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，变性女性的新艾滋病毒诊断率很高，其中黑人、拉丁裔、 和其他有色人种跨性别女性占这些病例的大多数。 Continua 强调需要通过定期艾滋病毒检测、持续使用安全套来降低艾滋病毒传播风险 使用以及与艾滋病毒预防和护理的联系，例如艾滋病毒阴性者的暴露前预防（PrEP） 然而，艾滋病毒感染者的抗逆转录病毒治疗（ART）和病毒抑制。 这些连续体的每一步都有大幅下降，跨性别女性在 PrEP 方面远远落后 有色人种的跨性别女性经历了交叉耻辱，导致性别未得到满足。 肯定需求，这与艾滋病毒预防和持续成果的差异有关。 通过广泛的形成性工作，该项目旨在测试“Let’s Be”干预措施的有效性，该干预措施是 整合基于证据、创伤知情的艾滋病毒预防和治疗干预措施，所有这些都已 可行性、可接受性和对跨性别女性的初步疗效已得到证实。 旨在减轻交叉耻辱（包括艾滋病毒 耻辱），从而减少性危险行为，提高艾滋病毒预防措施（PrEP 使用）和治疗 Let's Be 在团体和个人层面开展工作，包括两个同行主导的项目。 通过远程医疗的组成部分：1) 先前测试的 Sheroes 状态中立干预措施，以及 2) 先前测试的 Sheroes 状态中立干预措施 测试了改编自 Healthy Divas 干预的个人级同伴导航，我们提出了一种混合类型。 1 有效性实施研究主要侧重于测试 Let's Be 的有效性，其次是 同时在实施过程中收集重要的经验教训。 依从性/病毒抑制，我们的次要结果是艾滋病毒风险的综合指标， 承认不存在一种适合所有人或所有人都期望的单一有效预防策略 我们将招募并随机抽取来自加利福尼亚州旧金山的 250 名有色人种跨性别女性。 和密歇根州底特律（按城市和艾滋病毒状况分层），对参与者进行 12 个月的跟踪并收集 生物学（即用于测量 PrEP 使用或病毒载量的干血斑）和行为数据。 由有色人种跨性别女性组成的咨询委员会将提供持续的咨询。 有效性实施设计将告知实施注意事项，以将 Let’s Be 扩大到其他领域 EHE 司法管辖区如果有效，调查结果将为紧急的有效性评估提供重要见解。 需要通过远程医疗提供基于创伤的多层次状态中立干预措施，以减少差异 有色人种跨性别女性是美国最优先预防艾滋病毒的人群之一。