Prevalence of HIV and STDs in a Dutch transgender population: TITAN- study

According to the World Health Organization (WHO), transgender people are part of the five key populations at high risk for contracting HIV (1). In a recent meta-analysis conducted in the United States, an average HIV prevalence of 27.7% was determined among transgender women (people assigned male sex at birth who identify as women), in contrast to an average self-reported HIV prevalence of 11.8%(4). According to some studies, transgender women are more vulnerable to contract HIV and bacterial STDs (sexually transmitted diseases) than cisgender MSMs (men who have sex with men), who are widely recognized as a population disproportionately affected by HIV and STDs(11-13). Moreover, little is known about HIV and STD risk among transgender men (people assigned female sex at birth who identify as men). Selection bias is present in most studies, e.g., samples were selected at STD clinics or among sex workers.
In the Netherlands and Western Europe, epidemiological data on HIV and STDs among transgender people is scarce. To design HIV behavioral interventions targeted at all transgender people, accurate and complete epidemiological data is needed (6).

Objectives:
1) to assess the prevalence of HIV and STDs (Hepatitis B and C, Syphilis, Chlamydia and Gonorrhea) among a broad and unselected group of adult transgender people.
2) to identify determinants that are associated with HIV and STD presence (through questionnaires).

The prevalence of HIV and STDs (Hepatitis B/C/ Syphilis/ Chlamydia/ Gonorrhea) in the adult transgender population in the Netherlands is lower than the global reported prevalence of these diseases.

There is only one timepoint (at inclusion).
During routine check-up at the outpatient clinic, blood tests (4.5ml EDTA) (including HIV, hepatitis B, C, Syphilis , will be collected once at the outpatient clinic. Swab tests(anal, pharyngeal or vaginal) or urine will be collected at the outpatient clinic or at the subjects home.

Test specifications:
Serological test
HIV : ELISA for screening, if positive a confirmatory Western Blot will be performed
Hepatitis B: HBsAg for screening and Anti-HBc for previous infections
Hepatitis C: Anti-HCV for screening, if positive RNA
Syphilis: TP-ELISA/TTPA , if positive a confirmatory VDRL will be performed

Swabs (anal, pharyngeal and vaginal) and urine test:
Gonorrhoea and Chlamydia Trachomatis: nucleic acid amplification test (NAAT)