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

• 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
• 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

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，跨性别妇女（TGW）受HIV流行的影响不成比例 估计HIV患病率为19.1％。马来西亚是东南亚亚洲发展最快的经济之一，目睹了迅速的 过渡到其HIV流行。马来西亚估计有80,000个TGW国内，其中12.4％居住 与艾滋病毒。 TGW经历了许多独特的艾滋病毒脆弱性，包括歧视就业 和经济机会，将许多TGW转向高危占领，例如性工作。高水平 医疗保健提供者对TGW的污名和歧视可以促进敌对的环境，以实现TGW， 使跨性别妇女之间的艾滋病毒测试和预防服务扩展的努力变得复杂，包括 预防预防（PREP）。建模研究表明，增加的HIV检测和PREP的吸收是 减少新感染的最有影响力和成本效益的策略。尽管如此，马来西亚只有37％的TGW 曾经经过艾滋病毒测试。在马来西亚的TGW中，艾滋病毒自我测试（HIVST）可能特别影响 反跨性别的污名持续存在的地方。尽管在马来西亚TGW中使用HIVST的意愿很高（48％），但 由于缺乏获得HIVST套件的访问，与失踪结果有关的问题以及错过的问题，使用仍然很少。 咨询和联系的机会。在这种情况下，eHealth代表了一个创新的平台 改变艾滋病毒服务的面孔（即HIVST和与Care的联系）。利用eHealth技术 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），表明对HIVST的基于Web的平台非常偏爱。因此，HIVST实时 与在线对官能线（O2O）链接到预防和治疗的E-counseling（EHIVST）提供了一个 可以改变TGW对HIV测试和参与的创新和授权方法 更广泛的艾滋病毒护理连续体。该提案 - 响应特殊利益通知提交 （有关性和性别少数群体研究的行政补充；非od-22-032） - 请求SGM管理补充剂以将TGW样本添加到父母奖（R34MH130233），一个项目 重点是开发和测试一个名为JOM-TESTPLUS的基于Web的平台，该平台将结合使用O2O 使用EHIVST的服务交付模型促进了与HIV预防和治疗连续性的快速联系 适用于马来西亚与男人发生性关系的男人。扩展jom-testplus以包括tgw表示 利用父母奖中现有资源的重要机会来解决艾滋病毒和其他健康状况 更广泛的SGM人群之间的不平等。如果成功，JOM-TESTPLUS将作为一个很容易成为的模型 适用于这些人群和其他LMIC中的各种健康成果和医疗服务提供。