Att 4b_Exploratory Testing Guide_ Transgender Health

Form Approved

OMB No. 0920-xxxx

Expiration Date XX/XX/XXXX

“Formative Research to Develop HIV Social Marketing Campaigns for Healthcare Providers”

Attachment 4b: Exploratory Testing Guide

Transgender Health

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I. Welcome

Thank you for coming here today. Your participation is very important. I’m _______ and I’m from ______________________ (insert contractor name). The Centers for Disease Control and Prevention (CDC) is sponsoring this research. The purpose of this interview is to inform the development of messages and materials that will promote HIV testing, prevention, and care services for transgender individuals. Therefore, we will be asking you questions about your experiences providing health care and HIV-related services to this population. Your insights today are very important as they will aid in the development of HIV-related resources and materials to better meet the needs of the transgender community materials for transgender patients and their providers. We really appreciate your time today. We will have about 1 hour for our discussion.

[Interviewer gives participant the consent form] Here is an informed consent form. Take a moment to review it and if you agree to it, please sign it.

[Interviewer gives participant 5 minutes to review and sign consent form]

• The consent form states that you have agreed to be part of a study about HIV.

Before we begin, I want to review a few ground rules for our discussion.

• Your participation is voluntary and you have the right to withdraw from the study at any time. You may choose not to answer any questions that you do not wish to answer.

• You have probably noticed the microphones in the room. They are here because I am audio taping [If applicable: and we have a live video stream]. At the end of today’s discussion, I have to write a report. I want to give you my full attention and not have to take a lot of notes.

• Behind me is a one-way mirror. Some of the people working on this project may be observing this discussion so that they can hear your opinions directly from you. [If applicable: Members of CDC staff are watching via a live video stream].

• Your identity and anything you personally say here will remain private. Your name, address, and phone number will not be given to anyone, and no one will contact you after this interview is over. Interview notes will be kept secure and separate from identifiable information.

• The informed consent has contact information for the project director, in case you have questions about the study or questions about your rights as a participant.

• Most importantly, there are no right or wrong answers. We want to know your opinions and what you think about the materials we will be discussing. I do not work for the people sponsoring this research and I did not develop any of these materials, so don’t hold back on giving me your honest opinions.

• Please turn your cell phone or beeper to vibrate or silent mode. The interview will last no more than 1 hour.

• If you need to go to the restroom during the discussion, please let me know.

• Do you have any questions before we begin?

II. Warm up

1. I would like to begin our discussion by asking you to introduce yourself and tell me:

• your first name

• number of years in practice

• professional affiliations (HIV Medicine Association (HIVMA); American Academy of HIV Medicine (AAHIVM); American College of Physicians (ACP) American Academy of Family Physicians (AAFP); Society for General Internal Medicine (SGIM); National Medical Association (NMA); and National Hispanic Medical Association (NHMA); state and local organizations)

• a description of your practice (size, number of patients with HIV seen per month)

• your patients’ insurance coverage (Medicare, Medicaid, HMO, private insurance, self-pay)

• about the patients you see in your practice (men, women, transgender, diverse populations, age range)

III. Questions (Note that bulleted items are probes.)

Knowledge of Transgender Experience

2. First, we’d like to learn about the types of transgender patients you treat. Please tell us a little about your transgender patients.

• Self-identification (e.g., MTF/FTM/”gender queer”/other)

• Stage of gender reassignment

• Age group

• Economic status

  • Housing status

  • Employment status

  • Sex work

• Insurance status

• Race/ethnicity

• HIV status

2. As a care provider, how do you define a transgender person?

Gender affirming care/Ancillary services

2. What kinds of services do you or other health professionals in your practice/facility provide to transgender patients?

   • Hormone therapy

   • Surgery

   • Mental health services

   • Social support around transition

   • Psychiatric or psychological services

   • Gynecological

   • HIV-related (e.g., testing, pre-exposure prophylaxis, etc.)

Note: If participant mentions HIV services, mention that more specifics will be covered later on in the interview.

2. Would you describe your practice as transgender-friendly?

   • If so, what specific steps did you take to make your practice trans-friendly? (e.g., trans-friendly bathrooms, training for all staff, transgender staff, appropriate gender assignment on forms, etc.)?

     • Do you actively seek transgender patients? If so, what approaches have you used? What approaches have proven effective?

   • If not, please describe any barriers you have faced or (potentially might face) to having a transgender-friendly environment.

HIV-Related Care

2. What kinds of HIV-related services and/or interventions do you or other health professionals in your practice provide to transgender patients?

• HIV testing/counseling

• HIV referrals/linkage to care

• HIV-specific medical care (e.g., viral load/CD4 testing, prescribing ART)

• PrEP/PEP

2. Can you tell me about how and when you might recommend HIV testing for one of your transgender patients?

2. Can you tell me what you know about pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) as HIV prevention strategies for certain high risk groups, including sexually active transgender patients and/or their partners?

