Purpose: HIV viral suppression rates are often lower among transgender and gender diverse (TGD) people compared to cisgender individuals. We sought to determine if insurance-based care coordination mitigated disparities in viral suppression for TGD individuals.
Methods: We examined two tiers of care coordination (standard or health homes) from a Medicaid HIV Special Needs Plan between 2016 and 2018, which identified TGD or cisgender clients. Durable viral suppression (DVS) was defined as having at least two successive suppressed viral loads (≤200 cc/mL) ≥90 days apart. Logistic regression estimated whether DVS was associated with gender identity, care coordination, and their interaction, adjusting for demographics and the social deprivation index.
Results: There were 5893 enrollees, with a median age of 45 (range: 18–64); most were non-Hispanic (NH) Black (n = 3023, 51.3%), and few were TGD (n = 485, 8.2%) or used health homes (n = 1086, 18.4%). Being TGD was not associated with DVS; therefore, no interaction was examined. Health home enrolment (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.02, 1.39) and older age (OR: 1.01, 95% CI: 1.01–1.02) were associated with higher odds of DVS. Being NH Black (OR: 0.53, 95% CI: 0.41–0.68), Hispanic White (OR: 0.71, 95% CI: 0.54–0.93), or Hispanic Black (OR: 0.66, 95% CI: 0.49–0.90) compared with NH White and greater social deprivation (OR: 0.99, 95% CI: 0.98–0.99) were associated with lower odds of DVS.
Conclusions: Structural factors were more strongly associated with DVS than gender identity. However, future research is needed to understand the remaining disparities.
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