Translating Domestic Provider Training Programs for Pakistan Regarding Culturally Competent HIV Healthcare for Transgender Persons

Introduction:

Pakistani transgender persons (PTP) suffer from high rates of untreated HIV. Dramatic PTP healthcare inequalities relate to social determinants of health and stigma, and the National Aids Control Program in Pakistan indicates need for transgender-competent healthcare. We aim to translate domestic provider training for transgender-competent healthcare for administration in Pakistan. Here we describe our first steps in this process: 1) Develop organizational partners in Pakistan to help in program implementation and 2) Prepare for interviews of PTP to identify their perceived needs, barriers, and recommendations regarding HIV-related healthcare.

Methods:

We used community-based participatory research (CBPR) principles to involve PTP, organizational representatives, researchers, and healthcare providers in all stages of this translational research. In regard to creating local organizational research partners, our domestic research team included a member well connected to the PTP community. The research team facilitated this team member’s social networking and strategic planning, and adherence to CBPR principles in the development of organizational research partners. In regard to needs assessment interviews of PTP, we plan on interviewing 12 persons who self-identify as transgender in Islamabad. A semi-structured interview, an interview protocol, a recruitment strategy, consent form, and University Institutional Review Board (IRB) package was developed in partnership with new PTP research partners following CBPR principles. PTP will be asked about their needs, barriers, and recommendations for providers regarding their sexuality/gender, sexual health, drug use/HIV, HIV testing, and PrEP.

Results:

Eight PTP-serving organizations were identified and they provided a full description of their organizational characteristics and services. One of these organizations, a PTP-lead organization, provided letters of agreement to coordinate with local participants, community members, regulatory representatives, researchers, and healthcare providers. The reliability and integrity of the relationship between the researchers and this organization was developed through preparation of the PTP needs assessment interview. To date, there has been broad input of PTP, healthcare providers, and research stakeholders; and consensus resulting in completion of all the components of the needs assessment interview IRB package.

Conclusions:

This formative research regarding translating domestic provider training programs for culturally competent HIV healthcare of PTP has progressed rapidly and has met our first two objectives: CBPR-based development of organizational research partners and the IRB protocol for needs assessment interviews. The CBPR process indicates that we are addressing an urgent need and that PTP and healthcare providers are willing to participate in all aspects of the formative research for this project.