跨性别者包容性性健康问卷改善跨性别患者的人类免疫缺陷病毒/性传播感染（STI）护理：特定解剖部位 STI 流行率和筛查。
Trans-inclusive Sexual Health Questionnaire to Improve Human Immunodeficiency Virus/Sexually Transmitted Infection (STI) Care for Transgender Patients: Anatomic Site-Specific STI Prevalence and Screening.
机构信息
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.
出版信息
Clin Infect Dis. 2023 Feb 8;76(3):e736-e743. doi: 10.1093/cid/ciac370.
BACKGROUND
In 2018, the municipal Sexual Health Clinic in Seattle, implemented trans-inclusive questions about sexual behavior, anatomy, gender-affirming surgeries, and sexually transmitted infection (STI) symptoms in the clinic's computer-assisted self-interview (CASI) to improve care for transgender and nonbinary (TNB) patients.
METHODS
We calculated test positivity, the proportion of TNB patient visits that received testing for human immunodeficiency virus (HIV); syphilis; pharyngeal, rectal, and urogenital gonorrhea (GC); and chlamydia (CT) before (5/2016-12/2018) and after (12/2018-2/2020) implementation of new CASI questions, and the proportion of asymptomatic patients who received anatomic site-specific screening based on reported exposures.
RESULTS
There were 434 TNB patients with 489 and 337 clinic visits during each period, respectively. Nonbinary patients assigned male at birth (AMAB) had the highest prevalence of GC (10% pharyngeal, 14% rectal, 12% urogenital). Transgender women, transgender men, and nonbinary people AMAB had a high prevalence of rectal CT (10%, 9%, and 13%, respectively) and syphilis (9%, 5%, and 8%). Asymptomatic transgender women, transgender men, and nonbinary patients AMAB were more likely to receive extragenital GC/CT screening compared with nonbinary patients assigned female at birth. After implementation of trans-inclusive questions, there was a 33% increase in the number of annual TNB patient visits but no statistically significant increase in HIV/STI testing among TNB patients.
CONCLUSIONS
TNB people had a high prevalence of extragenital STIs and syphilis. Implementation of trans-inclusive medical history questions at a clinic that serves cisgender and transgender patients was feasible and important for improving the quality of affirming and inclusive sexual healthcare.
背景
2018 年，西雅图市性健康诊所（municipal Sexual Health Clinic in Seattle）在其诊所的计算机辅助自我访谈（computer-assisted self-interview，CASI）中纳入了关于性行为、解剖结构、性别肯定手术和性传播感染（sexually transmitted infection，STI）症状的跨性别和非二进制（transgender and nonbinary，TNB）群体包容性问题，以改善对跨性别和非二进制群体（TNB）患者的护理。
方法
我们计算了 TNB 患者就诊时 HIV；梅毒；咽、直肠和泌尿生殖道淋病（gonorrhea，GC）；和衣原体（chlamydia，CT）检测的阳性率，分别在实施新的 CASI 问题之前（5/2016-12/2018）和之后（12/2018-2/2020），以及根据报告的暴露情况，对无症状患者进行解剖部位特异性筛查的比例。
结果
共有 434 名 TNB 患者，分别有 489 次和 337 次就诊。出生时被指定为男性的非二进制患者（assigned male at birth，AMAB）的 GC 患病率最高（咽 10%，直肠 14%，泌尿生殖道 12%）。跨性别女性、跨性别男性和 AMAB 的非二进制人群的直肠 CT（10%、9%和 13%）和梅毒（9%、5%和 8%）患病率较高。无症状的跨性别女性、跨性别男性和 AMAB 的非二进制患者比出生时被指定为女性的非二进制患者更有可能接受外生殖器 GC/CT 筛查。在实施跨性别包容性问题后，TNB 患者每年就诊次数增加了 33%，但 TNB 患者的 HIV/STI 检测并没有统计学上的显著增加。
结论
TNB 人群的外生殖器 STI 和梅毒患病率较高。在为顺性别和跨性别患者服务的诊所中实施跨性别包容性病史问题是可行的，对于改善肯定和包容的性保健质量非常重要。
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