Piloting a multi-level intervention to promote viral suppression among transgender women living with HIV

试点多层次干预措施，促进感染艾滋病毒的跨性别女性的病毒抑制

• 批准号: 10676883
• 负责人: CLARE L BARRINGTON
• 金额: $ 25.93万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676883
• 关键词: Address; Adherence; Adult; Affect; Appointment; Area; Behavior Therapy; Belief; Buffers; Caribbean region; Caring; Clinic; Communities; Consultations; Continuity of Patient Care; Control Groups; Counseling; Discrimination; Dominican Republic; Dose; Education; Emotional; Exclusion; Feeling; Focus Groups; Fright; HIV; Health; Health Status; Health education; Individual; Interruption; Intervention; Interview; Latin America; Modeling; Modification; Outcome; Participant; Pathway interactions; Population; Prevalence; Process; Provider; Randomized; Recommendation; Reporting; Resources; Site; Surveys; Training; Treatment outcome; Trust; Viral; Viral Load result; Woman; Work; arm; care outcomes; cisgender; cohesion; comparison intervention; experience; female sex worker; gender affirmation; improved; insight; internalized stigma; intervention participants; maltreatment; negative affect; peer; public health relevance; randomized trial; response; scale up; self esteem; sex; social cohesion; social determinants; social stigma; staff intervention; substance use; transgender; transgender women; trend

Project Summary/Abstract: Transgender (trans) women across the globe experience a disproportionate burden of HIV with an estimated global HIV prevalence of 19%. Trans women living with HIV also have worse HIV care and treatment outcomes than cisgender adults, including lower rates of viral suppression. Multilevel responses are needed to improve HIV outcomes among trans women by simultaneously and synergistically addressing individual, provider, and community dynamics. Trans women experience intersectional stigma due to the frequent association between trans identity, HIV, and sex work. These intersecting forms of stigma include internalized stigma in the form of applying negative beliefs and enacted stigma in the form of exclusion and discrimination. Developing social cohesion can be a critical first step in community processes to address stigma. We adapted a multilevel intervention, Abriendo Puertas (Opening Doors), including individual counseling, peer navigation, and community mobilization for trans women living with HIV in the Dominican Republic using an iterative consultation process. We assessed feasibility and initial effects on HIV care and treatment behaviors with 30 trans women living with HIV (no control group) and documented positive trends in ART use (70% to 85%, p=0.03), missed care appointments (35% to 20%, p=0.39) and ART adherence (86% to 96%, p=0.50). Participants emphasized that trusting intervention staff and being treated with respect in individual sessions allowed them to improve self-esteem. Limited trust and cohesion among trans women, however, inhibited more extensive engagement with peer navigation and community activities. In response, we identified two key modifications to strengthen and further tailor the intervention for trans women living with HIV: 1) integrate more gender affirming content, including with providers and 2) focus on building trust among trans women through sequential implementation of individual and then community components. The purpose of the proposed study is to conduct a pilot randomized trial of the GAP model, or Gender-affirming Abriendo Puertas. In Aim 1, we will assess preliminary efficacy of the GAP intervention on viral suppression among trans women randomized to the intervention compared to those randomized to control. We will randomly assign trans women living with HIV to the GAP intervention (n=60) (individual counseling, peer navigation, provider training, and community support building) or control group (n=60). We will conduct baseline, 6, and 12-month surveys and viral load assessments to assess differences across study arms. In Aim 2, we will examine pathways of influence (e.g. decreased stigma, increased cohesion) and experiences with the intervention to identify specific areas for improvement and scale up. We will conduct longitudinal qualitative interviews at baseline, 6, and 12 months with 20 intervention participants and, together with surveys, assess how GAP participation affects pathways between stigma, cohesion, and HIV outcomes. We will also elicit experiences and recommendations from providers and intervention staff in focus groups at 6 (n=2) and 12 months (n=2).

项目摘要/摘要： 全球跨性别者（跨性别）妇女经历了艾滋病毒的不成比例负担 全球艾滋病毒患病率为19％。感染艾滋病毒的跨性别妇女的艾滋病毒护理和治疗结果也较差 比奇异的成年人，包括病毒抑制率较低。需要多级响应来改进 通过同时且协同解决个人，提供商和 社区动态。跨性别女性由于经常关联 跨性别身份，艾滋病毒和性工作。这些相交的污名形式包括以 以排斥和歧视的形式应用负面信念并制定污名。发展社会 凝聚力可能是解决污名的社区过程中的关键第一步。我们改编了一个多级 干预，Abriendo Puertas（开门），包括个人咨询，同行导航和 为多米尼加共和国的跨性别妇女动员社区动员使用迭代 咨询过程。我们评估了30条对艾滋病毒护理和治疗行为的可行性和初始影响 患有艾滋病毒的跨性别妇女（无对照组），并记录了艺术使用的积极趋势（70％至85％， p = 0.03），错过的护理约会（35％至20％，p = 0.39）和艺术依从性（86％至96％，p = 0.50）。 参与者强调，信任干预人员并在各个会议上受到尊重 使他们能够提高自尊心。但是，跨性别妇女之间的信任和凝聚力有限，抑制了更多 与同行导航和社区活动的广泛参与。作为回应，我们确定了两个关键 修改以加强和进一步量身定制艾滋病毒的跨性别妇女的干预措施：1）整合更多 性别确认内容，包括提供者和2）专注于通过跨性别妇女建立信任 顺序实施个人，然后是社区组成部分。拟议研究的目的 是为了进行差距模型或性别肯定的艾伯利恩·波尔塔尔（Abriendo Puertas）进行试验随机试验。在AIM 1中，我们将 评估差距干预对跨性别女性抑制病毒抑制的初步疗效 与随机对照的干预相比，将其随机分配给干预措施。我们将随机分配trans 患有艾滋病毒的妇女接受差距干预（n = 60）（个人咨询，同行导航，提供者培训， 和社区支持建设）或对照组（n = 60）。我们将进行基线，6个月和12个月的调查 和病毒载荷评估以评估整个研究组的差异。在AIM 2中，我们将检查 影响（例如，污名降低，内聚力增加）和干预措施的经验 改进和扩展的特定领域。我们将在基线上进行纵向定性访谈 6个和12个月，有20名干预参与者，并与调查一起评估差距的参与方式 影响污名，内聚和HIV结果之间的途径。我们还将获得经验， 在6（n = 2）和12个月（n = 2）的焦点小组提供者和干预人员的建议。