47. Development of Quality Assurance Measures of Gender-Affirming HIV Prevention Services for Young Transgender Women


      Human immunodeficiency virus (HIV) prevention services including HIV testing and Pre-Exposure Prophylaxis (PrEP) are a crucial component of healthcare for young transgender women (YTW), who are disproportionately impacted by HIV in the U.S. However, these services and spaces are often not inclusive or gender-affirming. The purpose of this study was to adapt and develop two quality assurance measures of HIV prevention services for use with transfeminine identified youth quality evaluators in order to assess HIV and sexually transmitted infection (STI) services for gender-affirming competencies.


      Focus groups were conducted with provider and research experts in transgender health and HIV care for adolescents (N=14) and transfeminine identified youth experts (N=7) in transgender health to obtain feedback on two measures adapted from the Quick Investigation of Quality (QIQ) framework. These included: (1) a mystery shopping site assessment tool and (2) a facility audit tool. The mystery shopping site assessment tool was originally developed to assess LGBTQ+ competency in HIV testing and counseling services for young men who have sex with men. The facility audit tool has been used to address quality and access in other populations experiencing similar barriers to care. Nominal group technique was used to prioritize items for inclusion. The five focus groups were recorded and transcribed, and the research team used thematic analysis to identify the most salient themes and incorporate participant feedback into the development of the tools.


      Researcher, provider, and youth experts (n=21) expressed overall support of using these tools to evaluate HIV prevention services and made several valuable suggestions to tailor them to the needs of YTW. Research and provider experts made several content-based suggestions, such as adding items to address the behavior of other clients in the waiting room, presence of trans-specific symbols and materials in the facility, ADA and Spanish language-speaking accommodations, and diversity and inclusion training for staff. Youth experts were more likely to offer suggestions that improved the overall clarity, conciseness, and readability of items, such as removing repetitive items and rephrasing confusing questions. Feedback that was not incorporated directly into the tools was included in training materials developed for the youth quality evaluators.


      By leveraging input from a diverse group of researcher, provider, and youth experts in transgender health, we adapted and developed two tools that take an intersectional approach to measuring the quality of HIV prevention services for young transgender women. Next steps are to recruit and hire youth quality evaluators to pilot and validate these tools with agencies that provide HIV prevention services in a large urban area.

      Sources of Support

      Stoneleigh Foundation, Leadership Education in Adolescent Health.