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1.
J Am Acad Psychiatry Law ; 52(2): 186-195, 2024 Jun 04.
Article in English | MEDLINE | ID: mdl-38834363

ABSTRACT

The care and housing of transgender (TGD) incarcerated persons is a complex concern that is growing because of the increased recognition and diagnosis of gender dysphoria in society. To remain current in this evolving landscape, there have been updates to federal manuals and state guidelines regarding the medical care and housing of the TGD population. Since the publication by Glezer and colleagues in 2013, there has not been a comprehensive overview of current federal and state guidelines, and legal and other considerations on this topic. We provide an update with special consideration given to housing practices, safety, and access to care. A review of the literature shows that the World Professional Association for Transgender Health (WPATH) standards and Prison Rape Elimination Act (PREA) requirements are not uniformly implemented and enforced on a state level. In fact, some states have policies that are in direct conflict with federal requirements. The safety and equitable treatment of both TGD and cisgender populations is an important topic that merits attention. As new challenges emerge, an increase in federal enforcement and consistency is needed to ensure the humane treatment and protection of TGD inmates.


Subject(s)
Housing , Prisoners , Transgender Persons , Humans , Transgender Persons/legislation & jurisprudence , Prisoners/psychology , United States , Housing/legislation & jurisprudence , Male , Health Services Accessibility/legislation & jurisprudence , Female
2.
PLoS One ; 19(6): e0305059, 2024.
Article in English | MEDLINE | ID: mdl-38843166

ABSTRACT

Three-dimensional (3D) imaging techniques are promising new tools for measuring breast volume, for example in gender-affirming therapy. Transgender individuals can be treated with gender-affirming hormone therapy (GAHT). A robust method for monitoring breast volume changes is critical to be able to study the effects of feminizing GAHT. The primary aim of this study was to compare the accuracy of three 3D devices (Vectra XT, Artec LEO and iPhone XR) for measuring modest breast volume differences using a mannequin. The secondary aim of this study was to evaluate these methods in several performance domains. We used reference prostheses of increasing volumes and compared the volumes using GOM-inspect software. For Vectra XT 3D images, manufacturer-provided software was used to calculate volumes as well. The scanning methods were ranked based on their performance in a total of five categories: volume estimations, costs, user-friendliness, test subject-friendliness and technical aspects. The 3D models analyzed with GOM-inspect showed relative mean estimate differences from the actual volumes of 9.1% for the Vectra XT, 7.3% for the Artec LEO and 14% for the iPhone XR. For the Vectra XT models analyzed with the built-in software this was 6.2%. Root mean squared errors (RMSE) calculated based on the GOM-inspect volume analyses showed mean RMSEs of 2.27, 2.54 and 8.93 for the Vectra XT, Artec LEO and iPhone XR, respectively. The Vectra software had a mean RMSE of 3.00. In the combined performance ranking, the Vectra XT had the most favorable ranking, followed by the Artec LEO and the iPhone XR. The Vectra XT and Artec LEO are the preferred scanners to monitor breast development due to the combination of higher accuracy and overall performance. The current study shows that 3D techniques can be used to adequately measure modest breast volume differences and therefore will be useful to study for example breast changes in transgender individuals using feminizing GAHT. These observations may also be relevant in other fields of 3D imaging research.


Subject(s)
Breast , Imaging, Three-Dimensional , Humans , Female , Breast/diagnostic imaging , Imaging, Three-Dimensional/methods , Male , Software , Organ Size , Manikins , Transgender Persons
3.
PLoS One ; 19(6): e0304219, 2024.
Article in English | MEDLINE | ID: mdl-38843195

ABSTRACT

INTRODUCTION: Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW). OBJECTIVE: To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil. METHODS: A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant. RESULTS: A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use. CONCLUSION: Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.


