An online HIV self-testing intervention with online-to-offline linkage to care for transgender women

在线艾滋病自检干预，线上线下联动，关爱跨性别女性

基本信息

批准号：
10772677
负责人：
Roman Shrestha
金额：
$ 10万
依托单位：
UNIVERSITY OF CONNECTICUT STORRS
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10772677
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Administrative Supplement Affect Asia Attitude Award Behavior Therapy Caring Cellular Phone Clinical Services Collaborations Communities Computers Continuity of Patient Care Counseling Country Diagnostic Reagent Kits Discrimination Drug usage Economics Employment Environment Epidemic Evidence based intervention Exclusion Face Fostering Government HIV HIV Infections Health Health Personnel Human immunodeficiency virus test Hybrids Individual Infection Injecting drug user Interpersonal Violence Intervention Laws Legal Malaysia Malaysian Medical Mental Depression Mental Health Modeling Names Occupations Online Systems Outcome Parents Phase Population Prevalence Prevention Professional counselor Research Resources Risk Risk Behaviors Sampling Service delivery model Services Sexual Transmission Sexual and Gender Minorities Study models Tablets Technology Testing Time Work acceptability and feasibility antiretroviral therapy cost effective distrust eHealth empowerment experience gender affirming care gender minority group health care service health inequalities high risk implementation context implementation determinants implementation science improved innovation interest laptop low and middle-income countries men who have sex with men pilot trial pre-exposure prophylaxis preference prevention service response scale up self testing service delivery sex social social stigma structural determinants substance use testing services theories tool transgender women treatment as usual uptake usability web platform willingness

项目摘要

Abstract Globally, transgender women (TGW) are disproportionately impacted by the HIV epidemic, with an estimated HIV prevalence of 19.1%. Malaysia, one of SE Asia's fastest-growing economies, is witnessing a rapid transition to its HIV epidemic. Malaysia has an estimated 80,000 TGW in-country, of which 12.4% are living with HIV. TGW experience numerous unique vulnerabilities to HIV, including discrimination in employment and economic opportunities, steering many TGW into high-risk occupations, such as sex work. High levels of stigma and discrimination against TGW by healthcare providers can foster a hostile environment toward TGW, complicating efforts to scale-up of HIV testing and prevention services among trans women, including preexposure prophylaxis (PrEP). Modeling studies suggest that increased HIV testing and uptake of PrEP is the most impactful and cost-effective strategy for reducing new infections. Despite this, only 37% of TGW in Malaysia have ever been HIV tested. HIV self-testing (HIVST) may be particularly impactful among TGW in Malaysia, where anti-trans stigma persists. Although willingness to use HIVST is high (48%) among Malaysian TGW, its use is still minimal due to a lack of access to HIVST kits, concerns related to misinterpreting results, and missed opportunities for counseling and linkage to care. In this context, eHealth represents an innovative platform to transform the face of HIV service delivery (i.e., HIVST and linkage to care). Leveraging eHealth technology for HIV services delivery is ideal given that nearly all (>93.6%) TGW use online technology (e.g., smartphone, tablet, computer) and indicate a strong preference for a web-based platform for HIVST. As such, HIVST with real-time e-counseling (eHIVST), integrated with online-to-offline (O2O) linkage to prevention and treatment, offers an innovative and empowering approach that could transform TGW's uptake of HIV testing and engagement in the broader HIV care continuum. This proposal – submitted in response to the Notice of Special Interest (Administrative Supplements for Research on Sexual and Gender Minority Populations; NOT-OD-22-032) – requests an SGM administrative supplement to add a sample of TGW to parent award (R34MH130233), a project that focuses on developing and testing a web-based platform, called Jom-TestPlus, that will incorporate an O2O service delivery model with eHIVST that facilitates rapid linkage to the HIV prevention and treatment continuum for men who have sex with men (MSM) in Malaysia. Expanding Jom-TestPlus to include TGW represents a significant opportunity to leverage existing resources from the parent award to address HIV and other health inequities among broader SGM populations. If successful, Jom-TestPlus will serve as a model that can easily be adapted for various health outcomes and healthcare services delivery in these populations and other LMICs.

抽象的在全球范围内，跨性别女性 (TGW) 受到艾滋病毒流行的影响尤为严重，其中马来西亚是东南亚增长最快的经济体之一，其艾滋病毒感染率估计为 19.1%。马来西亚估计有 80,000 名 TGW，其中 12.4% 仍在世。感染艾滋病毒的 TGW 面临许多独特的艾滋病毒脆弱性，包括就业歧视。和经济机会，引导许多 TGW 从事高风险职业，例如性工作。医疗保健提供者对 TGW 的污名和歧视可能会形成对 TGW 的敌对环境，使扩大跨性别女性艾滋病毒检测和预防服务的工作变得更加复杂，包括暴露前预防 (PrEP) 模型研究表明，增加 HIV 检测和 PrEP 的使用是关键。尽管如此，马来西亚只有 37% 的 TGW 是减少新感染的最有影响力和成本效益的策略。曾经接受过 HIV 检测。 HIV 自检 (HIVST) 对马来西亚的 TGW 可能特别有影响力，虽然马来西亚 TGW 中使用 HIVST 的意愿很高（48%），但其反跨性别污名依然存在。由于无法获得 HIVST 试剂盒、担心误解结果以及错过检测结果，使用率仍然很低在此背景下，电子医疗代表了一个创新平台。改变艾滋病毒服务提供的面貌（即艾滋病毒ST和与护理的联系）。鉴于几乎所有 (>93.6%) TGW 使用在线技术（例如智能手机、平板电脑、计算机）并表明对基于网络的 HIVST 平台的强烈偏好因此，HIVST 具有实时性。电子咨询（eHIVST）与线上线下（O2O）的预防和治疗联系相结合，提供了创新和赋权的方法可以改变 TGW 对艾滋病毒检测的接受和参与该提案是为了响应特别关注通知而提交的。（性少数群体研究的行政补充；NOT-OD-22-032） – 请求SGM行政补充，将TGW样本添加到家长奖（R34MH130233），一个项目专注于开发和测试名为 Jom-TestPlus 的基于 Web 的平台，该平台将整合 O2O 具有 eHIVST 的服务提供模式，有助于快速连接到艾滋病毒预防和治疗连续体对于马来西亚的男男性行为者 (MSM)，将 Jom-TestPlus 纳入其中代表了一项利用家长奖的现有资源来解决艾滋病毒和其他健康问题的重要机会如果成功，Jom-TestPlus 将成为一个可以轻松实现的模型。适应这些人群和其他中低收入国家的各种健康结果和医疗保健服务提供。