We present findings from qualitative interviews (N = 67) with 36 staff and 31 participants of nine distinct individual and/or group level interventions to engage transgender women of color (TWOC) in HIV care in the U.S. We examine the commonalities amongst the intervention services (addressing unmet basic needs, facilitating engagement in HIV care, health system navigation, improving health literacy, emotional support), and the relationships formed during implementation of the interventions (between interventionists and participants, among participants in intervention groups, between participants and peers in the community). Interventionists, often TWOC themselves, who provided these services developed caring relationships, promoted personal empowerment, and became role models for participants and the community. Intervention groups engaged participants to reinforce the importance of health and HIV care and provided mutual support. Gender affirming services and caring relationships may be two key characteristics of interventions that address individual and structural-level barriers to engage TWOC in HIV care. Keywords Transgender women of color • HIV care • Gender-affirming services • Navigation services • Group interventions Resumen Presentamos resultados de entrevistas cualitativas (N = 67) con 36 integrantes del personal implementador y con 31 participantes en nueve distintas intervenciones a nivel individual y/o grupal para vincular a mujeres transgénero de minorías a la atención médica para el VIH en EE.UU. Examinamos: (1) los servicios (satisfacer necesidades básicas no cubiertas, facilitar vinculación a la atención médica para el VIH, ayudar a navegar el sistema de salud, incrementar alfabetización en salud, proveer apoyo emocional) provistos por las diferentes intervenciones, y (2) las relaciones parte de la implementación de las intervenciones entre intervencionistas y participantes, las participantes en los grupos de las intervenciones, y las participantes y sus pares en la comunidad. Las intervencionistas que proveían dichos servicios, muchas de ellas también mujeres transgénero de minorías, desarrollaron relaciones afectuosas, promovieron el empoderamiento personal, y se convirtieron en modelos de roles para las participantes y la comunidad. Los grupos parte de las intervenciones reforzaron la importancia de la salud y la atención médica para el VIH y fomentaron el apoyo mutuo. Intervenciones que incluyen servicios con una perspectiva de afianzamiento de la identidad de género y relaciones afectuosas como dos características claves pueden ser cruciales para superar barreras individuales y estructurales para vincular a mujeres transgénero de minorías a la atención médica para el VIH.
Ensuring continuity of and retention in care after release from prison is critical for optimizing health outcomes among people living with HIV. As part of a large federal initiative, we conducted qualitative interviews (n = 24) with individuals living with HIV and recently released from prison in four states to understand their experiences in different navigation interventions to improve access to HIV care post-release. Interventions were delivered only in prison, only in the community, or in both settings. While the interventions varied by design, overall, participants appreciated the breadth of support received from interventionists, including health system navigation, case management and social support. Even when individuals leaving prison were returning to clinics that they were familiar with, systems navigation supported continuity of care. Our findings elucidate why navigational support was instrumental, and underscore the value of a variety of types of navigation programs in facilitating continuity of care and reintegration post-prison.
Background There is an urgent need to fully understand the impact of variable COVID-19 experiences and the optimal management of post-acute sequelae of SARS-CoV-2 infection. We characterized the variability in the acute illness experience and ongoing recovery process from participants in a COVID-19 recovery cohort study in Northern California in 2020. Method We completed 24 semi-structured in-depth interviews with adults with confirmed positive SARV-CoV-2 nucleic acid amplification test result, had recovered or were recovering from acute infection, and underwent serial evaluations. We purposefully sampled English- and Spanish-speaking adults with asymptomatic, mild, and severe symptomatic infection, including those who were hospitalized and those with HIV co-infection. We used a thematic analysis to analyze interviews and identify salient themes. Results After integrating the thematic analysis with clinical data, we identified key themes: (1) across symptom profiles and severity, experiencing COVID-19 was associated with psychological distress; (2) symptomatic infection carried uncertainty in symptom presentation and ongoing recovery (e.g., long COVID); and (3) health information-seeking behavior was facilitated by access to medical care and uncertainty with the recovery process. Conclusion Our data informs the emerging field of “long COVID” research and shows a need to provide information and continuous support to persons with post-acute sequelae to ensure they feel secure along the path to recovery.
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