Subject(s)
Crack Cocaine , Transgender Persons , Humans , Female , Brazil/epidemiology , Adult , Transgender Persons/statistics & numerical data , Cross-Sectional Studies , Young Adult , Cocaine-Related Disorders/epidemiology , Prevalence , Male , Marijuana Abuse/epidemiology , Cannabis/adverse effects
4.
J Health Care Poor Underserved ; 35(2): 731-742, 2024.
Article in English | MEDLINE | ID: mdl-38828592

ABSTRACT

Despite facing many social and structural challenges inside and outside of health systems, transgender and gender diverse (TGD) Brazilian immigrants in the U.S. are understudied, and their barriers to care are largely unnamed. In this commentary, we build on existing literature and our experiences at a safety-net community health system that sees a high volume of Brazilian patients to discuss challenges facing TGD Brazilian immigrant populations. We highlight that while Brazilian TGD populations face discrimination in Brazil, major challenges persist upon immigrating to the U.S., and include: difficulty updating identity documents and changing immigration status, barriers seeking general and specialized health care (including finding bilingual and bicultural providers), challenges navigating complex health and insurance systems, and a lack of community supports. We end by recommending more coordinated efforts between health care and community organizations to help ensure the health and wellness of TGD Brazilian immigrants in the United States.


Subject(s)
Health Services Accessibility , Transgender Persons , Humans , Brazil , Transgender Persons/statistics & numerical data , Transgender Persons/psychology , United States , Female , Male , Emigrants and Immigrants/statistics & numerical data
5.
Bull Menninger Clin ; 88(2): 128-147, 2024.
Article in English | MEDLINE | ID: mdl-38836851

ABSTRACT

Eating disorders (EDs) have been traditionally viewed as a disorder affecting cisgender, heterosexual women. Yet, the prevalence of EDs among queer and trans (QnT) individuals, coupled with the lack of interventions that attend to contextual factors related to sexual orientation and gender identity, underscore a critical health disparity issue requiring urgent attention. Here, we first review factors pertaining to QnT individuals' minoritized sexual and gender identities that are important to consider in ED conceptualization for this population (e.g., minority stressors, identity-based body image standards). Next, we describe problematic assumptions present in existing ED assessment and propose more inclusive approaches. Lastly, we provide suggestions for practices that providers can implement within their treatment of EDs among QnT individuals.


Subject(s)
Feeding and Eating Disorders , Sexual and Gender Minorities , Transgender Persons , Humans , Feeding and Eating Disorders/therapy , Sexual and Gender Minorities/psychology , Transgender Persons/psychology , Female , Male , Body Image/psychology , Gender Identity
6.
Hastings Cent Rep ; 54(3): 53-55, 2024 May.
Article in English | MEDLINE | ID: mdl-38842852

ABSTRACT

Amidst the misinformation climate about trans people and their health care that dominates policy and social discourse, autonomy-based rationales for gender-affirming care for trans and nonbinary youth are being called into question. In this commentary, which responds to "What Is the Aim of Pediatric 'Gender-Affirming' Care?," by Moti Gorin, we contextualize the virulent ideas circulating in misinformation campaigns that have become weaponized for unprecedented legal interference into standard health care. We conclude that the current legal justifications for upending gender-affirming care gloss over how this health care field meets conventional evidentiary standards and aligns protocols with most other fields of medicine. Refusal to offer gender-affirming care is more harmful than centralizing trans and nonbinary people's health autonomy.


Subject(s)
Transgender Persons , Humans , Communication , Female , Male , Gender-Affirming Care
7.
Hastings Cent Rep ; 54(3): 57-58, 2024 May.
Article in English | MEDLINE | ID: mdl-38842870

ABSTRACT

What ethically justifies the provision of invasive and irreversible treatments to minors? In this commentary, I examine this question in response to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," which critiques autonomy-based arguments for justification of gender-affirming care in minors. Minors generally lack sufficient autonomy to make significant medical decisions or major life decisions. For this reason, parents are generally their decision-makers, working with medical professionals to choose treatments that serve the best interests of the minor. Medical care in minors is justified by beneficence, not autonomy, and this should be no different for gender-affirming care. This severely undermines autonomy-based arguments for provision of gender-affirming care to minors. Given the lack of conclusive evidence for benefit, the nature of the treatment, and the fact that gender dysphoria in minors resolves spontaneously in most cases, there is presently insufficient justification for provision of such care to minors.


Subject(s)
Gender Dysphoria , Minors , Personal Autonomy , Humans , Gender Dysphoria/therapy , Transgender Persons , Adolescent , Child , Female , Decision Making/ethics , Male , Informed Consent By Minors/ethics , Gender-Affirming Care
8.
Hastings Cent Rep ; 54(3): 35-50, 2024 May.
Article in English | MEDLINE | ID: mdl-38842886

ABSTRACT

The original "Dutch Protocol"-the treatment model comprised of puberty blockers, cross-sex hormones, and surgery-was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions' effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, leading to significant international differences in what treatments are offered to youth. Against this backdrop, a different argumentative approach has emerged in support of gender-affirming care. This approach appeals not to reductions in patient morbidity or mortality but to patient autonomy, where medical intervention is pursued as a means to the satisfaction of a patient's "embodiment goals." In this article, I raise objections to autonomy-based justifications for pediatric gender-affirming care, concluding that these arguments misunderstand the place of autonomy in clinical decision-making and, consequently, put patients at risk of medical harm.


