CC-BY 4.0 · ACI Open 2018; 02(01): e1-e9
DOI: 10.1055/s-0038-1639603
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Feasibility Study of a Telehealth Intervention on Health Care Service Utilization among Transgender Women of Color in Washington, DC

Manya Magnus
1  Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Elizabeth Edwards
2  Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Aurnell Dright
2  Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Leandrea Gilliam
2  Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Angela Brown
2  Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Matthew Levy
1  Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Neal Sikka
3  Section of Innovative Practice, Department of Emergency Medicine, The George Washington University, District of Columbia, United States
,
Marc Siegel
4  Medical Faculty Associates, The George Washington University, District of Columbia, United States
,
Vittoria Criss
2  Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Christopher Chauncey Watson*
2  Contractors at the Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
,
Edward Machtinger
5  Department of Medicine, University of California, San Francisco, California, United States
,
Irene Kuo
1  Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, District of Columbia, United States
› Author Affiliations
Funding This research has been facilitated by the services and resources provided by the District of Columbia Center for AIDS Research, an NIH funded program (AI117970), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR.
This study was funded by a grant from NIH/NIMHD (5R21MD008624). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Further Information

Publication History

13 February 2018

13 February 2018

Publication Date:
03 May 2018 (online)

Abstract

Background Transgender women of color (TWC) are a medically underserved population who often experience substantial barriers to care. TWC experience high rates of stigma, violence, and entrenched barriers to receiving routine or specialty health services. Novel ways to improve access for TWC are urgently needed. Telehealth is one way to support TWC in overcoming barriers, yet this approach has been largely unexamined. The purpose of this study was to develop a TWC-specific telehealth intervention to increase access to primary and specialty care and then pilot test this intervention in a sample of TWC with at least one structural barrier to care.

Methods Eligible participants were 18 years or older, identified as male sex at birth with a current gender identity of either female or transgender, a member of a racial/ethnic minority, and had experienced at least one study-defined structural barrier to primary or specialty care in the past 6 months. Following a 3-month preintervention phase, participants began a 3-month telehealth intervention which provided secure, remote access to trained, culturally appropriate, peer health consultants (PHCs) via video chat, e-mail, text, or phone. Health care utilization was assessed monthly via computer-assisted self-interview. Outcomes of intention to seek care in the next month and receipt of care in the past month were modeled using generalized estimating equations (GEE).

Results Twenty-five eligible participants were enrolled in the study; a majority were black (96%), older than 25 years (69%), living with human immunodeficiency virus (HIV) (52%), and reported depressive symptomatology (67%). Of the 16 who had at least one pre- and one intervention data collection point, 13 downloaded the mobile video chat application and 7 participated in a qualitative exit interview. The intervention was associated with significantly (p < 0.05) increased odds of intention to seek transgender-specific care (adjusted odds ratio, aOR: 1.76 [95% confidence interval, CI: 1.001–3.08]); participants with depression defined by an elevated Center for Epidemiologic Studies 8-item depression scale (CES-D-8) score were significantly more likely to have intention to seek specialty care (aOR: 10.53 [95% CI: 1.42–77.97]), HIV-specific care (aOR: 2.56 [95% CI: 1.27–5.17]), and mental health care (aOR: 2.56 [95% CI: 1.27–5.17]) during the intervention period. Participants with elevated CES-D-8 scores had significantly greater odds of having sought HIV-specific care (aOR: 2.31 [95% CI: 1.31–4.06]) during the intervention period relative to those with lower scores.

Conclusion These pilot data suggest that telehealth with remote access to PHCs who can provide immediate, culturally competent, nonclinical, education, and referral guidance may be effective in overcoming multiple barriers and improving care utilization outcomes for TWC. Telehealth may be an innovative, low-cost solution to improve health outcomes for populations with multiple barriers to health care services.

Clinical Relevance Statement

Novel ways to improve access to care among transgender women of color are urgently needed. Although telehealth interventions offer new ways to overcome the barriers that transgender women of color often experience, this approach has been previously unexamined among this population. Data from this study suggest that providing immediate remote access to peer health consultants who can nonclinically advise, answer questions, provide health education, and refer patients to appropriate, culturally competent care, may be effective in overcoming multiple barriers and improving care utilization outcomes among transgender women of color.


Protection of Human and Animal Subjects

All study instruments, interventions, and procedures were approved by the George Washington University Institutional Review Board. None of the faculty or staff have financial interest in or conflict with the vendor providing the Digigone application. Use or nonuse of the application had no impact on staff or participant compensation. No animals were used in this study.


* Mr. Watson was an employee of George Washington University during the conduct of the study and preparation of the publication, and is now an employee of Gilead Sciences.