Although every youth in pediatric/adolescent HIV care will need to transition to adult-oriented care, there are no existing evidence-based interventions to optimize health through this process. Healthcare transition poses a persistent challenge to the health of youth living with HIV, which may result in gaps in care engagement, medication adherence, and viral suppression. Our process evaluation of iTransition, a multilevel mobile health (mHealth) intervention, included iterative interviews with youth, providers, and Transition Champions. These data, along with team meeting notes, highlight the important role the intervention plays in addressing healthcare transition-related challenges, positioning it to fill a critical gap for both youth and providers. It also highlights important individual (e.g., competing priorities of youth and providers), clinical (e.g., electronic health record integration), and contextual (e.g., clinical policies during COVID-19 pandemic) challenges to intervention reach and implementation. More work is needed to refine interventions to support care continuity for youth living with HIV as they transition to adult-oriented care.

Globally, transgender and other gender diverse (trans) people experience widespread prejudice, discrimination, violence, and other forms of stigma, which contribute to negative health outcomes. Most anti-trans stigma research has been conducted in high-income countries. Measurement of anti-trans stigma in low- and middle-income countries (LMICs) is important for understanding and improving the health of trans populations globally. Accordingly, this scoping review explores the use of quantitative anti-trans stigma measures in LMICs. This scoping review follows the guidance of the PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist and examines empirical research with trans populations in LMICs published in English, Spanish, Arabic, and Russian between 2001–2024. Study eligibility criteria included: 1) trans study population, 2) LMIC study location, 3) quantitative or mixed-method study design, and 4) quantitative measurement of anti-trans stigma. The search yielded 82 articles (representing 65 unique studies) from 34 LMICs. Most articles were published since 2018. No articles focused exclusively on trans men. About 62% of articles included a primary focus on stigma; health outcomes primarily examined HIV and mental health. Nearly all articles (95%) measured enacted stigma; other forms of stigma (e.g., internalized and anticipated) were less commonly measured, and structural stigma was only measured in 4 articles. More than half of the articles (55%) measured stigma both broadly and within specific contexts (e.g., from family, in health care). More research exploring anti-trans stigma is needed, especially with trans-masculine and other gender diverse people, measuring outcomes beyond HIV and mental health, and measuring forms of stigma beyond enacted stigma. Expanding and improving measurement of anti-trans stigma in LMICs can improve our understanding of the mechanisms shaping health equity to inform context specific and tailored health interventions to support trans communities worldwide.

Barriers to initiating and maintaining HIV care continue to impede efforts to “End the HIV Epidemic” in the United States, particularly among members of Black sexual and gender minoritized (BSGM) groups in the US South. Evidence-informed social network-based interventions may improve engagement in HIV care services among BSGM; however, understanding and addressing context-specific barriers and facilitators to HIV service use are critical for intervention effectiveness. We explored barriers to HIV care engagement to inform the adaptation of a social network strategy to increase participation in HIV prevention and care services in Charlotte, NC. We interviewed BSGM with HIV who were in treatment, local health department officials, clinicians, and community-based organization leaders and held four focus groups (FGs) with HIV public health services staff. Transcripts were iteratively coded and analyzed thematically. We identified two themes across all FGs and in-depth interviews (IDIs). Two additional themes were identified specifically from IDIs with BSGM. Across data sources, participants described multi-level stigma, competing priorities, and logistical hurdles that impede BSGM engagement in HIV care. BSGM with HIV indicated that supportive social networks enhanced HIV treatment adherence and described how their personal agency and self-efficacy evolved after receiving an HIV diagnosis. Interventions to improve HIV care engagement among BSGM with HIV must address inequities, leverage social support networks, and enhance self-efficacy.