Subject(s)
Gender Dysphoria , Humans , Gender Dysphoria/psychology , Gender Dysphoria/therapy , Personal Autonomy , Female , Transgender Persons/psychology , Child , Male , Adolescent
9.
Hastings Cent Rep ; 54(3): 55-56, 2024 May.
Article in English | MEDLINE | ID: mdl-38842885

ABSTRACT

This commentary responds to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?" We argue that Gorin's case against pediatric gender-affirming care rests upon numerous false conceptual binaries: female/male, public/private, objective/subjective, and medically necessary/elective. Drawing on feminist bioethics, we show how such dichotomous thinking is both inaccurate and marginalizing of gender minorities.


Subject(s)
Feminism , Humans , Bioethics , Female , Transgender Persons , Male , Pediatrics/ethics , Sexual and Gender Minorities , Gender Identity , Gender-Affirming Care
10.
Hastings Cent Rep ; 54(3): 51-53, 2024 May.
Article in English | MEDLINE | ID: mdl-38842883

ABSTRACT

This commentary responds to the article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," by Moti Gorin, in the same issue of the journal. Gender-affirming care is often treated as exceptional and subject to heightened scrutiny. This exceptionalization results in its being held to stricter evidentiary standards than other forms of medical interventions are. But values and value judgments are inextricable from the practice of evidence-based medicine. For gender-affirming care, values shape what counts as "strong" evidence, whether the legitimacy of transgender identity is assumed versus treated as something to be investigated, how to characterize the testimonial accounts of trans and gender-nonconforming patients, and more. We argue that these kinds of questions are part of the practice of medicine, not exceptional to transgender people and gender-affirming care. However, litigation of evidence for gender-affirming care in state and national policy underscores the moral urgency of thinking carefully about what values ought to guide evidence.


Subject(s)
Transgender Persons , Humans , Transgender Persons/psychology , Evidence-Based Medicine , Female , Gender Identity , Male , Transsexualism , Gender Dysphoria/therapy , Gender Dysphoria/psychology , Gender-Affirming Care
11.
Psychoanal Q ; 93(2): 273-319, 2024.
Article in English | MEDLINE | ID: mdl-38847749

ABSTRACT

The aim of this article is twofold: firstly, to describe the seven-year analytic treatment of a TG adolescent (F "April" to M "Tran") and, secondly, based on the clinical observations, to propose a reflection on the intrapsychic events linked to gender transition. We could witness during this analysis that the dissonant anatomical sex, which is at the heart of the gender dysphoria, resists mentalization and consequently its psychological integration. The psychic events of transition, understood here on the model of a mourning process, could denote the various strategies necessary to the TG individual to negotiate the obstacle of mentalization.


Subject(s)
Gender Dysphoria , Psychoanalytic Therapy , Transgender Persons , Humans , Adolescent , Transgender Persons/psychology , Male , Female , Gender Dysphoria/psychology , Gender Dysphoria/therapy , Psychoanalytic Therapy/methods , Gender Identity
12.
PLoS One ; 19(6): e0298821, 2024.
Article in English | MEDLINE | ID: mdl-38829881

