RESUMEN
BACKGROUND: Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC-specific telehealth intervention to increase access to care. METHODS: Formative qualitative semi-structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC ≥ 18 years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18 years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day-long meetings with TWC and stakeholders were convened to develop the intervention. RESULTS: Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. CONCLUSIONS: Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population-specific challenges to care. Further development of this model may be able to improve health outcomes among TWC.
Asunto(s)
Etnicidad/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Grupos Raciales/psicología , Telemedicina/organización & administración , Personas Transgénero/psicología , Adulto , Estudios Transversales , District of Columbia , Etnicidad/estadística & datos numéricos , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Investigación Cualitativa , Grupos Raciales/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricosRESUMEN
Characterization of structural barriers that impede the receipt of HIV prevention and care services is critical to addressing the HIV epidemic among Black men who have sex with men (BMSM). This study investigated the utilization of HIV prevention and general care services among a non-clinic-based sample of BMSM who reported at least one structural barrier to engagement in care. Proportions of participants who had received HIV prevention services and general care services in different settings were compared using Fisher's exact test and correlates of service receipt were assessed using logistic regression. Among 75 BMSM, 60% had accessed a community-based clinic, 21% had accessed a primary care setting, and 36% had accessed an acute care setting in the last 6 months. Greater proportions of participants who had accessed community-based clinics received HIV prevention services during these visits (90%) compared to those who had accessed primary care (53%) and acute care (44%) settings (p = .005). Opportunities for BMSM to receive HIV prevention interventions differed by care setting. Having access to health care did not necessarily facilitate the uptake of HIV prevention interventions. Further investigation of the structurally rooted reasons why BMSM are often unable to access HIV prevention services is warranted.
Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Negro o Afroamericano/psicología , Infecciones por VIH/diagnóstico , Homosexualidad Masculina/psicología , Aceptación de la Atención de Salud/psicología , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Servicios de Salud Comunitaria , Estudios Transversales , Atención a la Salud , District of Columbia , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Homosexualidad Masculina/etnología , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/estadística & datos numéricos , Análisis de Regresión , Adulto JovenRESUMEN
Eliminating racial HIV disparities among men who have sex with men (MSM) will require a greater uptake of HIV prevention and care interventions among Black MSM (BMSM), yet such strategies generally require meaningful engagement in a health care system that often does not meet the unique needs of BMSM. This study assessed the acceptability of, and correlates of having favorable perceptions of, a mobile smartphone application (app) intervention for BMSM that aims to remove structural barriers and improve access to culturally relevant HIV prevention and care services. An Internet-based sample of 93 BMSM completed an online survey on their perceptions of the app using 14 items measured on a 100-point visual analogue scale that were validated in exploratory factor analysis (alpha=0.95). Among the sample, perceptions of two sample app modules were generally favorable and most BMSM agreed that they would use the modules (81.2% and 87.1%). Correlates of having favorable perceptions included trusting medical advice from social networks, lacking private health insurance, and not having accessed a primary care physician in the last year. Our findings warrant the further development of this app and point to subgroups of BMSM for which it may have the greatest impact.