American Cohort to Study HIV Acquisition among Transgender Women in High Risk Areas

美国队列研究高风险地区跨性别女性的艾滋病毒感染情况

• 批准号: 9982768
• 负责人: Sari Reisner
• 金额: $ 158.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-21 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982768
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; American; Ancillary Study; Area; Baltimore; Behavioral; Biological; Blood; Boston; Caring; Cohort Studies; Collection; Continuity of Patient Care; Country; Cross-Sectional Studies; Data; Development; Eligibility Determination; Enrollment; Environment; Epidemic; Epidemiology; Exposure to; Funding; Future; General Population; Guidelines; HIV; HIV Infections; HIV risk; Health; Health Services; High Prevalence; Hormone use; Incidence; Individual; Infrastructure; Intervention; Intervention Studies; Laboratories; Longitudinal cohort; Measures; Mental Health; Meta-Analysis; Methods; New York City; Outcome; Participant; Patient Self-Report; Phase; Population; Population Intervention; Populations at Risk; Prevalence; Prevention; Prevention Research; Preventive Intervention; Principal Investigator; Productivity; Prospective cohort; Research; Research Priority; Risk; Risk Factors; Sample Size; Sampling; Sampling Biases; Site; Specimen; Structure; Subgroup; Technology; Testing; Time; United States; United States National Institutes of Health; Validation; Viral Load result; Visit; Washington; Woman; base; behavioral health; biobehavior; care systems; cohort; comparison group; design; evidence base; follow-up; high risk; improved; men who have sex with men; metropolitan; new technology; physical conditioning; placebo group; pre-exposure prophylaxis; prevent; prevention service; prospective; racial and ethnic; recruit; response; screening; social; social structure; socioeconomics; success; testing services; transgender women; transmission process; trend

Abstract: In the United States (U.S.), transgender women (TW) are one of the populations most affected by HIV infection. The high prevalence of HIV infection among U.S. TW is driven by, and/or concomitant with, structural barriers that limit access to HIV prevention, care, and health services. Despite an emergence of research to characterize the HIV epidemic among TW, the majority of studies are cross-sectional designs and typically include small sample sizes, often subsuming TW among broader risk groups, such as men who have sex with men. These practices have thwarted identification of acceptable, effective recruitment and study methods for use among TW and prevented temporal assessment, causal inference, and generalizability of study findings to the TW population. To date, there is no robust estimate of HIV incidence and no intervention with evidence of efficacy for the prevention of HIV acquisition among TW. The proposed American Cohort study will address these limitations by establishing a multi-site, longitudinal cohort of TW spanning eastern and southern U.S. (Boston, New York City, Baltimore-Washington, Atlanta, and Miami metropolitan areas) to characterize HIV incidence and risk factors for HIV acquisition, access to biobehavioral HIV prevention methods, and linkage to care for those who HIV seroconvert. The cohort will include a racially/ethnically and culturally diverse sample of TW, supported by the use of technology-infused recruitment and retention methods. The specific aims are: 1) To determine the efficiency and acceptability of novel, technology-infused recruitment methods to enroll HIV- uninfected TW into a prospective cohort. 2) To describe the demographic, socioeconomic, behavioral, and physical and mental health profiles of HIV-uninfected TW in the first, multi-site cohort of TW in the eastern and southern U.S. 3) To estimate HIV incidence among TW in high-risk eastern and southern U.S. areas, trends in incidence, and associated individual, social, and structural risk factors. 4) To estimate the HIV Prevention Continuum among HIV-uninfected participants, and the HIV Care Continuum among newly HIV-infected TW. To achieve these aims we will recruit 1,750 TW who will be enrolled in either a HIV-uninfected cohort or an HIV-infected cross-sectional comparison group. These data will be used to assess differences between cohort participants and the wider population and for cross-sectional incidence estimation at enrollment. The HIV- uninfected cohort will be followed for at least 24 months to estimate HIV incidence, trends, and risk factors for HIV acquisition. Cohort participants who seroconvert will be followed for an additional 6 months to assess prospective engagement in the HIV Care Continuum. Study findings will provide critical epidemiologic parameters for future HIV prevention research among TW, provide a platform upon which other research questions can be explored, and inform the development of evidence-based and acceptable HIV interventions to reduce HIV acquisition among TW in the U.S.

抽象的： 在美国（美国），变性妇女（TW）是受艾滋病毒影响最大的人群之一 感染。美国TW中艾滋病毒感染的高流行率是由和/或伴随着结构性的 限制获得预防艾滋病毒，护理和卫生服务的障碍。尽管研究出现了 表征TW中HIV流行的特征，大多数研究是横截面设计，通常是 包括少量样本量，通常在更广泛的风险群体中包含TW，例如与之发生性关系的男性 男人。这些做法挫败了可接受，有效招聘和研究方法的识别 在TW中使用并防止时间评估，因果推断以及研究结果的普遍性 TW人群。迄今为止，还没有强大的艾滋病毒发病率估计，也没有任何干预措施 TW之间预防艾滋病毒的疗效。拟议的美国队列研究将解决 这些局限 （波士顿，纽约市，巴尔的摩 - 华盛顿，亚特兰大和迈阿密大都会地区） 艾滋病毒获取的发生率和危险因素，获得生物行为预防方法的机会以及与 照顾那些HIV Seroconvert的人。该队列将包括种族/种族和文化上的不同样本 TW，在使用技术注入的招聘和保留方法的支持下。具体目的是：1） 确定新颖的，技术注册的招聘方法的效率和可接受性，以注册HIV- 未感染的TW进入了潜在的队列。 2）描述人口，社会经济，行为和 艾滋病毒未感染的TW的身心健康概况在东部的TW的第一个多站点队列中 美国南部3）估计美国高危东部和南部地区TW的艾滋病毒发病率 发病率以及相关的个人，社会和结构性风险因素。 4）估计预防艾滋病毒 艾滋病毒未感染的参与者的连续性以及新艾滋病毒感染的TW的艾滋病毒护理连续性。 为了实现这些目标 HIV感染的横截面比较组。这些数据将用于评估队列之间的差异 参与者和更广泛的人口以及入学时横断面发病率的估计。艾滋病毒 - 未感染的队列将遵循至少24个月，以估计艾滋病毒的发病率，趋势和风险因素 艾滋病毒收购。 Seroconvert的队列参与者将遵循另外6个月的时间来评估 潜在参与艾滋病毒护理连续性。研究结果将提供关键的流行病学 TW之间未来艾滋病毒预防研究的参数，提供了一个平台，其他研究 可以探索问题，并告知开发循证和可接受的HIV干预措施 减少美国TW中的艾滋病毒收购