ABSTRACT

PURPOSE: The overall aim of this scoping review was to identify, explore and map the existing literature pertaining to healthcare access for transgender and non-binary individuals. DESIGN: The scoping review followed Arksey and O'Malley's methodological framework, and the reporting adhered to the guidelines provided by the PRISMA Extension for Scoping Reviews. METHODS: To gather relevant articles, a comprehensive search strategy was employed across four electronic databases, with the assistance of a university librarian. In addition, manual and internet searches were conducted for grey literature. From the initial search, a pool of 2,452 potentially relevant articles was retrieved, which was supplemented by an additional 23 articles from the supplemental search. After an independent review by two researchers, 93 articles were assessed, resulting in the inclusion of 41 articles in the review. RESULTS: The literature highlights the identification of barriers and enablers, spanning across 32 individual data sets that affect healthcare accessibility for transgender and non-binary individuals. Leveque's five dimensions of healthcare access, namely approachability, acceptability, availability and accommodation, affordability, and appropriateness, were utilized to categorise these 42 factors. Some of the key themes that emerged in these dimensions include challenges in accessing information about services, concerns about acceptance from family and peers, past experiences of discrimination in healthcare settings, considerations related to cost and insurance, and the difficulty in finding appropriately trained competent providers. CONCLUSIONS: The review focused on the most commonly researched aspects of healthcare access and identified gaps in research and opportunities for future studies. The findings provide recommendations for policy and practice, which could guide the development of interventions aimed at addressing the barriers faced by transgender individuals seeking gender-affirming care.


Subject(s)
Health Services Accessibility , Transgender Persons , Humans , Transgender Persons/psychology , Female , Male , Gender-Affirming Care
13.
Perspect Biol Med ; 67(2): 244-260, 2024.
Article in English | MEDLINE | ID: mdl-38828602

ABSTRACT

Legislation banning gender-affirming medical care (GAMC) for minors is inconsistent with the Consensus Recommendations for Pediatric Decision-Making (Salter et al. 2023). Gender dysphoria is a medical condition, and GAMC promotes adolescents' health interests. The evidence for GAMC is comparable to the evidence for other types of pediatric medical care. Parents are permitted to consent for similar risks in the treatment of other conditions. Evaluation of the potential benefits, risks, and treatment alternatives is contingent on individual patients' clinical conditions and adolescents' and their parents' values and preferences. Such decisions are within the scope of parental discretion and should be made through shared decision-making with health-care providers. Parents' declining GAMC does not inherently create a significant risk of serious imminent harm required to justify state intervention. Usurping parental discretion for GAMC is unjust: it treats this medical care differently than other comparable types of medical care without sufficient justification.


Subject(s)
Gender Dysphoria , Humans , Gender Dysphoria/psychology , Gender Dysphoria/therapy , Adolescent , Decision Making , Female , Male , Parents/psychology , Transgender Persons/psychology
14.
J Int AIDS Soc ; 27(6): e26304, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38867431

ABSTRACT

INTRODUCTION: Mathematical models of HIV have been uniquely important in directing and evaluating HIV policy. Transgender and nonbinary people are disproportionately impacted by HIV; however, few mathematical models of HIV transmission have been published that are inclusive of transgender and nonbinary populations. This commentary discusses current structural challenges to developing robust and accurate trans-inclusive models and identifies opportunities for future research and policy, with a focus on examples from the United States. DISCUSSION: As of April 2024, only seven published mathematical models of HIV transmission include transgender people. Existing models have several notable limitations and biases that limit their utility for informing public health intervention. Notably, no models include transgender men or nonbinary individuals, despite these populations being disproportionately impacted by HIV relative to cisgender populations. In addition, existing mathematical models of HIV transmission do not accurately represent the sexual network of transgender people. Data availability and quality remain a significant barrier to the development of accurate trans-inclusive mathematical models of HIV. Using a community-engaged approach, we developed a modelling framework that addresses the limitations of existing model and to highlight how data availability and quality limit the utility of mathematical models for transgender populations. CONCLUSIONS: Modelling is an important tool for HIV prevention planning and a key step towards informing public health interventions, programming and policies for transgender populations. Our modelling framework underscores the importance of accurate trans-inclusive data collection methodologies, since the relevance of these analyses for informing public health decision-making is strongly dependent on the validity of the model parameterization and calibration targets. Adopting gender-inclusive and gender-specific approaches starting from the development and data collection stages of research can provide insights into how interventions, programming and policies can distinguish unique health needs across all gender groups. Moreover, in light of the data structure limitations, designing longitudinal surveillance data systems and probability samples will be critical to fill key research gaps, highlight progress and provide additional rigour to the current evidence. Investments and initiatives like Ending the HIV Epidemic in the United States can be further expanded and are highly needed to prioritize and value transgender populations across funding structures, goals and outcome measures.


