HIV prevention and HIV care among transgender and gender diverse youth: design and implementation of a multisite mixed-methods study protocol in the U.S.

Abstract

BackgroundIn the U.S., transgender and gender diverse (TGD) populations face structural, interpersonal, and individual barriers to healthcare. Less is known, however, about the HIV prevention and treatment experiences of TGD youth in the U.S. The current study was developed to fill this research gap.MethodsThis article describes the research protocol for a multi-site, U.S.-based mixed-methods study that sought to identify the multi-level facilitators and barriers that influence participation of TGD youth in various stages of the HIV prevention (e.g., pre-exposure prophylaxis uptake) and care continua. A sample of diverse TGD youth ages 16–24 was recruited from 14 U.S. sites. TGD youth participants completed a one-time, in-person visit that included an informed consent process, computer-based quantitative survey, and in-depth qualitative interview assessing experiences accessing HIV prevention and/or care services. Providers serving TGD youth were recruited from the same 14 sites and completed a one-time visit via phone that included informed consent, demographic questionnaire, and in-depth qualitative interview assessing their experiences providing HIV prevention or treatment services to TGD youth.ResultsOverall, 186 TGD youth ages 16–24 and 59 providers serving TGD youth were recruited and enrolled from across the 14 U.S. sites. TGD youth participants had a mean age of 20.69; 77.3% youth of color; 59.7% trans-feminine; 15.5% trans-masculine; 24.9% non-binary; 53.6% family income under poverty level. Providers included medical and mental health providers as well as case manager/care coordinators, HIV test counselors, and health educators/outreach workers. Providers were 81.3% cisgender and 30.5% people of color. Successes with community-engagement strategies and gender-affirming research methods are reported.ConclusionsThis study addresses critical gaps in current knowledge about the HIV prevention and care experiences of TGD youth. Findings have implications for the development of HIV interventions across levels to support the health and well-being of TGD youth. Future research is warranted to replicate and expand on lessons learned regarding recruitment and engagement of communities of TGD youth, including longitudinal designs to assess engagement across their developmental stages. Lessons learned working with TGD youth through developing and implementing the study protocol are shared.Trial registrationRegistered on ClinicalTrials.gov on 05/20/2015 (NCT02449629).

A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event

“…Youth typically contribute to research as participants, key informants, and assistants [10,11]. While some studies have expanded youth engagement in HIV research by creating youth advisory boards (YABs), the extent of meaningful engagement varies [12][13][14][15][16][17][18][19][20][21]. Providing youth with opportunities to create solutions to health problems that affect them can enhance program implementation and build capacity for youth as co-creators [10,22].…”

Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines

“…Low-risk perception as a significant barrier to HIV testing was also seen in previous studies [50][51][52][53], not only among TG populations. Other reasons for TM or TW not getting their HIV testing also included fear of HIVrelated stigma and discrimination [54,55], insufficient knowledge on HIV/AIDS or poor health literacy [56,57], and limited availability due to lack of time [58]. Further investigation on why TM and TW in VLY do not know their HIV status because of refusal should be conducted to engage more TM and TW clients in HTC services.…”

HIV Testing Preferences Among Trans Men and Trans Women: A Retrospective Study of Client Records from 2017 to 2019 in a Community-Based Transgender Health Center in Metro Manila, Philippines

“…Low-risk perception as a signi cant barrier to HIV testing was also seen in previous studies [38][39][40][41], not only among TG populations. Others reasons for TM or TW not getting their HIV testing also included fear of HIV-related stigma and discrimination [42,43], insu cient knowledge on HIV/AIDS or poor health literacy [44,45], and limited availability due to lack of time [46]. Further investigation on why TM and TW in VLY not knowing their HIV status because of refusal should be conducted to engage more TM and TW clients in HTC services.…”