Assessing the predictors of treatment-seeking and health care access barriers among transgender individuals in Pakistan.

BACKGROUND: Transgender individuals in Pakistan face barriers to health care access, increasing the risk of serious disease transmission. AIM: To identify the predictors of treatment-seeking intention and health care access delays among transgender individuals in Karachi, Pakistan. METHODS: Between December 2024 and April 2025 we interviewed 360 individuals, aged ≥18 years, who identified as transgender and had accessed health care within the past 12 months. We analysed the data using SPSS version 20 and conducted hierarchical logistic and linear regression analyses to identify the predictors of intention to seek health care and delays in seeking care. RESULTS: Discrimination (B = -0.94, SE = 0.19, P < 0.01) and perceived provider competence (B = 0.35, SE = 0.16, P = 0.03) were significant contextual predictors of intention to seek care. Participants with greater discrimination reported lower intention to seek care, while those perceiving their providers as competent reported higher intention. Older age [odds ratio (OR) = 1.05, 95% confidence interval (CI): 1.01-1.09, P = 0.027], primary and higher education (OR = 5.35, 95% CI: 1.63- 17.60, P = 0.006; OR = 5.49, 95% CI: 1.49-20.11, P = 0.010), and discrimination (OR = 3.77, 95% CI: 1.32-10.74, P = 0.013) were significant predictors of delay in seeking care, while delay was reduced by non-traditional income sources (OR = 0.29, 95% CI: 0.09-0.93, P = 0.036), frequent health care visits (OR = 0.92, 95% CI: 0.86-0.99, P = 0.017), and poor perceived provider competence (OR = 0.29, 95% CI: 0.09-0.92, P = 0.007). CONCLUSION: Discrimination, perceived provider incompetence and income source significantly influenced intention and delay in seeking care, while age, education and visit frequency predicted delays only. Interventions to address these predictors are essential to increase timely and equitable health care access for transgender individuals in Karachi, Pakistan.