ENTRUST - economic navigation and strengthening to realize unrestricted services for transgender women

ENTRUST - 经济导航和加强，为跨性别女性实现不受限制的服务

• 批准号: 10683578
• 负责人: Elena Cyrus
• 金额: $ 228万
• 依托单位: UNIVERSITY OF CENTRAL FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683578
• 关键词: Acquired Immunodeficiency Syndrome; Address; Budgets; Caring; Counseling; Development; Economics; Education; Epidemic; Epidemiologist; Evaluation; Exhibits; Goals; HIV; Health; Incidence; Intervention; Lead; Link; Methods; National Institute of Drug Abuse; Outcome; Participant; Perception; Policies; Population; Poverty; Productivity; Public Health; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Research; Research Priority; Sampling; Services; Socioeconomic Status; Statistical Methods; Substance Use Disorder; Testing; Training; Waiting Lists; barrier to care; community engaged research; community setting; economic disparity; experience; health economics; high risk; implementation intervention; implementation outcomes; implementation science; improved; marginalization; novel; pre-exposure prophylaxis; programs; psychosocial; satisfaction; screening, brief intervention, referral, and treatment; skills; social; social cohesion; standard of care; structural determinants; substance misuse; substance use; transgender; transgender women; transmission process; treatment arm

Background: Transgender women commonly live in poverty and have among the highest risk for substance use and HIV transmission, yet existing programs fail to address how structural factors such as socio-economic status and social marginalization are significant barriers to care and survival. The study objective is to evaluate the effect of a novel intervention called ‘ENTRUST’ (economic navigation and strengthening to realize unrestricted services for transgender women) that will combine group-based financial skill-building training with adapted screening, brief intervention and referral to treatment (SBIRT) counseling. Study aims are: Aim 1: To develop and pretest ENTRUST, an HIV status-neutral intervention consisting of group-based financial skill-building training with adapted SBIRT to increase social cohesion and financial skills (e.g., budgeting, financial goals setting) among transgender women, and facilitate linkage to substance use and HIV care/PrEP. The ADAPT-ITT framework will be used to create ENTRUST and pretest it in a sample of n=10 Aim 2: To conduct a pilot RCT among (n=80) transgender women to evaluate acceptability, feasibility, and preliminary efficacy of ENTRUST on a) linkage to substance use and HIV care/PrEP; b) economic strengthening and social cohesion. Participants will be randomized to the ENTRUST intervention arm (adapted SBIRT + economic navigation and strengthening) or the standard of care (adapted SBIRT) wait-listed control. To assess social cohesion, as well as other outcomes associated with linking to substance use and HIV care/PrEP and economic strengthening, Photovoice will be used to document and exhibit participant’s experiences. Aim 3: To examine the implementation of ENTRUST in group settings as guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Sequential, explanatory mixed methods will be used to evaluate participant’s perspectives on key implementation outcomes of acceptability, feasibility, and satisfaction and their interventional experiences, and, perceptions of programmatic sustainability. PI Cyrus, a trained social epidemiologist with a history of community engaged research, will lead a team of experts on health economics, microfinance, and sustainable economic interventions; implementation science and RCT evaluation; intervention implementation in group/community settings; development and implementation of substance use and HIV interventions in transgender populations; and advanced statistical methods. Significance: ENTRUST has the potential to shift regional and national policy by providing evidence of trans women’s needs and sustainable and practical approaches that can improve their overall health and productivity. In alignment with NIDA and Office of SGM research priorities, the proposed study will overcome structural and psychosocial barriers to facilitate trans women linking to substance use and HIV care/PrEP to reduce substance misuse and HIV incidence. The study adheres to the national HIV public health targets set forth by the 2019 presidential directives of Ending the HIV Epidemic (EHE) and the Office of AIDS Research priorities.

背景：跨性别女性普遍生活贫困，物质风险最高 的使用和艾滋病毒传播，但现有计划未能解决社会经济等结构性因素如何影响艾滋病毒的传播。 地位和社会边缘化是护理和生存的重大障碍。本研究的目的是评估。 名为“ENTRUST”（经济导航和加强以实现 为跨性别女性提供不受限制的服务），将基于团体的金融技能建设培训与 适应性筛查、简短干预和转诊治疗 (SBIRT) 咨询研究的目的是： 目标 1：开发和预测试 ENTRUST，这是一种 HIV 状态中立干预措施，包括基于团体的财务 通过适应的 SBIRT 进行技能建设培训，以提高社会凝聚力和财务技能（例如预算、 跨性别女性的财务目标设定），并促进与药物使用和艾滋病毒护理/PrEP 的联系。 ADAPT-ITT 框架将用于创建 ENTRUST 并在 n=10 的样本中对其进行预测试 目标 2：在 (n=80) 跨性别女性中进行试点随机对照试验，以评估可接受性、可行性和 ENTRUST 在 a) 与物质使用和 HIV 护理/PrEP 的联系 b) 经济强化方面的初步功效； 参与者将被随机分配到 ENTRUST 干预组（改编后的 SBIRT +）。 经济导航和加强）或护理标准（改编的 SBIRT）候补控制。 社会凝聚力，以及与药物使用和艾滋病毒护理/PrEP 相关的其他结果 为了增强经济实力，Photovoice 将用于记录和展示参与者的经历。 目标 3：按照覆盖范围、有效性、 采用、实施和维护 (RE-AIM) 框架将采用顺序的、解释性的混合方法。 用于评估参与者对可接受性、可行性和关键实施结果的看法 满意度及其干预经验，以及对计划可持续性的看法。 PI Cyrus 是一位训练有素的社会流行病学家，拥有社区参与研究的历史，他将领导一个团队 卫生经济学、小额信贷和可持续经济干预措施专家； 团体/社区环境中干预措施的制定和实施； 跨性别人群的药物使用和艾滋病毒干预措施；以及先进的统计方法。 意义：ENTRUST 有潜力通过提供跨区域和国家政策的证据来改变区域和国家政策。 妇女的需求以及可持续和实用的方法，可以改善她们的整体健康和生产力。 根据 NIDA 和 SGM 办公室的研究重点，拟议的研究将克服结构性和 促进跨性别女性与药物使用和艾滋病毒护理/PrEP联系起来以减少药物使用的社会心理障碍 该研究遵循 2019 年制定的国家艾滋病毒公共卫生目标。 结束艾滋病毒流行 (EHE) 和艾滋病研究办公室优先事项的总统指令。