2. Based on what you know, would you consider these to be effective HIV prevention strategies for your patients? Why or why not?

2. Earlier you said you provide [list services from Question 6] to transgender patients. Would you be interested in offering any of the following HIV-related services to transgender patients? [Note: List services NOT mentioned in Question 6.]

2. [If no to all] What are some barriers to offering these services in your practice?

• Is there any kind of information, resource, or tool that could be provided to you to make you more interested, comfortable, and willing to offer [service]? Please explain.

• [If yes] If you had access to this/these materials, would you be willing to provide [list services] to your transgender patients?

2. So you said you’re interested in providing [list services from Question 10] to transgender patients. How comfortable are you in offering [list each service individually from Question 10] to your transgender patients?

   • [If participant expresses discomfort with any service] What kinds of resources or tools would help you feel more comfortable providing [list service]?

Psychosocial Issues

2. What are the top [number] barriers to accessing [HIV testing/HIV prevention/HIV care/health care] services by your transgender patients?

• Trauma/history of abuse

• Homelessness/inadequate housing

• Acceptance/rejection by family and friends

• Substance abuse

• Mental health/suicide risk

• Employment/sex work

• Gender identity

• Sexual identity

• Body image

• Surgeries/silicone

• Harassment

• Stigma

• Violence

• Discrimination

• Health insurance coverage

• Low income/financial barriers

• Other (specify)__________________________________________

2. Please consider the top 5 barriers you identified. How do you think each of these barriers could be addressed?

Provider Education

2. What kind of training have you received to enhance your skills/ capacity to work with transgender individuals?

• Was this sensitivity training or related to provision of their medical care?

• What topics were covered? Of these, which did you find most helpful?

• Who offered/sponsored this training? How did you access this training (e.g., online, in-person, CMEs, etc.)?

• Did others in your practice attend? Why or why not? What motivated you to attend this training? Why did you take part in this training?

2. How often do you seek out new information about how to work with transgender patients? On what topics?

2. What websites do you use to learn more about treating transgender patients generally and on topics such as [insert topics here]?

2. Is there information or topics that you think would be helpful to you as a provider to transgender patients that you currently do not have access to? What topics?

2. What resources/materials/information would be helpful to help you address the HIV-related needs of your transgender patients? (E.g., HIV toolkit tailored to transgender patients, website, CME course, a brochure, peer mentoring, list serve focusing on transgender topics, etc.)

2. What kind of information on [topic such as adherence, risk reduction among HIV-positive patients or retention in care] would help you better serve your transgender patients?

   • Probes: Specific tips for how to speak to your patients? Specific resources to refer to your patients? CDC publications on transgender health? Other tools?

Patient Education & Referrals

2. What printed materials do you have available for your transgender patients that address [insert topic here]?

   • Where did these materials come from?

   • If none, why don’t you have any materials available on this topic?

2. Do you provide transgender patients with [HIV/health] educational materials specifically designed for them? Why or why not?

• If so, what kinds of materials? Where did you get them?

• If not, what stops you from providing your transgender patients with [HIV/health] educational materials specifically designed for them?

2. What, if any, HIV-related topics do your transgender patients ask you about?

   • Which topics or questions do you wish you had more guidance and information to provide a better answer?

   • What about the format of the materials? Would you like any of the following:

     • Websites you could refer them to?

     • An online tool that you could use with them to understand risk?

     • A brochure you could hand to them?

     • Posters you could put in the waiting room?

     • Other?

2. What kinds of referrals for other [HIV/health/transgender/social] services are you able to make for your transgender patients? What other types of referrals/services would be helpful?

2. Do your transgender patients have access to computers and the Internet?

   • [If yes…]

     • Do you refer your transgender patients to any websites related to [insert topic here – HIV prevention, testing, care; hormones; PrEP/PEP, etc.]?

     • What are they?

   • [If no…]

     • Why not?

2. Do you ever refer your transgender patients to CDC’s website for HIV information?

   • [If yes…]

     • What do patients like about the website?

     • What do they dislike?

     • How can the website be improved?

2. In your opinion, what kinds of communication materials should CDC develop and/or adapt to encourage HIV prevention, testing, and treatment for transgender people?

2. What websites do you use to learn more about transgender health topics?

• What do you like about these websites?

• What do you dislike about these websites?

• How can the websites be improved?

2. If CDC were to develop new materials for transgender people on [topic such as adherence, risk reduction among HIV-positive patients or retention in care], how can we ensure that the imagery and content affirms gender identity and are culturally appropriate?

   • How can we ensure that the imagery will resonate with transgender individuals?

     • Using images of well-known or famous transgender individuals?

     • Using copy to describe that the people photographed are transgender?

IV. Closing

Okay, we are pretty much out of time.

2. Do you have any last thoughts?

[Moderator will check with observers for additional questions or comments.]

I would like to thank you for coming here today and working hard on this. This has been very useful in helping us to inform future HIV information, education, and communication efforts. .