Subject(s)
HIV Infections , Health Policy , Models, Theoretical , Transgender Persons , Humans , HIV Infections/prevention & control , HIV Infections/transmission , HIV Infections/epidemiology , HIV Infections/drug therapy , Male , Female , United States/epidemiology , Disease Transmission, Infectious/prevention & control
16.
Multimedia | Multimedia Resources, MULTIMEDIA-SMS-SP | ID: multimedia-13182

ABSTRACT

Explica quais as implicações na saúde de quem utilizou silicone industrial em procedimentos estéticos e os cuidados possíveis para melhorar a qualidade de vida dessas pessoas.


Subject(s)
Transgender Persons , Silicone Gels/adverse effects , Sexual Vulnerability
17.
Front Endocrinol (Lausanne) ; 15: 1258495, 2024.
Article in English | MEDLINE | ID: mdl-38774227

ABSTRACT

Objective: The aim of this study was to describe the treatment trajectories of Austrian children and adolescents with gender incongruence seeking gender-affirming medical care. Methods: Patients who presented with gender incongruence at the pediatric outpatient clinic for differences in sex development at a large university hospital in Austria from January 2008 to December 2022 were included in a retrospective chart review, and analyzed regarding referral numbers, patient characteristics, treatment trajectories, fertility preservation, and legal gender marker changes. Results: Of 310 eligible patients, 230 (74.2%) were assigned female at birth (AFAB), and 80 (25.8%) were assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018, whereafter it stabilized at around 50 per year. At the time of initial presentation, the median age of patients was 15.6 years (IQR 14.3-16.8). AMAB individuals tended to be younger (median 14.9 years, IQR 13.9-16.8) than AFAB individuals (median 15.8 years, IQR 14.4-16.8; p= 0.012). 207 (66,8%) completed the assessment process and were eligible for gender affirming medical treatment (GAMT). Of those, 89% (186/207) commenced gender affirming hormone therapy in the pediatric outpatient clinic (79/186 received GnRHa monotherapy, 91/186 GnRHa and sex steroids, and 16/186 sex steroid monotherapy). Of the 54 AMAB individuals receiving GAMT, 6 (11.1%) completed fertility preservation prior to therapy initiation. Only 1/132 AFAB adolescents receiving GAMT completed fertility preservation. Chest masculinization surgery was performed in 22 cases (16.7%), and breast augmentation in two cases (3.7%) between the ages of 16 and 18. Changes in legal gender marker were common, with 205 individuals (66.1%) having changed their legal gender marker. Conclusion: This is the first time that treatment trajectories, fertility preservation rates, and changes of legal gender marker have been described in Austrian adolescents with gender incongruence seeking GAMT. The majority received GAMT and changed their legal gender marker, while gender affirming surgery rates were low, and utilization of fertility preservation treatment options was rare.


Subject(s)
Gender Dysphoria , Humans , Male , Female , Adolescent , Austria/epidemiology , Retrospective Studies , Gender Dysphoria/drug therapy , Gender Dysphoria/epidemiology , Transgender Persons/statistics & numerical data , Sex Reassignment Procedures/statistics & numerical data , Fertility Preservation/statistics & numerical data , Fertility Preservation/methods , Child
18.
Curr Probl Cancer ; 50: 101103, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38744064

ABSTRACT

OBJECTIVE: Currently, available data on preventive measures for Human Papillomavirus (HPV) infection and cervical cancer in the transgender assigned female at birth (AFAB) community are extremely limited. Our aim was to analyze adherence to primary and secondary cervical cancer prevention screening programs among transgender AFAB people attending our gender clinic. METHODS: Transgender AFAB people attending our center were recruited. Anamnestic data were collected for each person through completion of a medical history form and medical records. Variables recorded included previous HPV vaccination, adherence to regional screening programs (Pap smear or HPV DNA test), subject age, duration of current or prior gender-affirming hormone therapy (GAHT) and whether gender affirmation surgery (GAS) with hysterectomy had been performed. Open questions regarding reasons for not undergoing screening tests were also included. RESULTS: In this cross-sectional study, 263 AFAB transgender people were included, with a mean age of 30.6 ± 10.5 years. GAS with hysterectomy had been performed on 37.6 % of these people. Of our participants, 71.7 % who were born after 1998 (the first cohort to receive HPV vaccination invitations in Italy) had been vaccinated for HPV. Seventy-four-point-nine percent of participants who were still eligible for cervical screening had never undergone Pap smear or HPV DNA testing, whereas those who had undergone at least one cervical screening had done so on average 4.2 ± 4.5 years ago. CONCLUSION: HPV vaccination prevalence in the AFAB transgender population born after 1998 is in line with the Italian AFAB general population. However, adherence to cervical cancer screening programs in the transgender AFAB population appears to be lower in comparison to the cisgender population. Further efforts are required from the medical community to enhance AFAB transgender people's adherence to HPV vaccination and to cervical screening.


