Transaccess: Gender affirming HIV primary care for San Francisco's transwomen of color

Historically, transgender women experience worse outcomes throughout the HIV care continuum compared to the general population, including lower rates of engagement, retention, and viral suppression. According to a 2011 CDC report, racial health disparities place transwomen of color at particularly high risk for HIV. Once diagnosed, HIV+ transgender women of color are much less likely to engage in care, receive and adhere to antiretroviral therapy, and experience viral suppression. Poor HIV outcomes in this population are driven by the disproportionately high risk of homelessness, poverty, lack of employment access, trauma/mental illness, and substance use disorder. In the most recent HIV Epidemiology Report, transgender women accounted for 3% of all HIV cases in San Francisco; however, transgender women account for 10% of homeless HIV cases. These associations between psychosocial factors and medical outcomes required an innovative model of care to address this population's unique needs and exceptionally high acuity. In an effort to improve HIV outcomes amongst transwomen of color in San Francisco, the San Francisco Department of Public Health and the Asian & Pacific Islander Wellness Center created the TransAccess Project in 2013. To date, TransAccess has reached 68 HIV+ transwomen of color in San Francisco, of whom 22% were amongst the top 2-5% of medical service utilizers in SF at time of enrollment. Currently, TransAccess is providing primary care and support services to 42 clients. Despite a very high degree of medical and psychosocial acuity, TransAccess has retained over 90% of our clients in care, with 72% virologically suppressed to <200 copies/ml, and 57% suppressed to <40 copies/ml.