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‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’: protocol of community-based intervention development and a non-randomised multisite pilot study with pre–post test design in Canada
  1. Ashley Lacombe-Duncan1,2,
  2. Carmen H Logie2,3,
  3. Yasmeen Persad2,
  4. Gabrielle Leblanc4,
  5. Kelendria Nation5,
  6. Hannah Kia6,
  7. Ayden I Scheim7,
  8. Tara Lyons8,9,
  9. Mona Loutfy2,10
  1. 1School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Women’s College Hospital, Toronto, Ontario, Canada
  3. 3Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
  4. 4Action Santé Travesti(e)s & Transsexuel(le)s du Québec, Montreal, Québec, Canada
  5. 5Prism Education Series, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
  6. 6School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
  7. 7Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
  8. 8Department of Criminology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
  9. 9Center for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, British Columbia, Canada
  10. 10Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Ashley Lacombe-Duncan; lacombed{at}


Introduction Educational workshops are a promising strategy to increase healthcare providers’ ability to provide gender-affirming care for transgender (trans) people. This strategy may also reduce healthcare providers’ stigma towards trans people and people living with HIV. There is less evidence, however, of educational workshops that address HIV prevention and care among trans women. This protocol details development and pilot testing of the Transgender Education for Affirmative and Competent HIV and Healthcare intervention that aims to increase gender-affirming HIV care knowledge and perceived competency, and to reduce negative attitudes/biases, among providers.

Methods and analysis This community-based research (CBR) project involves intervention development and implementation of a non-randomised multisite pilot study with pre–post test design. First, we conducted a qualitative formative phase involving focus groups with 30 trans women and individual interviews with 12 providers to understand HIV care access barriers for trans women and elicit feedback on a proposed workshop. Second, we will pilot test the intervention with 90–150 providers (n=30–50×3 in-person settings). For pilot studies, primary outcomes include feasibility (eg, completion rate) and acceptability (eg, workshop satisfaction). Secondary preintervention and postintervention outcomes, assessed directly preceding and following the workshop, include perceived competency, attitudes/biases towards trans women with HIV, and knowledge needed to provide gender-affirming HIV care. Primary outcomes will be summarised as frequencies and proportions (categorical variables). We will conduct paired-sample t-tests to explore the direction of preintervention and postintervention differences for secondary outcomes.

Ethics and dissemination This study has been approved by the University of Toronto HIV Research Ethics Board (Protocol Number: 00036238). Study findings will be disseminated through community forums with trans women and service providers; manuscripts submitted to peer reviewed journals; and conferences. Findings will inform a larger CBR research agenda to remove barriers to engagement in HIV prevention/care among trans women across Canada.

Trial registration number NCT04096053; Pre-results.

  • education & training (see medical education & training)
  • quality in health care
  • HIV & AIDS

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  • Contributors All authors (AL-D, CHL, YP, GL, KN, HK, AIS, TL and ML) were responsible for the initial conception of the study, study design and study protocol. AL-D, CHL, YP, GL, KN and YP developed the initial TEACHH workshop materials, which were subsequently edited by and expanded upon by the rest of the team (HK, AIS, TL and ML). AL-D and CHL led the first draft of this manuscript. All authors (YP, GL, KN, HK, AIS, TL and ML) provided feedback on drafts of this manuscript and have read and approved the final manuscript.

  • Funding This work was supported by a Canadian Institutes of Health Research (CIHR) CBR Catalyst grant (2017). The work was also supported by the CIHR Clinical Trials Network (CTN 317). TEACHH development activities were also supported by CHL’s Ontario Ministry of Research & Innovation Early Researcher Award, Canada Foundation for Innovation grant, and the Canada Research Chairs Program. AIS was supported by a CIHR Fellowship.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by the University of Toronto HIV Research Ethics Board (protocol number: 00036238).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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