Transgender Women's Internet Survey and Testing: Protocol and Key Indicators Report

Area of Science:

• Public Health
• Epidemiology
• Behavioral Science

Background:

• Ongoing surveillance of HIV/STI risk behaviors among transgender women is crucial.
• Existing assessments may not be adequately adapted for this population.
• The Transgender Women's Internet Survey and Testing (TWIST) study was developed to address this need.

Purpose of the Study:

• To develop and pilot the TWIST study, an online survey and remote biospecimen collection for HIV/STI risk assessment in transgender women.
• To examine behavioral indicators related to HIV/STI risk in this population.
• To assess the feasibility of online recruitment and remote biospecimen collection for ongoing surveillance.

Main Methods:

• A cross-sectional online survey was administered to transgender women aged 15+ in the United States recruited via social media.
• Participants reported demographics, sexual behaviors, and HIV/STI status.
• Multivariable regression analyzed behavioral indicators by age, population density, and medical gender affirmation; remote HIV/STI testing was offered to a subsample.

Main Results:

• The study recruited 401 participants, predominantly non-Hispanic white and under 25 years old.
• Self-reported HIV prevalence was 1.3%, with 47.1% unaware of their status.
• Medical gender affirmation was significantly associated with past-year HIV and STI testing; 31% of those invited returned biospecimens for testing.

Conclusions:

• The TWIST pilot study successfully recruited transgender women online and collected behavioral data.
• Online recruitment and remote biospecimen collection offer a scalable strategy for monitoring HIV/STI trends in U.S. transgender women.
• This approach can provide valuable insights into HIV/STI prevention and intervention needs for this population.