevalence
                 All estimates from a country were pooled and weighted by sample size to
                  achieve prevalence estimate
           Background HIV Prevalence
                 UNAIDS data from Men and Women 15+ living with HIV as numerator in each
                  country
                 Denominator was calculated by using US Census Bureau Data for all men and
                  women 15-49 in that country separately
       Heterogeneity testing done with DerSimonian and Laird’s Q test
       Random Effects Modeling
         Assumption that the HIV prevalence in one country is independent of
          the HIV prevalence in other countries
    Systematic Review Results

   1512 citations were retrieved
    877    unique titles
           414 abstract reviews
             145 full text reviews
               39 studies that met inclusion criteria
   11066 Transgender women included in meta-analysis
     10 Low and Middle Income Countries
     5 High Income Countries
Results
   The pooled global HIV prevalence was
    19.1% (95% CI 17.4-20.7)

   In 7,197 TG from 10 LMIC, HIV prevalence
    was 17.7%(95%CI 15.6-19.8)

   In 3,869 TG from 5 HIC, HIV prevalence was
    21.6%(95% CI 18.8-24.3)
Meta-Analysis of HIV Prevalence Data
among TG women compared to all adults
Limitations
   There were only data available for 15 Countries
    meeting inclusion criteria
     Studiesonly available from countries with concentrated
      and male-predominant HIV epidemics
     Note: each of these countries have expanding
      epidemics
   Significant heterogeneity of study results and
    methods
     Pooling of results masks wide geographical variations
      within a country such as India
    Conclusions
   Male to female TG persons are at very high risk for
    HIV infection in both low and high income countries

   They are some 50 times more likely to have HIV
    infection than other adults of reproductive age in the
    15 countries for which data were available

   TG are an understudied but very at risk group for HIV
    and are clearly in urgent need of HIV services
     Virtually   no data from the generalized epidemics of the
      world

								
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