Interruptions in HIV Prevention and Treatment Due to the COVID-19 Pandemic: A Cross-sectional Study of Transgender and Gender Nonbinary Adults in the U.S.

Background: Transgender and gender non-binary (TNB) people have been disproportionately impacted by HIV and the COVID-19 pandemic. This study explored the prevalence of HIV prevention and treatment (HPT) interruptions during the pandemic and identified factors associated with these interruptions. Setting: Data were drawn from LITE Connect, a U.S.-based, nationwide, online, self-administered survey designed to examine the experiences of TNB adults during the COVID-19 pandemic. A convenience sample of 2,134 participants were recruited between June 14, 2021 and May 1, 2022. Methods: The analytic sample was restricted to participants taking antiretroviral medications to prevent or treat HIV prior to the onset of the pandemic (n=153). We calculated descriptive statistics as well as Pearson chi-square bivariate tests and multivariable models to identify factors associated with HPT interruptions during the pandemic. Results: 39% of participants experienced an HPT interruption. We found a lower odds of HPT interruptions among participants living with HIV [aOR 0.45; 95%CI: 0.22, 0.92; p=0.02] and essential workers [aOR 0.49; 95%CI: 0.23, 1.0; p=0.06], and higher odds among people with chronic mental health conditions [aOR 2.6; 95%CI: 1.1, 6.2; p=0.03]. When gender and education were included, we found a lower odds of interruptions among people with higher eduction. Confidence intervals widened, but the magnitude and direction of effects did not change for the other variables. Conclusion: Focused strategies to address longstanding psychosocial and structural inequities are needed to mitigate HPT treatment interruptions in TNB people and prevent similar challenges during future pandemics.