Addressing violence and HIV cascade of care outcomes among transgender women

解决跨性别女性中的暴力和艾滋病毒护理结果连锁反应

• 批准号: 9912488
• 负责人: Kristi E Gamarel
• 金额: $ 19.1万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9912488
• 关键词: Address; Adherence; Adult; Affect; Alcohol or Other Drugs use; Birth; Caring; Chronic stress; Color; Communities; Community Health; Continuity of Patient Care; Data; Development; Diagnosis; Discrimination; Drops; Education; Enrollment; Epidemic; Female; Feminine; Future; Gender; Gender Identity; HIV; HIV diagnosis; Health Personnel; Immune; Imprisonment; Individual; Infection; Inflammatory Response; Intervention; Intervention Studies; Interview; Law Enforcement; Length; Link; Mediating; Medical; Michigan; Modeling; Outcome; Participant; Pathway interactions; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Poverty; Prevention program; Public Health; Randomized Controlled Trials; Recording of previous events; Research; Research Design; Resources; Risk; Role; Safety; San Francisco; Screening procedure; Self Efficacy; Services; Sexual and Gender Minorities; Symptoms; Testing; Time; Trauma; United States; Violence; Viral; Viral Load result; arm; base; care outcomes; cisgender; efficacy trial; empowered; empowerment; evidence base; experience; flexibility; follow-up; health care availability; health care quality; health disparity; improved; intervention program; male; meetings; partner violence; post intervention; primary outcome; programs; public health relevance; rapid diagnosis; recruit; retention rate; secondary outcome; self esteem; seroconversion; social structure; stressor; therapy design; transgender; transgender women

PROJECT SUMMARY Transgender (`trans') women of color experience violence in a variety of contexts, including from partners, strangers, law enforcement, healthcare providers, and in public accommodations. Violence is consistently linked with avoiding care, suboptimal ART adherence, and lower odds of viral suppression via pathways including chronic stress, immune inflammatory response, posttraumatic stress disorder (PTSD) symptoms, and substance use. These epidemics are concurrent and mutually reinforcing, constituting a “syndemic” or synergistic interaction that contributes to documented inequities in HIV continuum of care outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in engagement in HIV care. In this R21 exploratory/developmental research application, we propose to adapt and pilot test a culturally-responsive, evidence-based, and trauma-informed intervention to improve engagement in HIV care (primary outcome), reduce PTSD symptoms (secondary outcome), and increase sustained viral suppression (tertiary outcome) among trans women of color living with HIV. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of the intervention, with a focus on the unique aspects of violence, gender affirmation needs, and engagement in HIV care by conducting interviews with trans women of color and key stakeholders to inform the adaptation. Our community advisory board consisting of trans women of color will review all adapted materials. The second aim seeks to examine the feasibility, acceptability, and preliminary efficacy of the adapted intervention in a one-arm pilot with follow-ups immediate and 3-month post- intervention. The third aim seeks to gather qualitative data from one-arm pilot participants to identify strategies to overcome barriers to implementing rigorous randomized controlled trial research designs with trans women of color within limited-resources settings. Study findings will provide the necessary groundwork for a subsequent community-engaged large-scale randomized controlled trial. Findings also have the potential to provide a blueprint to guide future research efforts with trans women of color who are often embedded in close- knit communities with few existing culturally-responsive services.

项目摘要 跨性别者（“跨性别”）有色妇女在各种情况下经历暴力，包括合作伙伴， 暴力是一贯的。 与避免护理，次优艺术依从性和通过途径较低的病毒替代相关的联系 包括慢性应激，免疫炎症反应，创伤后应激障碍（PTSD）症状以及 这些流行的物质是同时且共同加强的 有助于记录的协同互动 密歇根州，有色人种的跨性别女性是艾滋病毒的“危险最高”群体之一，在 参与艾滋病毒护理。 试点测试一种具有文化响应，循证和创伤干预的文化响应性，以改善参与 HIV护理（主要结果），减少PTSD症状（次要结果）并增加持续病毒 抑制艾滋病毒有色人种的跨性别女性中的抑制（第三级结果）。 我们的第一个目标旨在对干预进行系统的适应，重点是 暴力，性别肯定的需求和参与艾滋病毒护理，通过对跨性别妇女的访谈 颜色和关键利益相关者为我们的社区顾问委员会提供信息。 颜色将审查所有适应材料。 对单臂飞行员进行的调整干预措施的初步疗效，随访后3个月立即 间隔。 克服与跨性别女性实施随机对照试验设计的障碍 在限量资源设置中的颜色。 随后的社区参与大规模随机对照试验。 提供蓝图，以指导未来的研究敌对，以有色人种的跨性别妇女近距离地嵌入 编织社区很少有文化响应的服务。