Uptake of Primary Care Services and HIV and Syphilis Infection among Transgender Women attending the Tangerine Community Health Clinic, Bangkok, Thailand, 2016 – 2019

The clinic's goal is to engage and retain TGW in primary care, and it offers a range of services, including gender affirmative hormone therapy, HIV and STI testing, treatment and prevention services, and gender-identity and risk-behaviour counselling. During the study period from 2016 to 2019, a total of 2,947 TGW clients accessed services at the Tangerine Clinic, making a total of 5,227 visits. The number of clients significantly increased from 446 in 2016 to 1,050 in 2019, and the number of visits also increased from 616 to 2,198 during the same period. The prevalence of HIV at the first visit was 10.8%, and the prevalence of syphilis was 9.8%. The HIV incidence was 1.03 per 100 person-years (PY), and the syphilis incidence was 2.06 per 100 PY of follow-up. From 2016 to 2019, there were significant decreases in the annual prevalence of HIV, from 14.6% to 9.9%, and the annual incidence of HIV also decreased, from 1.68 to 1.28 per 100 PY. However, the annual incidence of treponemal test seroconversion significantly increased from zero in 2016 to 4.55 per 100 PY in 2019. The Tangerine Clinic's comprehensive package of services, including co-located gender affirmative hormone therapy, appears to be an effective model in engaging and retaining TGW in primary care. The decrease in HIV prevalence and low HIV incidence across calendar years suggest a possible reduction of HIV acquisition among the TGW population served by the clinic. However, the increasing prevalence of syphilis suggests ongoing high-risk sexual behaviour and underscores the need for screening and treatment for this infection at the time of delivery of HIV services. The clinic's routine data collection and analysis provide valuable insights into the healthcare needs of TGW and the effectiveness of the clinic's services. The study highlights the importance of providing comprehensive and targeted healthcare services to TGW, who face significant barriers to accessing healthcare due to stigma and discrimination. The findings of this study have implications for the development of effective healthcare strategies for TGW and other marginalized populations. The Tangerine Clinic's model of care, which includes a comprehensive package of services and a focus on engaging and retaining TGW in primary care, may be an effective approach to improving the health outcomes of TGW. The clinic's data collection and analysis also provide a valuable resource for researchers and policymakers seeking to understand the healthcare needs of TGW and develop effective interventions to address these needs. The study's findings on the prevalence and incidence of HIV and syphilis among TGW in Thailand are consistent with previous studies, which have reported high rates of HIV and other STIs among TGW in the region. The study's findings also highlight the need for continued investment in HIV prevention and treatment services, as well as the importance of addressing the social and structural determinants of health that contribute to the high rates of HIV and other STIs among TGW. The Tangerine Clinic's model of care and the study's findings have implications for the development of effective healthcare strategies for TGW and other marginalized populations. The study highlights the importance of providing comprehensive and targeted healthcare services to TGW, who face significant barriers to accessing healthcare due to stigma and discrimination. The findings of this study have the potential to inform the development of effective healthcare strategies for TGW and other marginalized populations, and to improve the health outcomes of these populations.