ABSTRACT
Purpose: Undercounting of transgender people with HIV (PWH) in New York City (NYC) remains prevalent. We sought to improve our ability to accurately enumerate transgender PWH and address their needs for gender-affirming health care. Methods: We enhance previous algorithms used to identify transgender beneficiaries, using diagnoses, prescriptions, and sex at birth from Medicaid claims in 2013-2017. We then matched beneficiaries to individuals diagnosed with HIV in the HIV surveillance registry to identify transgender PWH. Results: Our algorithm identified 6043 transgender persons who accessed Medicaid in 2013-2017, with 1472 (24%) reported to the HIV registry, 1168 (79%) of whom were accurately identified as transgender in the registry. We found 292 transgender persons in the registry that had accessed Medicaid but were not identified by our algorithm, for a total of 6335 transgender persons accessing Medicaid (0.1% of the NYC Medicaid population), including 1764 transgender PWH (28% of transgender persons accessing Medicaid). From 2013 to 2017, there was a 35% increase in transgender persons identified in Medicaid claims using our algorithm. Conclusion: We identified a large number of transgender persons in Medicaid, many of whom were PWH. We saw a sizeable increase over the 5-year period, likely due, in part, to expansion of Medicaid policy to cover gender-affirming health care. Given the high proportion of transgender PWH accessing Medicaid, Medicaid claims data are a valuable source of health information for the transgender population, a group that is often difficult to identify due to issues of underreporting, stigma, reduced access to appropriate care, and misgendering by health care personnel.
ABSTRACT
BACKGROUND: HIV surveillance data can be used to improve patient outcomes. OBJECTIVE: This study aimed to describe and present findings from the HIV care continuum dashboards (CCDs) initiative, which uses surveillance data to quantify and track outcomes for HIV patients at major clinical institutions in New York City. METHODS: HIV surveillance data collected since 2011 were used to provide high-volume New York City clinical facilities with their performance on two key outcomes: linkage to care (LTC), among patients newly diagnosed with HIV and viral load suppression (VLS), among patients in HIV care. RESULTS: The initiative included 21 facilities covering 33.78% (1135/3360) of new HIV diagnoses and 46.34% (28,405/61,298) of patients in HIV care in New York City in 2011 and was extended to a total of 47 sites covering 44.23% (1008/2279) of new diagnoses and 69.59% (43,897/63,083) of New York City patients in care in 2016. Since feedback of outcomes to providers began, aggregate LTC has improved by 1 percentage point and VLS by 16 percentage points. CONCLUSIONS: Disseminating information on key facility-level HIV outcomes promotes collaboration between public health and the clinical community to end the HIV epidemic. Similar initiatives can be adopted by other jurisdictions with mature surveillance systems and supportive laws and policies.
