Bridging gaps in HIV care for transgender women: A decade of real-world evidence.

BackgroundTransgender women (TGW) face a disproportionately high HIV burden, yet real-world evidence on their engagement in the care cascade is scarce. This study analysed HIV care cascade outcomes and associated factors in a large Argentinian cohort to identify key challenges and inform public health strategies.MethodsThis was a retrospective cohort study of TGW with confirmed HIV linked to care at a public hospital in Buenos Aires (2011-2022). We analyzed 12-month retention in care, antiretroviral therapy (ART) use, and virologic suppression using bivariate and multivariate logistic regression.ResultsOf 240 TGW included, 186 completed 12-months follow-up. The cascade outcomes were: 71.5% retained in care; 87.9% on ART among those retained; and 70.7% virologically suppressed among those on ART. In multivariate analysis, ART initiation at linkage was the strongest predictor of retention (aOR: 35.93; 95%CI: 9.72-132.75), while baseline cocaine use was associated with a lower likelihood of being on ART (aOR: 0.17; 95%CI: 0.04-0.68).ConclusionsSignificant gaps persist in the HIV care cascade for TGW in this real-world setting. While immediate ART initiation is a powerful tool for retention, structural barriers like substance use require integrated interventions. This evidence is critical for designing effective public health strategies to improve health equity.