Despite having a higher burden of health problems, transgender persons face challenges in accessing healthcare in India. Most studies on healthcare access of transgender persons in India focus only on HIV related care, mental healthcare, gender affirmative services or on the ethno-cultural communities or transgender women. This study fills this gap by focusing on diverse gender identities within the transgender community with a specific focus on experiences in accessing general or routine healthcare services. A qualitative descriptive approach was used in this study. 23 in-depth interviews and 6 focus group discussions were conducted virtually and in-person with a total of 63 transgender persons in different regions of India between May and September 2021. The study used a community-based participatory research approach and was informed by the intersectionality approach. Thematic analysis was conducted to analyze the data. Four key themes emerged: (i) intersectional challenges in accessing healthcare start outside of the health system, continue through cisgender-binary-normative health systems that exclude transgender persons; and at the interface with individuals such as health professionals, support staff and bystanders; (ii) the experiences negatively impact transgender persons at an individual level; (iii) in response, transgender persons navigate these challenges across each of the levels: individual, health system level and from outside of the health system. This is a first of its kind qualitative participatory study focusing on routine healthcare services of transgender persons in India. The findings indicate the need to move conversations on trans-inclusion in healthcare from HIV and gender affirmative services to routine comprehensive healthcare services considering the higher burden of health problems in the community and the impact of poor access on their lives and well-being.

Introduction: India has the second-largest population of diabetes globally. The long-term complications due to poor glycemic control are concerning. Diabetes Self-Management Education (DSME) is a fundamental component in managing diabetes better. Objectives: This study was conducted to compare the effectiveness of group-based DSME in achieving glycemic control and improving self-care practices among people with type-2 diabetes as against the usual care. Methods: A non-blinded parallel-arm RCT among adults (? 30 years) diagnosed with Type-2 DM. Written informed consent was taken from each patient before enrollment. The sample size is estimated to be 85 in each arm according to the formula for equivalence design for an RCT. Randomization was done using a computer-generated random number table. The control arm received usual care, while the intervention group received group-based DSME in addition to usual care. At the end of 6 months, the change in glycemic control and self-care activity scores were compared between the two arms. Results: A total of 139 individuals (intervention =69; control =70) were analyzed. The proportion of females (62.1%) was higher than males (37.9%). There was no statistically significant difference at baseline. At end line, HbA1c showed a reduction from 9.3% to 6.9% in the intervention arm (P<0.001), which was greater than that in the control arm (p=0.017). All the self-care components showed a statistically significant improvement, except the medication score. Conclusions: Group-based DSME effectively increases self-care practices among people with diabetes, resulting in better glycemic control.

This pilot study is the first in India to longitudinally integrate trans-affirmative competencies into the MBBS physiology curriculum using a mixed-methods approach. Delivered over 11 mo, it demonstrated that nearly 17 h of gender-inclusive education can be embedded without disrupting existing teaching schedules. Using health humanities tools like poetry, trigger films, and Theater of the Oppressed, the curriculum enhanced student engagement and empathy. The study offers a scalable model for incorporating transgender health into early medical education, bridging curricular gaps and aligning with legal and professional mandates for inclusive health care.

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.

The rapid onset and progression of the COVID-19 pandemic highlighted the critical necessity for standardized, timely epidemiological investigations to generate actionable evidence for public health policy. The World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS) and Unity Studies and Investigations initiative (Unity Studies) provides the standardized framework to address these critical knowledge gaps. This manuscript reflects upon the Hamdard Institute of Medical Sciences and Research (HIMSR)’s experience as an active site implementing three WHO Unity protocols between 2020 and 2021. We synthesize key findings from the Household Transmission Investigation (HHTI) and the Health Facility Transmission (HCW cohort) studies, detail the operational and analytical complexities addressed through intensive collaboration with WHO HQ, South-East Asia Regional Office (SEARO), and WHO India, and outline the subsequent institutional capacity transmission. Building directly on this established expertise, HIMSR has been designated as the dedicated Nodal network site for the WHO SEAR Unity Studies Network in India, coordinating administration activities of a vast network of national institutes for ongoing pandemic preparedness. This trajectory demonstrates the potential for low- and middle-income country (LMIC) institutions not only to contribute critical evidence during crises but also to transition into resilient national and regional research and surveillance platforms for future pan-respiratory pathogen threats. We detail the essential findings and operational lessons from the COVID-19 pandemic response and elaborate extensively on the strategic implementation plan for the proposed WHO Unity Nodal Network site in India, emphasizing capacity building, standardization, and the integration of research into public health policy.