A Gender-Affirming Stigma Intervention to Improve Substance Misuse and HIV Risk among Transgender Women

性别肯定耻辱干预措施可改善跨性别女性的药物滥用和艾滋病毒风险

• 批准号: 10641010
• 负责人: Arryn Aleia Guy
• 金额: $ 17.99万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641010
• 关键词: AIDS prevention; Address; Area; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Caring; Collaborations; Communities; Coping Skills; Data; Diagnostic; Distress; Educational workshop; Effectiveness; Epidemic; Evidence based intervention; Feedback; Feeling; Focus Groups; Foundations; Fright; Future; Gender Identity; Goals; HIV; HIV disparities; HIV risk; Hazardous Substances; Health; Health Personnel; Healthcare; High Risk Woman; Human immunodeficiency virus test; Hybrids; Individual; Intervention; Interview; Learning; Life; Manuals; Mentors; Mentorship; Methods; Modeling; Modification; Needs Assessment; Outcome; Persons; Phase; Play; Policies; Population; Positioning Attribute; Process; Provider; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Risk; Role; Running; Scholarship; Science; Self Care; Services; Sexual and Gender Minorities; Shame; Social isolation; Source; Stigmatization; Strategic Planning; Substance Use Disorder; System; Testing; Theoretical model; Therapeutic Intervention; Thinking; Training; United States; United States Dept. of Health and Human Services; United States National Institutes of Health; Victimization; Violence; Woman; Work; analytical method; behavior change; behavioral health; behavioral response; career; community based participatory research; community engaged research; community organizations; community partnership; comparison intervention; consistent condom use; coping; design; effectiveness testing; effectiveness/implementation trial; evidence base; experience; flexibility; follow-up; gender affirmation; gender minority group; health inequalities; high risk; improved; internalized stigma; marginalized population; meetings; mindfulness; model design; peer; physical assault; pilot test; pilot trial; post intervention; programs; psychologic; psychological distress; recruit; scale up; sex; sexual assault; skills; social health determinants; social stigma; substance misuse; substance use; symposium; telehealth; therapy development; transgender; transgender women; transmission process; treatment as usual; usability; user centered design

The applicant seeks this K99/R00 award to achieve research independence in intervention science, with a focus on using community-based participatory research (CBPR) principles to reduce the negative psychological and behavioral sequela that result from stigma. Transgender (trans) women are at high risk for HIV and substance misuse due in part to elevations in three interrelated areas underpinned by stigma: internalized stigma, psychological distress, and healthcare avoidance. Acceptance and Commitment Therapy (ACT) improves internalized stigma, psychological distress, and treatment engagement and may thereby reduce substance misuse and HIV risk. However, the effects of a gender affirming ACT intervention on internalized stigma, psychological distress, healthcare avoidance, and subsequent substance misuse and HIV risk among trans women are unknown. Peer-led interventions are essential to decrease trans women’s sense of isolation, share skills for coping with daily sources of stigma, and encourage pride in one’s gender identity. ACT is a promising evidence-based intervention for peer delivery as ACT has been effectively delivered by non-therapists before. The applicant thus proposes to adapt ACT to create a gender-affirming wellness intervention (ACT+GA) that targets substance misuse and HIV risk among trans women (K99 phase), conduct an open pilot trial of ACT+GA (K99 phase), and then run a rigorous test of its effectiveness, acceptability, appropriateness, and feasibility (R00 phase). During the K99 phase, she will collaborate with her mentorship team and the assembled community- advisory board to develop the ACT+GA manual based on focus group (k = 4-6, n = 4-6 trans women/group) and stakeholder feedback (n = 10-15 treatment providers, organizational leaders, and peer staff), and then address any necessary refinements identified during open pilot testing (n = 10 trans women). During the R00 phase, trans women will be randomly assigned to ACT+GA (n = 62) or treatment-as-usual (n = 62). Internalized stigma, psychological distress, healthcare avoidance, substance use, and HIV risk will be assessed at baseline, post- intervention, and at three and six-month follow-up. The coordinated training plan will allow the applicant to build on her strong foundation in CBPR and scholarship of HIV disparities in sexual and gender minoritized (SGM) populations, developing new skills in three areas critical to her independence: (1) adaptation of ACT for telehealth delivery by trans women, (2) early phase behavioral intervention development and testing, (3) depth of learning and application of qualitative and longitudinal quantitative methods. During the K99 Phase, her mentorship team will draw on its sustained track record in mentoring junior scholars to full independence. This will be accomplished through regular meetings, directed readings, hands-on tutorials, and support of her activity in workshops, seminars, and conferences. Completion of the R00 phase will generate data to support a future R01 application to test the effectiveness and implementation of ACT+GA on a larger scale. The K99/R00 award will thus provide the applicant with a platform to launch her independent career in transgender health and intervention science.

申请人寻求这一K99/R00奖，以实现干预科学的研究独立性，重点 关于使用社区参与研究（CBPR）原则来减少负面心理和 由污名导致的行为后遗症。跨性别者（跨性别）妇女对艾滋病毒和底物有高风险 滥用部分是由于污名所支撑的三个相互关联的地区的海拔高度造成的：内在的污名， 心理困扰和避免医疗保健。接受和承诺疗法（ACT）改善 内部化的污名，心理困扰和治疗参与，可能会减少物质 滥用和艾滋病毒的风险。但是，性别确认行为干预对内在污名的影响， 跨性别的心理困扰，避免医疗保健以及随后的药物滥用和艾滋病毒风险 女人是未知的。同伴领导的干预措施对于降低跨性别女性的孤立感至关重要 应对日常污名来源的技能，并鼓励以性别认同感到自豪。行为是一个承诺 以前，非治疗师有效地提供了基于证据的同行交付作为ACT的干预措施。 因此，适当的提议适应行为以创建性别肯定的健康干预措施（ACT+GA） 针对跨性别妇女（K99期）之间的物质滥用和艾滋病毒风险，进行ACT+GA的开放式试验试验 （K99阶段），然后对其有效性，可接受性，适当性和可行性进行严格测试（R00 阶段）。在K99阶段，她将与她的Mentalship团队和集会的社区合作 - 咨询委员会根据焦点小组制定ACT+GA手册（K = 4-6，n = 4-6跨性别女性/组）和 利益相关者的反馈（n = 10-15个治疗提供者，组织领导者和同伴员工），然后解决 在开放试点测试期间鉴定出的任何必要的改进（n = 10个跨性别女性）。在R00阶段，trans 妇女将被随机分配为ACT+GA（n = 62）或与众不同（n = 62）。内部污名， 心理困扰，避免医疗保健，药物使用和HIV风险将在基线后进行评估 干预，以及三个月和六个月的随访。协调的培训计划将允许申请人建造 在她在CBPR和性别少的艾滋病毒差异方面的强大基础上（SGM） 人群，在对她独立至关重要的三个领域发展新技能：（1）改编远程医疗的行为 跨性别女性的交付，（2）早期行为干预的发展和测试，（3）学习深度 以及定性和纵向定量方法的应用。在K99阶段，她的Mentalship团队 将借鉴其在心理学者中持续的往绩，使其完全独立。这将完成 通过常规会议，定向阅读，动手教程以及对她在研讨会的活动的支持， 半人物和会议。 R00阶段的完成将生成数据以支持未来的R01应用程序 在更大范围内测试ACT+GA的有效性和实施。因此，K99/R00奖将提供 该平台启动她在跨性别健康和干预科学领域的独立职业的申请人。