Improving HIV testing and PrEP for transgender women through mHealth

通过移动医疗改善跨性别女性的艾滋病毒检测和 PrEP

基本信息

批准号：
10398983
负责人：
Roman Shrestha
金额：
$ 19.14万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-28 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10398983
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Affect Asia Attitude Behavior Therapy Caring Cellular Phone Clinic Clinical Clinical Services Complex Country Custom Data Decision Making Development Discrimination Drug usage Economics Employment Environment Epidemic Evidence based intervention Exclusion Focus Groups Fostering Gender General Population Government HIV HIV Infections Health Health Personnel Health Professional Health Services Healthcare Hearing Human immunodeficiency virus test Individual Infection Injecting drug user Interpersonal Violence Intervention Laws Learning Legal Malaysia Malaysian Medical Mental Depression Mental Health Mobile Health Application Modeling Names Occupations Population Populations at Risk Prevalence Privatization Process Provider Randomized Controlled Trials Religion and Spirituality Research Risk Risk Behaviors Services Sexual Health Sexual Transmission Socialization Strategic Planning Study models Testing Time Vulnerable Populations Work acceptability and feasibility base care systems cost effective design distrust empowered experience health care service health management high risk improved information gathering innovation mHealth men who have sex with men mobile application pre-exposure prophylaxis prevent prevention service preventive intervention prototype response scale up screening service delivery sex social social stigma statistics substance use testing services testing uptake theories tool transgender women treatment as usual trial comparing uptake usability

项目摘要

Abstract Despite decades of evidence-based interventions, including the 90/90/90 strategy, the HIV epidemic in Malaysia remains volatile. With over 100,000 cumulative HIV cases, Malaysia's rapidly expanding HIV epidemic is the fifth largest in the Asia-Pacific region and is concentrated within the most-at-risk populations. Originally driven by people who inject drugs, the majority of new infections today (>90%) are attributed to sexual transmission, many of which occur among transgender women (TGW). TGW are disproportionately impacted by HIV worldwide, with an estimated global prevalence of 19%. In Malaysia, an estimated 12.4% of TGW are living with HIV. TGW experience multi-level vulnerabilities to HIV, including discrimination in employment and economic opportunities, steering many TGW into high-risk occupations, such as sex work. High levels of stigma and discrimination against TGW by healthcare providers can foster a hostile environment toward TGW, complicating efforts to scale-up of HIV testing and prevention services among trans women, including pre-exposure prophylaxis (PrEP). Modeling studies suggest increased HIV testing and uptake of PrEP is the most impactful and cost-effective strategy for reducing new infections. Despite this, only 37% of TGW in Malaysia have ever been HIV tested. Similarly, while PrEP is recommended in Malaysia's National Strategic Plan to End AIDS (2016-2030), only 1 in 5 TGW has ever heard of PrEP. However, after learning about PrEP, more than 80% of TGW in Malaysia say they would take it. To scale-up of HIV testing and PrEP among TGW, innovative strategies are needed to rapidly overcome the complex barriers preventing uptake. In settings where anti-trans stigma is pervasive, such as Malaysia, mHealth may provide an empowering alternative approach to service delivery for TGW. An effective platform for reaching vulnerable and hidden populations, mHealth can overcome barriers associated with traditional clinic-based care by designing customized models of care tailored to the needs of vulnerable populations. Through confidential screening, rapid referrals to trans-friendly providers, and tools that facilitate access to gender-affirming health care needs, mHealth is a promising platform that can be leveraged for intervening around HIV prevention. Thus, we propose to develop and test a new clinic-affiliated app, called MyLink2care, to deliver an integrated HIV prevention intervention for TGW in Malaysia. Specifically, we propose to: 1) adapt, expand, and refine an existing mobile application by conducting formative research with TGW and clinical stakeholders to develop a prototype of the MyLink2Care app to undergo usability testing, followed by development of the beta version of the app; 2) conduct “beta testing” of the MyLink2Care app to assess its usability and acceptability; and 3) assess preliminary feasibility and acceptability of the MyLink2care app within a pilot, randomized-controlled trial, compared with treatment-as-usual for engagement in HIV prevention.

抽象的尽管采取了数十年的基于证据的干预措施，包括 90/90/90 战略，但艾滋病毒在马来西亚的艾滋病毒感染病例累计超过 10 万例，艾滋病毒感染人数正在迅速增加。该流行病是亚太地区第五大流行病，并且集中在高危人群中。最初是由注射吸毒者引起的，如今大多数新感染 (>90%) 归因于性传播，其中许多发生在跨性别女性（TGW）中，比例不成比例。全世界都受到艾滋病毒的影响，估计全球患病率为 19%，马来西亚估计为 12.4%。 TGW 感染了 HIV，TGW 面临着多层次的 HIV 脆弱性，包括在艾滋病方面的歧视。就业和经济机会，引导许多 TGW 从事高风险职业，例如性工作。医疗保健提供者对 TGW 的高度污名和歧视可能会营造一个敌对的环境 TGW，使扩大跨性别女性艾滋病毒检测和预防服务的努力变得更加复杂，包括暴露前预防 (PrEP) 模型研究表明增加了 HIV 检测和接受。 PrEP 是减少新发感染最有影响力和成本效益的策略，但仅占 37%。马来西亚的 TGW 也曾进行过类似的 HIV 检测，而马来西亚国家卫生局则建议进行 PrEP。终结艾滋病战略计划（2016-2030），只有五分之一的 TGW 听说过 PrEP。关于 PrEP，超过 80% 的马来西亚 TGW 表示他们愿意扩大 HIV 检测和 PrEP。 TGW 需要创新战略来快速克服阻碍吸收的复杂障碍。在反跨性别歧视普遍存在的地区，例如马来西亚，移动医疗可能会提供一种赋权 TGW 提供服务的替代方法一个接触弱势群体和隐藏群体的有效平台。移动医疗可以通过设计克服与传统临床护理相关的障碍通过保密筛选，根据弱势群体的需求量身定制护理模式。快速转介给跨性别者友好的提供者，以及促进满足性别肯定医疗保健需求的工具，移动医疗是一个很有前景的平台，可用于干预艾滋病毒预防。建议开发和测试一款名为 MyLink2care 的新诊所附属应用程序，以提供综合的 HIV 具体来说，我们建议：1）调整、扩展和完善马来西亚的 TGW 预防干预措施。通过与 TGW 和临床利益相关者进行形成性研究来开发现有的移动应用程序 MyLink2Care 应用程序原型将进行可用性测试，随后开发测试版应用程序；2) 对 MyLink2Care 应用程序进行“测试版测试”以评估其可用性和可接受性；以及 3) 在随机对照试验中评估 MyLink2care 应用程序的初步可行性和可接受性试验，与常规治疗参与艾滋病毒预防进行比较。