Interview Guide Healthcare Providers

Form Approved

OMB No: 0920-1091

Exp. Date: 12/31/2018

Attachment 3f: Interview Guide Healthcare Providers

Interview Guide: Healthcare Providers

Participant ID:________ Data Collector ID:_______

Date:_________ Start time: __:__am/pm End time:__:__am/pm

INTRODUCTION AND PURPOSE OF INTERVIEW

Hello my name is__________ and I work for [Atlas Research or Abt Associates]. My company was selected by the Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention (DHAP) to conduct a study to better understand the current barriers and facilitators to HIV prevention, care, and treatment for transgender women.

We are doing this study because we want to learn about how transgender women protect themselves from HIV, and how they take care of themselves if they have HIV. As part of this study, we are asking 20 transgender women living with HIV, 20 HIV-negative transgender women, and 10 providers who see transgender women in their clinic or office, to take part in a one hour interview in three different cities. The conversations we have will help us understand how we can inform improvements in HIV prevention and care for transgender women.

This interview is going to include a mix of open-ended and close-ended questions. For any close-ended questions, we will point to a list of responses for you to choose from. Throughout our discussion, if there are any questions you would prefer not to answer, just let me know and we can skip to the next question. Do you have any questions before we begin?

PROFESSION AND TRAINING

1. What, if any, specific training or specialization have you received that has prepared you to provide care to transgender women?

1. What gaps have you observed in the availability and content of training and specialization to help providers provide care to transgender women?

1. What else would you like to know?

2. What strategies do you use to stay up-to-date?

EXPERIENCE PROVIDING CARE TO TRANSGENDER WOMEN

2. How long have you been providing healthcare to transgender women?

____________ years _________months

3. For approximately how many transgender women do you currently provide healthcare services?

___________________

4. For approximately how many transgender women have you provided healthcare services throughout your career?

___________________

5. Tell me about your experiences providing care to transgender women.

1. Have you seen any changes in the number of transgender women you serve over time?

2. Have you seen any changes in the overall approach to providing care to transgender women since you began practicing healthcare? (e.g., medical advances, programmatic changes, administrative changes, etc.)

HORMONE THERAPY

6. Do you administer hormone therapy (HT) to transgender women?

No	0
Yes	1
Don’t know	77
Refused	99

IF ANSWERED ‘NO’, ‘DON’T KNOW’, OR ‘REFUSED TO ANSWER’ TO QUESTION 19, SKIP TO QUESTION 24

7. How long have you administered HT to transgender women?

____________ years _________months

8. For approximately what percentage of your transgender women patients do you currently prescribe HT?

___________________

9. For approximately what percentage of your transgender women patients have you prescribed HT throughout your career?

___________________

10. How does hormone therapy (HT) relate to HIV prevention and care services you provide transgender women?

1. What barriers, if any, have you experienced related to prescribing and administering HT to transgender women?

2. [If applicable] What strategies do you use to overcome those barriers?

3. Do you have conversations with your patients about whether or not they are receiving or have received hormones outside of a medical setting?

1. How might your knowledge of patients use of hormones outside of a medical setting impact your ability to provide care?

GENDER CONFIRMATION SURGERY

11. Approximately what percentage of the transgender women patients have you served throughout your career that have had any type of gender confirmation surgery? (e.g., penectomy, vaginoplasty, breast enhancement/augmentation, facial feminization surgery)

___________________

1. Approximately what percentage of those patients had any type of lower gender confirmation surgery? (e.g., penectomy, vaginoplasty)

___________________

2. Approximately what percentage of those patients had any type of upper gender confirmation surgery? (e.g., breast enhancement/augmentation, facial feminization surgery)

___________________

12. How does gender confirmation surgery relate to the HIV prevention and care services you provide transgender women?

1. What role do you play in providing prevention and care services to your patients who are contemplating gender confirmation surgery?

1. Those who are undergoing it? Those who have completed it?

2. What impact (positive or negative) might gender confirmation surgery have on a transgender woman’s engagement in HIV prevention and care activities?

3. What HIV risks should be considered for transgender women who have had gender confirmation surgery?

SEXUAL RISK AND TESTING

13. How do you assess sexual risk taking with transgender women?

1. What is your comfort level in discussing sexual risk reduction with transgender women?

2. How do you address sexual risk reduction with transgender women living with HIV?

3. Are these strategies different for transgender women than they are for other populations?

14. What strategies do you use to talk with patients who are transgender women about being tested for HIV (e.g., during routine appointments)?

