School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA.
Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109-5482, USA.
BMC Med Educ. 2021 Nov 4;21(1):561. doi: 10.1186/s12909-021-02991-3.
Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'. This theoretically-informed community-developed intervention aimed to increase providers' gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV.
Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons.
The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12-10.86, p < 0.001, possible score range: 16-96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90-4.90, p < 0.001, possible score range: 9-63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training.
This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women.
ClinicalTrials.gov ( NCT04096053 ).
跨性别（trans）女性在获得性别肯定的 HIV 预防和护理方面面临着受限的机会。这部分是由于社会和医疗保健提供者对跨性别者的知识和能力有限，以及对反跨性别和与 HIV 相关的污名的融合所致。为了推进性别肯定的 HIV 服务提供，我们实施并评估了“跨性别者接受肯定和有能力的 HIV 和医疗保健教育（TEACHH）”。这项有理论依据的、由社区制定的干预措施旨在提高提供者在性别肯定的 HIV 预防和护理方面的知识和能力，减少提供者对感染 HIV 和/或受 HIV 影响的跨性别女性的负面态度和偏见。
参与研究的医疗保健和社会服务提供者以及培训中的提供者（例如医生、护士、社会工作者）与感染 HIV 和/或受 HIV 影响的跨性别女性（n=78）一起参加了一项非随机多地点试点研究，采用预-后测试设计评估 TEACHH。在干预前后的调查中评估了参与者的特征、干预的可行性（例如，研讨会完成率）和可接受性（例如，参加另一次培训的意愿）。采用配对样本 t 检验评估了参与者在为感染 HIV 的跨性别女性和跨性别者提供性别肯定的 HIV 护理方面的感知能力、态度/偏见和知识方面的前后干预差异。
该干预措施具有可行性（100%完成研讨会）和可接受性（91.9%表示有兴趣参加未来的性别肯定的 HIV 护理培训）。干预后的评分表明，在以下方面有显著改善：1）性别肯定的 HIV 护理知识、态度/偏见和感知能力（得分平均差异（MD）8.49（95%置信区间 MD：6.12-10.86，p<0.001，可能得分范围：16-96），以及 2）性别肯定的医疗保健知识、态度/偏见和感知能力（MD=3.21；95%置信区间 MD：1.90-4.90，p<0.001，可能得分范围：9-63）。在过去一年中服务的跨性别者和跨性别女性客户较少、间接服务角色以及接受过较少先前培训的参与者，其干预前后的结果测量变化更大。
这项简短的医疗保健和社会服务提供者干预措施在提高性别肯定的提供者知识、感知能力和态度/偏见方面显示出了希望，特别是在那些跨性别和 HIV 经验较少的参与者中。TEACHH 的扩大可能会增加获得性别肯定的卫生服务和 HIV 预防和护理的机会，增加医疗保健机会，并减少跨性别女性的 HIV 差距。
ClinicalTrials.gov（NCT04096053）。
