Strengthening the HIV care continuum for transgender women living with HIV in Malaysia

加强马来西亚感染艾滋病毒的跨性别女性的艾滋病毒护理连续性

• 批准号: 10650426
• 负责人: Jeffrey Allen Wickersham
• 金额: $ 21.81万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10650426
• 关键词: AIDS prevention; Abbreviations; Address; Adherence; Affect; Asia; COVID-19; Caring; Chronic Disease; Client; Communities; Complex; Continuity of Patient Care; Country; Data; Development; Diabetes Mellitus; Diagnosis; Discrimination; Drops; Drug usage; Economics; Employment; Environment; Evidence based intervention; Feasibility Studies; Fostering; Future; Goals; Government; HIV; HIV Seropositivity; HIV antiretroviral; Health; Health Personnel; Health Professional; Health Services; Healthcare; Human immunodeficiency virus test; Income; Individual; Injecting drug user; International; Interpersonal Violence; Intervention; Interview; Knowledge; Laws; Link; Malaysia; Malaysian; Malignant Neoplasms; Measures; Medical; Modeling; Morbidity - disease rate; Muslim population group; Names; Newly Diagnosed; Occupations; Outcome; Patients; Persons; Physicians; Population; Prevalence; Process; Protocols documentation; Public Health; Publishing; Religion; Reporting; Research; Resource-limited setting; Risk; Scientist; Social Work; Source; Stigmatization; System; Testing; Treatment outcome; Trust; Vulnerable Populations; Work; acceptability and feasibility; antiretroviral therapy; care outcomes; care systems; design; empowerment; evidence base; experience; gender affirming care; health care service; heuristics; high risk; improved; innovation; intervention program; men who have sex with men; mortality; peer; pilot test; programs; response; sex; shared decision making; skills; social; social stigma; structural determinants; transgender; transgender women; treatment as usual; treatment services; viral transmission

Project Abstract HIV antiretroviral therapy (ART) is effective at lowering HIV-related mortality among people with HIV (PWH) and reducing onward transmission of the virus. The HIV care continuum has emerged as an internationally recognized framework for measuring and evaluating HIV treatment outcomes. For patients, however, navigating the complex system of HIV care services can be complex and challenging, particularly patients who face multiple layers of social stigma. Transgender women (TGW), for example, experience several unique vulnerabilities to HIV, including structural factors such as discrimination in employment and economic opportunities, steering TGW toward more high-risk occupations, such as sex work. Other structural factors, including civil and religious laws that ban TGW from changing their name or sex on government-issued identification, further limits TGW’s autonomy and ability to safely and effectively navigate social and health care services. In the context of health care, being both HIV-positive and transgender presents a dual-layer of stigma for patients that may lead to suboptimal encounters with health care professionals. Peer navigator programs (PNP), however, have been shown to improve engagement in medical care for people with chronic diseases, including patients with cancer, diabetes, and HIV. Currently, however, no published research has examined the impact of PNP among HIV+ TGW in Malaysia. Thus, in response to PA-20-145, “Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes”, we propose to develop and evaluate a peer navigation intervention (“MyLink+”) to engage (or re-engage) HIV+ TGW in the HIV care continuum. The specific aims of this application are: (1) Using the ADAPT-ITT intervention adaptation framework,20 create an adapted peer navigation program (“MyLink+”) to engage or reengage HIV+ Malaysian TGW in HIV treatment services; (2) To conduct a pilot RCT of the adapted PNP intervention (MyLink+) vs. enhanced treatment-as-usual (TAU+) among HIV+ TGW to measure feasibility, acceptability and preliminary efficacy; and (3) Using data from Aim 2, to conduct dyadic analyses of peers and clients to better understand shared decision-making and linkage to care outcomes. Dyadic effects between peer navigators and patients will be explored using data from baseline (T0) and weeks 12 (T12) and 24 (T24), including trust, compatibility, and perceived quality of peer-client interactions on (re-)engaging in ART. Findings from this research will yield important information about the use of PNP interventions for improving HIV care outcomes in the Malaysian context. Our results will also inform the optimal strategy for deploying PNP among a highly stigmatized and vulnerable population (HIV+ TGW) and illustrate the impact of shared decision-making processes between peer navigators and patients. Furthermore, our results will guide the development of a research protocol for a future R01 and large-scale RCT of the adapted PNP in Malaysia. This research will have widespread implications for the use of peer navigators to improve HIV outcomes among a highly vulnerable population in a unique, international context.

