An Implementation of a Community-Engaged, Group-Level Mental Health Pilot for Black and Latina Transgender Women.

The primary aim is to assess the implementation of an eight-session, group therapy pilot for Black and Latina transgender women in Chicago in terms of implementation outcomes regarding intervention effectiveness, acceptability, appropriateness, and feasibility. The Exploration Preparation Implementation Sustainment (EPIS) framework guided implementation processes, including community engagement as an implementation strategy, and an implementation taxonomy was used to evaluate outcomes of acceptability, appropriateness, and feasibility, in addition to intervention effectiveness regarding anxiety and community connectedness. Two rounds of the pilot were completed in 2020, during the COVID-19 pandemic, at a community-based organization serving LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth on Chicago's West Side. Participants (N = 14) completed a baseline and postintervention assessment and evaluations after each of eight intervention modules. Descriptive statistics show improvement across measures of anxiety and community connectedness, and high mean scores across domains of acceptability, appropriateness, and feasibility. Pilot findings indicate intervention effectiveness, acceptability, appropriateness, and feasibility to address mental health and social support of Black and Latina transgender women. Additional resources are needed for transgender community-engaged mental health programs and research to establish core and adaptable intervention elements, scaled-up evidence for clinical effectiveness, and, most importantly, to improve mental health outcomes and the sustainability of such interventions.

The Trans Accountability Project: Community Engagement to Address Structural Marginalization and Health Inequities.

BACKGROUND: Black and Latina Transgender women face systemic marginalization and harm, increasing vulnerability to social stress and poor health outcomes. These communities have limited access to resources to mobilize and create paths toward health equity. OBJECTIVES: In this paper we report on the results of a community partnership to engage Black and Latina transgender communities on the South and West Sides of Chicago and establish service priorities for collective empowerment. METHODS: The Trans Accountability Project (TAP), a steering committee of racially diverse transgender and nonbinary representatives from four partner organizations, was established and led the design, recruitment, implementation, and analysis of a community needs assessment. World café and human-centered design methods, guided two community conversations/listening sessions around four activities: the perfect provider, my dream job, safety planning, and a stake-holder reflection. RESULTS: Sixty-three participants completed three activities and envisioned innovations for 1) accessible and holistic gender-affirming health care, 2) autonomous, flexible, and community-focused jobs in the arts, nonprofit/business, and care professions, and 3) safer social interactions and spaces. Ten stakeholders attended to listen and inform their organizational and clinical practices to empower Black and Latina transgender women. CONCLUSIONS: TAP prioritized accountability, connectedness, and centering the voices of Black and Latina transgender women as a starting point to intervene upon structural marginalization. Five insights emerged and have directed TAP's focus toward employment and collective care. Although further structural change remains a priority, TAP represents a mechanism for sharing power, improving communication and collaboration, and increasing transparency across relevant Chicago community-based organizations.

Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity.

BACKGROUND: Recent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity. METHODS: A comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders. RESULTS: Both steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women. CONCLUSION: In Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.

Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative.

In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.

[Associated factors to extubation failure in the term newborns from a neonatal intensive care unit]. / Factores asociados para falla en la extubación de recién nacidos de término de una unidad de cuidados intensivos neonatales.

INTRODUCTION: The mechanical ventilator support (MVS) it is a procedure which improves survival of critically ill newborns (NB), but is not risk free one of them is tracheal damage reintubations by extubation failure. Knowledge that there is the medical literature is about preterm infant and there is not information about term NB. OBJECTIVE: To establish that factors are associated to the unsuccessful extubation in the term NB from 37 to 42 weeks of gestational age. MATERIAL AND METHODS: Retrospective study, of case-control in cohort including all the files and/or patient term NB that were interned in the Neonatal Intensive Care Unit of a Neonatology Service during the period of January from the 2004 to December of 2008 that they fulfilled the selection criteria. They were formed two groups: group A of cases (extubation failure) and group B of controls (successful extubation). Extubation failure was considered when there was need for the patient reintubate during first 72 hrs. We take into account to patient of term NB of one to 28 days of extrauterine life that remained with MVS at least 24 hrs and that to extubate was achieved with or without success, previous step for tracheal continuous positive airway pressure (CPAP), and that they were not more than 28 days with MVS. The statistical analysis was carried out by means of the descriptive and the inferential statistic. It was considered area of significance with p < 0.05. RESULTS: Fourty one patients were included divided in two groups: group A (cases) of 17 patients, and group B (controls) with 24 patients. The population's characteristics studied among the two groups didn't show significant differences. Of the variables studied between the two groups showed significant differences of age at start of ventilation, calories and the hemoglobin for controls and the time spent with MVS, reintubations number, and the peak inspiratory pressure (PIP) prior to the passage of the CPAP for cases, all with p < 0.05. In the multivariate analysis they were significant association as factor of risk for the extubation failure when the PIP was > 18 cm H2O, cycles > 15x' and hemoglobin < 13 g/dL. CONCLUSIONS: Based on the above we conclude that in the term NB with MVS before placing in tracheal CPAP for the extubation should have a PIP < or = 18 cm H2O, cycles < or = 15x' and a hemoglobin not smaller than 13 g/dL to avoid this way as much as possible the extubation failure and with it to improve the prognosis.