Subject(s)
Early Detection of Cancer , Papillomavirus Infections , Secondary Prevention , Transgender Persons , Uterine Cervical Neoplasms , Humans , Female , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/virology , Uterine Cervical Neoplasms/epidemiology , Transgender Persons/statistics & numerical data , Papillomavirus Infections/prevention & control , Papillomavirus Infections/complications , Papillomavirus Infections/epidemiology , Adult , Cross-Sectional Studies , Italy/epidemiology , Male , Early Detection of Cancer/statistics & numerical data , Secondary Prevention/methods , Secondary Prevention/statistics & numerical data , Papillomavirus Vaccines/administration & dosage , Papillomavirus Vaccines/therapeutic use , Primary Prevention/methods , Primary Prevention/statistics & numerical data , Young Adult , Middle Aged , Papanicolaou Test/statistics & numerical data , Vaginal Smears/statistics & numerical data , Follow-Up Studies
19.
Sex Transm Dis ; 51(6): 388-392, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38733972

ABSTRACT

BACKGROUND: Standard-of-care nucleic acid amplification tests (routine NAATs) for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) can take several days to result and therefore delay treatment. Rapid point-of-care GC/CT NAAT (rapid NAAT) could reduce the time to treatment and therefore onward transmission. This study evaluated the incremental cost per infectious day averted and overall cost of implementation associated with rapid compared with routine NAAT. METHODS: Prospective sexually transmitted infection (STI) treatment data from men who have sex with men and transgender women in San Diego who received rapid NAAT between November 2018 and February 2021 were evaluated. Historical time from testing to treatment for routine NAAT was abstracted from the literature. Costs per test for rapid and routine NAAT were calculated using a micro-costing approach. The incremental cost per infectious day averted comparing rapid to routine NAAT and the costs of rapid GC/CT NAAT implementation in San Diego Public Health STI clinics were calculated. RESULTS: Overall, 2333 individuals underwent rapid NAAT with a median time from sample collection to treatment of 2 days compared with 7 to 14 days for routine NAAT equating to a reduction of 5 to 12 days. The cost of rapid and routine GC/CT NAAT was $57.86 and $18.38 per test, respectively, with a cost-effectiveness of between $2.43 and $5.82 per infectious day averted. The incremental cost of rapid NAAT improved when at least 2000 tests were performed annually. CONCLUSIONS: Although rapid GC/CT NAAT is more expensive than routine testing, the reduction of infectious days between testing and treatment may reduce transmission and provide improved STI treatment services to patients.


Subject(s)
Chlamydia Infections , Chlamydia trachomatis , Gonorrhea , Homosexuality, Male , Neisseria gonorrhoeae , Nucleic Acid Amplification Techniques , Humans , Male , Gonorrhea/diagnosis , Gonorrhea/economics , Chlamydia Infections/diagnosis , Chlamydia Infections/economics , Nucleic Acid Amplification Techniques/economics , Neisseria gonorrhoeae/isolation & purification , Chlamydia trachomatis/isolation & purification , Adult , California/epidemiology , Cost-Benefit Analysis , Prospective Studies , Female , Point-of-Care Testing/economics , Transgender Persons
20.
Med Care ; 62(7): 481-488, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38761163

ABSTRACT

BACKGROUND: Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired. OBJECTIVE: This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System. RESEARCH DESIGN: This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository. PARTICIPANTS: A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code. MEASURES: Time-to-gender-affirming hormone initiation after diagnosis receipt. RESULTS: A total of 2439 Service members were included (M age 24 y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female ( P <0.001), and Asian and Pacific Islander ( P =0.02) and Black ( P =0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis. CONCLUSION: The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.


Subject(s)
Gender Dysphoria , Military Personnel , Transgender Persons , Humans , Female , Male , Military Personnel/statistics & numerical data , Retrospective Studies , United States , Adult , Transgender Persons/statistics & numerical data , Gender Dysphoria/drug therapy , Young Adult , Time-to-Treatment/statistics & numerical data , Sex Reassignment Procedures/statistics & numerical data
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