(P340) TransFormational Design: Co-creation of instructional self-collection diagrams to support the diagnosis of STIs through a participatory approach with transgender people in São Paulo, Brazil

Background: Visual aids are commonly used to support the self-collection of samples (SCS) for STI testing, including instructional diagrams or videos. There is a marked absence of self-guided diagrams with transgender inclusive or gender-neutral instructions to enable the SCS by transgender people and other gender- or anatomically-diverse populations. This project aimed to develop appropriate guidance for SCS among transgender people, including the participatory development of transgender inclusive self-sampling diagrams.



Methods: TransOdara was conducted in five Brazilian capital cities from December 2019 to July 2021 and recruited a total of 1,317 transgender women aged >18y. Participants were requested to provide samples from multiple sites for STI testing, and could choose whether anorectal, oropharyngeal, and genital (penile or neovaginal) samples were self-collected or provider-collected. Instructional diagrams developed for the study were provided to guide participants with SCS, and were asked about their experience of sample collection and use of diagrams. After termination of the study, participatory FGDs were organized with a diverse group of individuals from the transgender community in São Paulo to further co-create instructional, self-collection diagrams.

Results: Most participants (97-100%) who provided SCS and were guided by the pilot instructional diagrams indicated that the respective diagrams were ‘easy’ to follow (Table 1). In FGDs, participants expressed a preference for ‘trans-specific’ imagery due to potential empowerment of seeing a trans body, but expressed need to recognize the diversity that exists and use language commonly used by the community (e.g. often use different terms for certain body parts). A set of diagrams were co-designed to guide SCS of each: oropharyngeal, anorectal, genital/(neo)vaginal, genital/penile, and urine samples. Each set was developed in Portuguese and translated to English.

Conclusion: Imagery co-created with a diverse group of community members has the potential to ensure acceptability and usability for a wider audience, including those who might have difficulty reading written instructions. There is a role for imagery that is ‘trans-specific’ as well as ‘trans-inclusive’ or ‘gender-neutral’ for acceptability among the trans community and for wider use. The developed diagrams and/or the co-creation process have the potential to support transgender and other marginalized people to receive better access to care.