项目摘要 HIV 抗逆转录病毒治疗 (ART) 可有效降低 HIV 感染者 (PWH) 和 HIV 感染者与 HIV 相关的死亡率 减少病毒的继续传播。艾滋病毒护理连续性已成为国际公认的。 然而，对于患者来说，要在复杂的系统中导航。 艾滋病毒护理服务可能复杂且具有挑战性，特别是面临多层社会耻辱的患者。 例如，跨性别女性 (TGW) 面临着多种独特的艾滋病毒脆弱性，包括结构性因素 例如就业和经济机会方面的歧视，引导 TGW 转向更高风险的职业， 其他结构性因素，包括禁止 TGW 更改姓名的民法和宗教法。 政府颁发的身份证明上的性别进一步限制了 TGW 的自主权以及安全有效地驾驭社交的能力 在医疗保健方面，艾滋病毒呈阳性和跨性别者呈现出双层的关系。 患者的耻辱可能会导致与医疗保健专业人员的接触不佳， 然而，已被证明可以改善慢性病患者（包括患者）的医疗护理参与度 然而，目前尚无已发表的研究探讨 PNP 对 HIV+ 的影响。 因此，针对 PA-20-145，“艾滋病毒预防、检测、坚持和保留方面的创新以优化 “艾滋病毒预防和护理连续体成果”，我们建议开发和评估同伴导航干预措施 （“MyLink+”）让 HIV+ TGW 参与（或重新参与）HIV 护理连续体。该应用程序的具体目标是： (1) 使用 ADAPT-ITT 干预适应框架，20 创建一个适应的同伴导航程序（“MyLink+”） (2) 对改编后的 PNP 进行试点 RCT HIV+ TGW 中干预 (MyLink+) 与常规强化治疗 (TAU+) 的比较，以衡量可行性、可接受性 和初步成效；(3) 使用目标 2 的数据，对同行和客户进行二元分析，以更好地 了解同行导航者和患者之间的共同决策和与护理结果的联系。 使用基线 (T0) 以及第 12 周 (T12) 和第 24 周 (T24) 的数据进行探索，包括信任、兼容性和感知 这项研究的结果将产生重要的信息。 关于在马来西亚背景下使用 PNP 干预措施改善艾滋病毒护理结果的信息我们的结果也将。 告知在高度污名化和弱势群体（HIV+ TGW）中部署 PNP 的最佳策略，以及 说明同行导航者和患者之间共享决策过程的影响此外，我们的结果。 将指导马来西亚 PNP 未来 R01 和大规模 RCT 的研究方案的制定。 这项研究将对使用同伴导航器来改善高危人群中的艾滋病毒结果产生广泛的影响。 独特的国际背景下的弱势群体。

项目成果

Drivers of Active Amphetamine-Type Stimulant Use among Transgender Women in Malaysia: A Cross-Sectional Study.

马来西亚跨性别女性使用活性苯丙胺类兴奋剂的驱动因素：一项横断面研究。

• DOI: 10.21203/rs.3.rs-3607148/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: JadKarim,Luzan;Galka,Jonathan;Shrestha,Roman;Mazzeo,Rosanna;Restar,Arjee;Gautam,Kamal;Azwa,Iskandar;Wickersham,JeffreyA
• 通讯作者: Wickersham,JeffreyA