1321. Trans Females Receiving Gender-Affirming Surgical Referrals are More Likely to Have Durable Virologic Suppression at Whitman-Walker Health, 2008–2017

BACKGROUND: Trans females bear a disproportionate burden of HIV infection yet little is known about their HIV care continuum participation. We characterized the care continuum among trans female people with HIV (PWH) at Whitman-Walker Health (WWH) in Washington, DC and explored the impact of gender-affirming care on continuum participation. METHODS: This IRB-approved review from 2008 to 2017 analyzed trans female and nontrans PWH cohorts. Trans females were selected via self-identification and chart review, based on hormone prescription or narrative charting. Chi-square analysis was performed to examine associations between gender identity and demographic factors, comorbidities, and achieving steps in the care continuum. Bivariate analysis using chi-square test of independence and point-biserial correlation was performed between predictor and outcome variables in the care continuum. Multivariate logistic regression analysis was performed to identify predictors of poor outcomes in the care continuum. RESULTS: We analyzed 219 trans female and 456 nontrans PWH (Figure 1). Trans female PWH were more likely to be Black and/or Hispanic, have unstable housing, and be publically insured when compared with nontrans PWH (Table 1). There was no difference in ART initiation, retention in care (RiC), or durable virologic suppression (DVS) <200 copies/mL based on gender identity (Figure 2). Nontrans PWH had a higher odds of DVS at lower limits of detection (LLOD) than trans female PWH (OR 1.59, 95% CI 1.15–2.20). Hormone prescription did not impact trans female PWH continuum participation (Table 2). Surgical referral was found to impact DVS < 200 (P = 0.036) and DVS < LLOD (P = 0.021), but multivariate modeling could not be performed. Trans female PWH with surgical referrals were more likely to achieve DVS < 200 (OR 3.57, 95% CI 1.02–12.23) and DVS < LLOD (OR 2.85, 95% CI 1.14–7.12). CONCLUSION: This novel analysis of gender-affirming care and the HIV care continuum shows trans female PWH were less likely than nontrans to achieve durable VS < LLOD. Trans female PWH who received surgical referrals were 3.5 times more likely to achieve durable VS < 200 and almost three times more likely to achieve durable VS < LLOD. Further research is needed to explore this association between surgical referrals and DVS among trans female PWH. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.