A multi-level approach to improve HIV prevention and care for transgender women of color

改善跨性别有色人种女性艾滋病毒预防和护理的多层次方法

• 批准号: 10546317
• 负责人: Kristi E Gamarel
• 金额: --
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2022-11-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10546317
• 关键词: AIDS prevention; Address; Adherence; Automobile Driving; Behavioral; Biological; Black race; Blood; California; Caring; Cities; Communities; Computers; Consultations; Country; Data; Drops; Effectiveness; Ensure; Epidemic; Evidence based intervention; Gender; Glean; HIV; HIV Seronegativity; HIV diagnosis; HIV risk; Health; Health Educators; Hormones; Human immunodeficiency virus test; Hybrids; Income; Individual; Internet; Intervention; Intervention Studies; Latina; Legal; Link; Location; Logistics; Measures; Medical; Michigan; Modality; Modeling; Names; Outcome; Participant; Patient Self-Report; Persons; Plant Roots; Population; Prevalence; Prevention; Prevention strategy; Randomized; Risk; San Francisco; Sex Behavior; Spottings; Testing; Time; Trauma; Treatment outcome; United States; Viral; Viral Load result; Work; antiretroviral therapy; cisgender; community engagement; community partnership; community setting; condoms; consistent condom use; disparity reduction; effectiveness implementation design; effectiveness implementation study; efficacy evaluation; efficacy testing; evidence base; experience; falls; implementation framework; implementation process; improved; insight; intersectionality; intervention delivery; peer; pre-exposure prophylaxis; primary outcome; process evaluation; prospective; psychoeducation; psychologic; racism; recruit; scaffold; scale up; secondary outcome; sexual risk behavior; social; social stigma; telehealth; therapy adherence; therapy design; transgender; transgender women; transmission process; transphobia; uptake; women of color

ABSTRACT In the United States, transgender (`trans') women have high rates of new HIV diagnoses, with Black, Latina, and other trans women of color representing the majority of these cases. The HIV prevention and care continua emphasize the need for reducing HIV transmission risk via regular HIV testing, consistent condom use, and linkages to HIV prevention and care, such as pre-exposure prophylaxis (PrEP) among HIV-negative individuals and antiretroviral therapy (ART) and viral suppression among people living with HIV. However, there is substantial drop-off at each step of these continua with trans women falling far behind in terms of PrEP use and viral suppression. Trans women of color experience intersectional stigma that results in unmet gender affirmation needs, which have been linked to disparities in HIV prevention and continua outcomes. Building on extensive formative work, this project seeks to test the efficacy of the Let’s Be intervention, which is an integration of evidence-based, trauma-informed HIV prevention and treatment interventions, all of which have demonstrated feasibility, acceptability, and preliminary efficacy with trans women. Let’s Be is an HIV status- neutral intervention designed to mitigate the adverse health sequelae of intersectional stigma (including HIV stigma) thereby reducing sexual risk behaviors, increasing HIV prevention uptake (PrEP use), and treatment outcomes (viral suppression). Let’s Be works at both the group- and individual-levels, comprising two peer-led components via telehealth: 1) the previously tested Sheroes status-neutral intervention, and 2) previously tested individual-level peer navigation adapted from the Healthy Divas intervention. We propose a hybrid type 1 effectiveness-implementation study focused primarily on testing the efficacy of Let’s Be, while secondarily but simultaneously gleaning important lessons during implementation. Our primary outcome is PrEP adherence/viral suppression and our secondary outcome is a composite indicator of HIV risk that acknowledges there is not a singular effective prevention strategy that is appropriate or desired by all transgender women. We will recruit and randomize 250 trans women of color from San Francisco, California and Detroit, Michigan (stratified by city and HIV status), following participants for 12 months and collecting biological (i.e., dried blood spots to measure PrEP use or viral load) and behavioral data. Our community advisory boards composed of trans women of color will provide ongoing consultation. Our hybrid type 1 effectiveness-implementation design will inform implementation considerations to scale up Let’s Be to other EHE jurisdictions, if effective. Findings will provide critical insights into the efficacy evaluation of an urgently needed trauma-informed multi-level status-neutral intervention delivered via telehealth in reducing disparities among trans women of color, one of the highest priority HIV prevention populations in the United States.

抽象的 在美国，跨性别者（“跨性别”）妇女的新艾滋病毒诊断率很高，黑色，拉丁裔，拉丁裔， 以及其他代表大多数情况的有色妇女。艾滋病毒预防和关怀 Continua强调需要通过常规的HIV测试，一致的避孕套来降低HIV传播风险 使用以及与HIV预防和护理的联系，例如HIV阴性预防前预防（PREP） 艾滋病毒患者中的个体和抗逆转录病毒疗法（ART）和病毒抑制。然而， 在这些步骤中，每一步都有大量下降，而跨性别妇女在准备方面远远落后 使用和抑制病毒。有色人种的跨性别妇女经历了导致性别未满足性别的交叉污名 确认需求与预防艾滋病毒的差异有关并继续结果。建立 广泛的形成性工作，该项目旨在测试让我们干预的效率，这是一个 整合循证，创伤信息的艾滋病毒预防和治疗干预措施，所有这些都有 具有跨性别女性的可行性，可接受性和初步效率。让我们成为艾滋病毒状况 - 中性干预旨在减轻交叉污名的不良健康后遗症（包括艾滋病毒 污名）从而减少了性风险行为，增加了艾滋病毒的预防摄取（PREP使用）和治疗 结果（病毒抑制）。让我们在小组和个人级别上都可以工作，完成两个同行 通过远程医疗的组件：1）先前测试的Sheroes状态中性干预，以及2）以前 根据健康的DIVAS干预进行了测试的个体同行导航。我们提出了一种混合类型 1有效性实施研究主要重点是测试Let's Be的有效性，但 在实施过程中简单地收集重要的课程。我们的主要结果是准备 依从性/病毒抑制和我们的次要结果是艾滋病毒风险的综合指标 承认所有人都没有适当或需要的单一有效的预防策略 变性妇女。我们将从加利福尼亚州旧金山招募和随机分配250名有色人种的跨性别女性 以及密歇根州底特律（按城市和艾滋病毒状况进行分层），跟随参与者12个月并收集 生物学（即，干血点以测量PrEP使用或病毒载荷）和行为数据。我们的社区 由有色跨性别女性组成的咨询委员会将提供持续的咨询。我们的混合动力类型1 有效性实施设计将为实施注意事项提供信息，以扩展让我们成为其他 司法管辖区，如果有效。调查结果将为有效评估紧急评估提供关键的见解 通过远程医疗提供了所需的创伤信息的多级状态中性干预措施，以减少差异 在有色人种的跨性别妇女中，美国优先的艾滋病毒预防人群之一。