Resum

Background: Transgender and gender diverse (TGD) people in Argentina face a disproportionate HIV burden driven by structural vulnerabilities, stigma, and violence which hinder access to prevention and treatment. Trans-competent environments, including gender-affirming care models, may improve health outcomes. Given the limited data on the HIV care cascade among TGD, we aim to describe the cascade and evaluate HIV outcomes in the TransCITAR cohort. Methods: Between September 2019 and August 2022, 499 TGD were enrolled in the prospective TransCITAR cohort within a gender-affirming care model. This analysis included TGD with previous, baseline or incident HIV diagnoses. The HIV care cascade (diagnosed, on ART, virally suppressed) was assessed as of December 31 2024. Being on ART was defined as initiation of ART and viral suppression as the last available HIV viral load <50 copies/ml during calendar year 2024. For incident cases, outcomes were evaluated one year post-diagnosis. Descriptive statistics were used to estimate cascade proportions, and logistic regression models assessed factors associated with viral suppression at one year (±6 months), considering age, gender, unstable housing, internal migration, sex work and depressive symptoms at baseline, substance use, cocaine use, and sexualized drug use and physical and sexual violence, all in the last year. Results: At cohort entry, 178 TGD (35.7%) were living with HIV, 17 (3.4%) received HIV diagnoses at baseline and 19 (3.8%) during follow-up (2019–2025). As of December 31, 2024, 213 TGD were living with HIV; 91.5% were on ART and 66.7% had achieved viral suppression. Among the 36 TGD diagnosed since cohort entry, (median viral load 53,077 copies/mL, IQR 11,028-158,846; 26% with CD4<350 cells/mm³) 97% initiated ART within a median of 13.5 days (IQR 2-30), sustained treatment for at least one year, and 77% achieved viral suppression at one year. In bivariate analysis, factors associated with reduced the odds of viral suppression were internal migration (OR:0.20, p:0.04), depressive symptoms (OR:0.27, p:0.03), sexualized drug use (OR:0.30, p:0.04), physical violence (OR:0.14, p:0.001), and sexual violence (OR:0.19, p:0.02). In adjusted analysis, only physical violence remained significant (OR:0.21, p:0.02). Conclusions: In TransCITAR, within a gender-affirmative model, nearly all TGD initiated ART; however, viral suppression remained below the UNAIDS 95% target, underscoring the need for enhanced adherence support and structural interventions.