Reducing Discrimination and Bias and Improving Gender-Affirming Care Competency through a Provider Education Intervention: Implementation and Evaluation of Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)

Background and Purpose: Trans women experience many barriers to accessing gender-affirming HIV prevention and care, which constrains the health and wellbeing of trans women living with and/or affected by HIV. Access is impeded, in part, by the convergence of limited trans knowledge and competency with trans and HIV-related stigma among healthcare and social service providers. To advance gender-affirming HIV service delivery we implemented and evaluated ‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH). This theoretically-informed (Information-Motivation-Behavioral Skills Model) and community-developed intervention aimed to increase providers’ gender-affirming HIV prevention and care knowledge and competency, and to reduce negative provider attitudes and biases among regarding trans women living with and/or affected by HIV.

Methods: Healthcare providers and providers in-training (n=78) including in both direct (e.g., physicians) and indirect (e.g., management) positions participated in anon-randomized multi-site pilot study evaluating TEACHH with pre-post-test design. Pre- and post-intervention data assessed participant characteristics (e.g., sociodemographic characteristics, past HIV/trans training experience), and intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training about the experiences/clinical care for trans women living with/affected by HIV). Qualitative feedback about most beneficial aspects, gaps, and overall feedback of/on the intervention were also collected. Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons more broadly.

Results: The intervention was feasible (100% completion) and acceptable (91.9% interested in future gender-affirming HIV care trainings). Most beneficial aspects included content (gender-affirming language, explanations on new terms and concepts, introduction of new theories and approaches, resources on health and rights of trans women living with HIV, and how and where to access treatment, care, and support) and delivery (use of case studies, small groups, brainstorming, and discussion approaches). Suggestions were made to provide more in-depth information about pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), hormone therapy and antiretroviral therapy (ART) research evidence, as well as barriers to HIV care – among trans women with HIV – differ from barriers among cis women counterparts. Overall feedback was overwhelmingly positive, with 24 participants of 38 providing overall feedback describing the intervention as either “great,” “very informative, amazing facilitators,” or an “eye-opener”. Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12-10.86, p<0.001, possible score range 16-96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD=3.21; 95% CI of MD: 1.90-4.90, p<0.001, possible score range 9-63).

Conclusions and Implications: This brief provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases and was feasible and acceptable to participants in a wide range of roles with diverse past training experiences. These findings inform future directions for TEACHH and other intersectionally-affirming provider education interventions. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care for trans women, advancing healthcare access and reducing HIV disparities among trans women.