Background: During the COVID-19 pandemic, transgender and gender-diverse (TGD) people and people with disabilities in India faced disproportionate barriers to accessing vaccination services. Building on previous studies, this study explored the experiences of COVID-19 vaccine access in these two marginalized communities, using the WHO Behavioral and Social Drivers (BeSD) framework. Methods: Keeping community-based participatory methods (CBPR) at heart, we conducted a survey adapted from the BeSD COVID-19 survey tool. The survey was adapted using insights from a prior study, a literature review, stakeholder consultations, and discussions with a community leadership group (CLG) and an advisory board (AdB). Participants were recruited through transgender, gender-diverse, and disability rights networks. Data were analyzed descriptively, using percent analysis, and psychometrically, using exploratory factor analysis on polychoric correlations. Results: The adapted BeSD survey tool showed a high 0.85 (p < 0.05) internal consistency and criterion validity. Moreover, it showed a high willingness to be vaccinated (for ease of access to other services and community responsibility); however, systemic barriers hindered vaccination access. TGD people and people with disabilities faced multiple barriers in being vaccinated. The TGD community reported documentation mismatches and mistrust in health systems. People with disabilities reported mobility challenges, escort dependence, financial challenges, and variable accessibility at vaccination sites. Both groups faced digital exclusion, received inadequate information that did not address their specific needs, and experienced inconsistent implementation of inclusive policies. Community-led facilitation led to more uptake. Conclusions: Vaccine willingness alone is insufficient to ensure that vaccines reach everyone. Addressing trust deficits, infrastructural barriers, and digital exclusions requires diligent attention and commitment from the government to mitigate broader challenges faced by TGD people and people with disabilities.

BackgroundDepression is commonly treated with either psychotherapy or antidepressants, but patients differ widely in their comparative responses. Identifying the most effective treatment for each individual is crucial to optimizing scarce resources. AimsTo evaluate the feasibility and acceptability of a precision treatment trial comparing psychotherapy based on behavioral activation (the Healthy Activity Program) with antidepressant medication (fluoxetine) in adults with depression in primary care settings in India. MethodsSingle-blind, two-arm randomized pilot trial in eight primary healthcare centers with adults (≥18 years) with moderate-severe depression (PHQ-9≥10). Primary outcomes assessed recruitment, retention, treatment adherence/fidelity, assessment completion, and safety procedures. Secondary outcomes included changes in depressive symptoms, remission, and patient-reported improvement at 3 months.ResultsOf 578 screened individuals, 76/180 eligible (42%) enrolled. Retention was 82% at 3 months. Psychotherapy participants attended 5.6/6-8 sessions, while medication participants consumed 57.9% of prescribed doses. Although assessment completion was high (72-100%), some measures proved burdensome, prompting refinements. Depressive symptoms improved across both arms, with 45.2% achieving remission. However, treatment responses varied substantially within each arm (psychotherapy: –9.1 [SD=6.5]; medication: –7.6 [SD=6.9]), indicating marked individual heterogeneity.ConclusionsThis pilot demonstrated the feasibility and acceptability of implementing a precision treatment trial for depression in Indian primary care and identified refinements to optimize procedures for the main trial. Both treatments improved symptoms, but the heterogeneity observed in each modality supports the potential for and importance of identifying the optimal treatment for each given patient.Trial registration: Registered at ClinicalTrials.gov (NCT06153004) on 22 November 2023.