The South-East Asian Transgender Health Cohort: A Protocol for a Prospective Observational Study

BackgroundTransgender people worldwide are disproportionately affected by physical and mental health conditions. Systemic marginalization, stigma, discrimination, and violence contribute to their adverse health outcomes. Little is known about these factors, or their impact on health and wellbeing, among transgender people in South East Asia. MethodsThe South East Asian Transgender Health Cohort (SEATrans), clinicaltrial.gov registration number NCT05454579) is the first multisite, prospective observational cohort study for transgender people in the region, including participants from Thailand, The Philippines and Vietnam. The study aims to track physical and mental health; identify biomedical, structural, and psychosocial factors impacting physical and mental health; describe structural barriers to healthcare; and develop guidance on holistic healthcare policies for transgender people in South East Asia. The study will enroll and follow-up 450 transgender people (300 HIV-negative people, 150 people living with HIV) from four community health centers. Sociodemographic information, behavioral risk information, mental health information (e.g., depression, anxiety, post-traumatic stress disorder), and data on psychosocial barriers will be collected. Laboratory testing will include testing for HIV, syphilis, Chlamydia trachomatis, Neisseria gonorrhea, hepatitis B and C, metabolic profile (glucose, cholesterol, HDL, LDL, triglycerides), and hormone levels. Participants will be followed until up to month 24. Participants with physical and/or mental health diagnoses will receive treatment or be linked to care. Descriptive analyses will be conducted to summarize sociodemographic characteristics, physical and mental health status, and structural and psychosocial factors, while regression analyses will assess relationships between several variables and outcomes of interest. Expected ImpactData from this cohort will inform holistic healthcare policies for transgender people in Thailand, The Philippines and Vietnam, as well as multilevel interventions to address the risks faced by this population. Tailored service packages will combine HIV, sexual, psychosocial health and gender-affirming care.