Discussion
careWe, increases retention
RECRUITMENT
Considering the challenges of recruiting and retaining TrTGW living with HIV, which is a highly vulnerable population, the retention indicator in the TransAmigas project reached the expected value, according to what was hypothesized during its preparation. Several intervention studies have been using these indicators to assess factors that may interfere in the acceptability and feasibility analyses, especially in stigmatized populationsIn this study, we found a statistically significant association between retention at nine months and schooling level greater than or equal to 12 years and response to the check telephone call at three months. In studies with diverse populations, schooling is consistently associated with retentionThe association between the outcome and response to the check telephone call at three months shows that this strategy increases retention in longitudinal studies, considering the greater contact with the research team, regardless of the intervention. On the other hand, it may suggest a confluence of other factors that influence the response to the telephone call, such as housing stability, fixed income, participation in the labor market, access to a personal cell phone, and property security, even if these conditions have not been associated with the outcome. Some studies point having a cell phone and using social media, as well as the existence of safe spaces and researchers properly trained to establish bonds, important factors for greater retention of hard-to-reach populationsWe found no association between the outcome (“retention to the study at nine months”) and the variables study type, race/skin color, age, and name change on personal documents. The non-association between being part of the intervention group and greater retention suggests the need to treat retention to the project and retention to the intervention differently. Although the calculation of retention to the intervention and the evaluation of associated factors are outside of the scope of this study, the different contexts in which the intervention took place and the research procedures support this distinction. While the intervention was conducted by TrTGW living with HIV, the recruitment, enrollment, and interviews were performed in a health service by a team of cisgender interviewers with higher education. Moreover, only visits that occurred within the research period (baseline and at nine months) were reimbursed. On the other hand, peer navigation requires creating bonds and, therefore, more frequent contacts. They also allow the sharing of experiences potentially unique to this population.The variables age and race/skin color, in turn, had no significant effect in the TransAmigas project, although they were classically associated with higher retention in longitudinal studies, possibly due to the sample size. They were also not significantly associated with the outcome “name changed on personal documents”, which is a right legally guaranteed in Brazil. Discrimination and disrespect to the changed/preferred name exists at all levels of health careWe performed a qualitative analysis in order to evaluate the effect of stigma on the retention of TrTGW. This process is expressed, mainly, when social expectations based on heteronormativity conflict with gender identity and expression, leading to situations of discrimination and violenceAlthough the qualitative approach brings challenges for the operationalization of phenomena such as gender, race/skin color, and class, which are incorporated in the analysis, it allows a more comprehensive understanding and better reading and interpretation of the research object, expanding the capacity to act and transform realityThe research team sought strategies to understand the reasons why some participants did not regularly engage in the intervention. In these cases, they sought ways to intervene, considering the particular characteristics and demands of the participants, even offering the possibility of changing their PN if necessary.