Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study.

BACKGROUND: Sex hormone and preexposure prophylaxis (PrEP) drug interactions among transgender women (TGW), transgender men (TGM), and cisgender men (CGM) are not fully understood. METHODS: TGM and TGW on at least 6 months of stable sex hormone therapy containing testosterone or estradiol (respectively) were enrolled in a 4-week study of directly observed dosing of daily oral coformulated emtricitabine and tenofovir disoproxil fumarate (FTC/TDF). TFV-DP in dried blood spots and sex hormones in serum were measured at weekly intervals. TFV-DP was compared with 2- and 4-week samples from Directly Observed Therapy Dried Blood Spots (DOT-DBS) Study (NCT02022657). RESULTS: From May 2017 to June 2018, 24 TGM and 24 TGW were enrolled. Testosterone (total and free) and estradiol concentrations were comparable before and after 4 weeks of PrEP use in TGM and TGW, respectively. Historical controls included 17 cisgender women (CGW) and 15 CGM. TFV-DP concentrations at week 4 were comparable between TGW and TGM (mean difference, -6%; 95% confidence interval [CI], -21% to 12%; P = .47), comparable between TGW and CGM (mean difference, -12%; 95% CI, -27% to 7%; P = .21) and were lower among TGM compared with CGW (mean difference, -23%; 95% CI, -36% to -7%; P = .007). All persons in all groups were projected to reach the TFV-DP threshold that has been associated with high protection from human immunodeficiency virus. CONCLUSIONS: CGM, TGM, and TGW had comparable TFV-DP concentrations in dried blood spots after 4 weeks of directly observed daily FTC/TDF PrEP use. Serum hormone concentrations were not affected by FTC/TDF PrEP use. CLINICAL TRIALS REGISTRATION: NCT04050371.

Does your organization use gender inclusive forms? Nurses' confusion about trans* terminology.

AIMS AND OBJECTIVES: To describe nurses confusion around trans* terminology and to provide a lesson in Trans* 101 for readers. BACKGROUND: Of the estimated 9 million persons in the United States of America who are identified as lesbian, gay, bisexual and transgender, about 950,000 (0.2-0.5% of adult population) are identified as trans* (a term that encompasses the spectrum, including transgender, transsexual, trans man, trans woman and other terms). The Institute of Medicine (2011, The health of lesbian, gay, bisexual and transgender people: Building a foundation for better understanding. The National Academies Press, Washington, DC) identified transgender persons as an understudied population with significant need for health research, yet the nursing literature contains little guidance for educating nurses on trans* issues. DESIGN: This is a mixed methods structured interview design with nurse key informants. The scripted interview was based on the Health Care Equality Index, which evaluates patient-centred care to lesbian, gay, bisexual and transgender patients and families. These data were part of a larger research study that explored the current state of lesbian, gay, bisexual and transgender-sensitive nursing practice. METHOD: Undergraduate nursing students recruited and interviewed 268 nurse key informants about gender inclusive forms (capable of identifying trans* patients) at their agencies. RESULTS: Only 5% reported use of gender inclusive forms, 44% did not know about inclusive forms, 37% did not understand what a gender inclusive form was and 14% confused gender with sexual orientation. CONCLUSION: The study demonstrated a critical need for education in gender identity and sexual orientation terminology. RELEVANCE TO CLINICAL PRACTICE: The lack of understanding of concepts and terminology may affect basic care of lesbian, gay, bisexual and transgender patients especially those who identify as transgender.

"Never in All My Years... ": Nurses' Education About LGBT Health.

In spite of recent calls for patient-centered care and greater attention to the needs of lesbian, gay, bisexual, and transgender (LGBT) patients, nurses still lack basic education about LGBT patient care and, as a result, may have negative attitudes, endorse stereotypes, and/or feel uncomfortable providing care. This study reports on education/training of practicing nurses and explores some of the reasons for nurses reporting feelings of discomfort with LGBT patient care. Transcripts from structured interviews with 268 nurses in the San Francisco Bay Area revealed that 80% had no education or training on LGBT issues. Although most said they were comfortable with LGBT patient care, some of their comments indicated that they might not be providing culturally sensitive care. Implications for nursing education and for policies and procedures of health care institutions are addressed.

Nursing students' perceptions of their knowledge of lesbian, gay, bisexual, and transgender issues: effectiveness of a multi-purpose assignment in a public health nursing class.

Nurses work with diverse populations, but the nursing literature lacks research, theoretical frameworks, or practice guidelines regarding lesbian, gay, bisexual, and transgender (LGBT) health. Through diverse teaching strategies, students explored issues related to LGBT patients, families, and nurses using a cultural humility lens. Diverse teaching strategies included readings, a 2-hour presentation on LGBT health issues, and an assignment to conduct a scripted interview with two nurse key informants, based on the Health Care Equality Index (HEI). Students completed an online LGBT awareness preinterview survey, completed interviews, and completed a postinterview survey. Students showed a significant increase in knowledge about sexual orientation and gender identity and research and interview methods from pretest to posttest. The diverse teaching strategies involved in this assignment can enhance student knowledge, attitudes, and skills related to LGBT health care needs and increase appreciation of nursing research.