Developing Best Practices for Integrating HIV Prevention into Gender-Affirming Care for Transgender Adults
June 14, 2022
The proposed study will use quantitative data from EMR chart review and qualitative data from semistructured interviews to assess evidence for health care delivery models that leverage gender-affirming services to reduce disparities in PrEP uptake among trans communities. The proposed approach is twofold: (1) characterize clinical trajectories at the intersection of gender-affirming and HIV prevention services using retrospective EMR data and clustering classification techniques and (2) identify effective strategies for integration of gender-affirming and PrEP services through semi-structured interviews with 20 current and former trans WWH patients and at least 5 WWH providers to inform the development of a program for subsequent implementation and evaluation. EMR data that describe features of clinical trajectories, such as appointment data, prescription data, and clinician visit notes, will be abstracted from gender-affirming medical appointments that occur between entry to care and HIV- or PrEP-related endpoints. This data will be analyzed using a clustering algorithm to efficiently identify patient and clinical features of common trajectories among WWH’s trans and gender diverse medical population. Qualitative data obtained from patients in selected trajectories and WWH staff will be coded and analyzed using modified Grounded Theory methods. Inter-rater reliability will be assessed for chart review and qualitative coding.