1. What challenges or barriers do you encounter when talking with transgender women about getting tested for HIV?

PrEP

15. Are doctors in your clinic currently prescribing PrEP?

No	0
Yes	1
Don’t know	77
Refused	99

IF ANSWERED ‘NO’, ‘DON’T KNOW’, OR ‘REFUSED TO ANSWER’ TO QUESTION 28, SKIP TO QUESTION 33

16. Are you currently prescribing PrEP?

No	0
Yes	1
Don’t know	77
Refused	99

IF ANSWERED ‘NO’, ‘DON’T KNOW’, OR ‘REFUSED TO ANSWER’ TO QUESTION 29, SKIP TO QUESTION 33

17. For approximately what percentage of patients are you currently prescribing PrEP?

___________________

18. Of those, approximately what percentage of your transgender women patients are you currently prescribing PrEP?

___________________

19. Do you recommend PrEP for you HIV-negative transgender women patients?

1. If so, how do you approach the potential use of PrEP with your HIV-negative transgender women patients?

2. What are some of the strategies you use that help keep transgender women adherent to PrEP?

3. What barriers have you experienced engaging and retaining HIV-negative transgender women on PrEP?

4. Are you aware of any specific considerations for transgender women when prescribing PrEP?

IF CURRENTLY PRESCRIBING PREP, SKIP TO QUESTION 34

20. Even though you don’t prescribe PrEP yourself, do you recommend PrEP for your HIV-negative transgender women patients?

1. If so, how do you approach the potential use of PrEP with your HIV-negative transgender women patients?

2. Does your clinic have a preferred PrEP clinic or provider you refer patients to be prescribed PrEP?

1. How do you work with this clinic or provider to refer your transgender patients to them?

3. Do you have concerns about PrEP and transgender women? If so, what concerns do you have?

1. Have you refrained from referring transgender women patients to a PrEP program? If so, why?

HIV/AIDS CARE

21. How long have you been providing care for people living with HIV/AIDS (PLWH)?

____________ years _________months

22. For approximately what percentage of your patients are you currently providing HIV/AIDS care?

___________________

23. Approximately what percentage of your transgender women patients are living with HIV?

___________________

24. For approximately what percentage of your transgender women patients are you currently providing HIV/AIDS care?

___________________

25. How long have you been providing HIV/AIDS care for transgender women?

____________ years _________months

26. What challenges and or barriers have you experienced when attempting to engage and retain transgender women living with HIV in HIV care and treatment?

1. What strategies do you use to overcome those challenges?

2. Are these challenges different for transgender women than they are for other populations?

27. What are some of the facilitators that have helped you to engage and retain transgender women living with HIV in HIV care and treatment?

1. Are these facilitators different for transgender women than they are for other populations?

28. For approximately what percentage of your transgender women patients living with HIV do you currently prescribe antiretroviral therapy?

___________________

IF NOT CURRENTLY PRESCRIBING ART, SKIP TO QUESTION 43

29. What are some of the things you consider when prescribing ART for transgender women? (e.g., hormone therapy)

1. How do you raise the issue of taking ART with transgender women who are not currently taking them?

2. What strategies do you use to help transgender women remain adherent to ART?

3. Have you encountered any challenges when trying to help transgender women adhere to ART?

4. Have you encountered any situations where transgender women are concerned about the interactions of hormone therapy (HT) and ART?

1. If so, how do you address their concerns?

IF CURRENTLY PRESCRIBING ART, SKIP TO QUESTION 44

30. What has stopped you from prescribing ART?

FACILITY PROGRAMS AND POLICIES

31. Do you believe that the environment of the facility impacts your ability to engage and retain a transgender woman in HIV prevention, care, and treatment services? How so?

1. Does the facility offer any of the following services to transgender women?

Gender-neutral bathrooms	1
Gender affirming materials	2
Transgender-identified staff	3
Practice/clinic staff that are knowledgeable about transgender health	4
Referrals to organizations that are transgender-friendly/competent	5
Other Please specify_______________________________________	6

2. What impact do these supports have?

32. What are some of the policy or structural barriers facing transgender women related to receiving healthcare?

1. What has been the impact of these barriers on your ability to provide HIV-related services? How have you addressed them?

2. Has the gender identity of any of your transgender patients created barriers for you or the administrative staff at your facility? How so?

1. Has gender identity affected your clinic’s ability to maintain accurate health records or EMR entries? How so?

3. Have you experienced issues with insurance authorizations of prescriptions or treatments for your transgender female patients? How so?

KEY PRACTICES AND CLOSING

33. In your experience, are there any additional key practices that you see as critical to engaging transgender women in HIV prevention, care and or treatment?

Is there anything else that you would like to share with us regarding HIV prevention, care or treatment for transgender women?

Public reporting burden of this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1901)