PrEP Engagement Trajectories Among Transgender Women in the United States

美国跨性别女性的 PrEP 参与轨迹

• 批准号: 10223886
• 负责人: Erin Eileen Cooney
• 金额: $ 4.85万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10223886
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Advanced Development; American; Americas; Behavioral; Behavioral Sciences; Belief; Cohort Studies; Color; Data; Development; Diagnosis; Distal; Enrollment; Epidemic; Fellowship; Future; Geography; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Healthcare; Heterogeneity; High Prevalence; Hormones; Incidence; Infection; Infrastructure; Intervention; Interview; LGBT Health; Latina; Latinx; Link; Logistic Regressions; Longitudinal Surveys; Longitudinal cohort; Marketing; Medical; Mentors; Mentorship; Methodology; Methods; Modality; Modeling; National Institute of Mental Health; Nature; Oral; Parents; Pathway Analysis; Pattern; Population; Poverty; Prevalence; Public Health Schools; Recommendation; Reporting; Research; Research Personnel; Research Priority; Research Training; Risk; Risk Factors; Sample Size; Sampling; Shoulder; Site; Strategic Planning; System; Tenofovir; Time; Tissues; Training; Transportation; United States; United States National Institutes of Health; Variant; base; cohort; data infrastructure; demographics; design; doctoral student; experience; follow-up; health care service; housing instability; innovation; pre-exposure prophylaxis; prevent; prospective; rectal; secondary analysis; skill acquisition; social stigma; socioeconomics; tool; training opportunity; transgender women; transphobia; uptake

PROJECT SUMMARY/ABSTRACT Background: Transgender women (TW) shoulder the highest prevalence of HIV compared to other key populations in the epidemic with 14% of all TW in the United States (US) living with HIV. HIV pre-exposure prophylaxis (PrEP) has been available in the US since 2012 yet uptake has been slow and challenges related to adherence have emerged. A comprehensive understanding of the socioeconomic, behavioral and systems factors that contribute to PrEP uptake, adherence and persistence among TW will illuminate potential mechanisms for optimizing PrEP engagement and reducing HIV incidence. Study Goal and Aims: This study will identify factors that will optimize PrEP uptake, adherence and persistence among transgender women at risk for HIV acquisition in the United States. Specific aims are to: 1) Identify groups of TW with distinct longitudinal PrEP engagement trajectories; 2) Examine associations between membership in each PrEP engagement group with demographic, socioeconomic, behavioral and systems indicators; and 3) Develop a model for the mechanisms by which socioeconomic, behavioral and systems factors impact TW's PrEP engagement trajectories. Approach: This explanatory, sequential mixed-methods study will leverage the data and infrastructure of an existing parent study, which has established a longitudinal cohort of 1,215 TW at risk of HIV acquisition in the United States. Aims 1 and 2 will be secondary analyses of longitudinal survey data collected by the parent study. Aim 1 will utilize group-based trajectory modeling, an extension of latent class analysis appropriate for longitudinal data, to identify groups of TW who follow similar patterns of PrEP uptake, adherence and persistence over 24-months of follow-up. Aim 2 will use multinomial logistic regression to identify factors associated with membership in each PrEP trajectory group identified in Aim 1. Building on findings from Aims 1 and 2, Aim 3 will qualitatively explore the mechanisms by which socioeconomic, behavioral and systems factors impact TW's PrEP engagement trajectories through in-depth interviews with TW and stakeholders. Findings will be triangulated to develop a more nuanced understanding of this important topic. Fellowship Information: The proposed research is the doctoral dissertation of Ms. Erin Cooney, PhD student at Johns Hopkins Bloomberg School of Public Health. The training is mentored by experts in HIV prevention including one Sponsor, two Co-sponsors, and two Scientific Advisors with complementary methodological and topical expertise. The training plan outlines formal coursework, ongoing mentorship, research implementation, and other advanced training opportunities to prepare Ms. Cooney to become a leading independent researcher in HIV prevention. The proposed study directly aligns with the NIMH's Division of AIDS Research priorities of expanding approaches to integrate behavioral science with effective biomedical strategies for HIV prevention.

项目概要/摘要 背景：与其他关键人群相比，跨性别女性 (TW) 的艾滋病毒感染率最高 美国 (US) 14% 的台湾人感染了艾滋病毒。 HIV暴露前 预防 (PrEP) 自 2012 年以来已在美国推出，但采用速度缓慢且存在相关挑战 坚持已经出现。对社会经济、行为和系统的全面理解 有助于 TW 人群接受、坚持和坚持 PrEP 的因素将揭示其潜力 优化 PrEP 参与和降低 HIV 发病率的机制。 研究目的和目的：本研究将确定优化 PrEP 吸收、依从性和 在美国，跨性别女性中存在感染艾滋病毒的风险。具体目标是：1) 确定具有不同纵向 PrEP 参与轨迹的 TW 群体； 2）检查关联 每个 PrEP 参与小组的成员之间的人口、社会经济、行为和 系统指标； 3) 开发一个机制模型，通过该模型，社会经济、行为和 系统因素影响 TW 的 PrEP 参与轨迹。 方法：这项解释性、顺序混合方法研究将利用 现有的家长研究，该研究建立了一个由 1,215 名有感染艾滋病毒风险的台湾人组成的纵向队列 美国。目标 1 和 2 将是对家长收集的纵向调查数据进行二次分析 学习。目标 1 将利用基于组的轨迹建模，这是潜在类别分析的扩展，适用于 纵向数据，以确定遵循相似的 PrEP 摄取、依从性和使用模式的 TW 群体 坚持24个月的随访。目标 2 将使用多项逻辑回归来识别因素 与目标 1 中确定的每个 PrEP 轨迹组的成员资格相关。以目标 1 的发现为基础 2、目标 3 将定性探索社会经济、行为和系统的机制 通过对 TW 和利益相关者的深入访谈，了解影响 TW PrEP 参与轨迹的因素。 将对调查结果进行三角测量，以便对这一重要主题有更细致的理解。 奖学金信息：拟议的研究是博士生 Erin Cooney 女士的博士论文 约翰·霍普金斯大学彭博公共卫生学院。培训由艾滋病预防专家指导 包括一名申办者、两名共同申办者和两名科学顾问，具有互补的方法和方法 专题专业知识。培训计划概述了正式课程、持续指导、研究实施、 和其他高级培训机会，帮助库尼女士成为领先的独立研究员 在艾滋病毒预防方面。拟议的研究与 NIMH 艾滋病研究部门的优先事项直接一致 扩大将行为科学与有效的艾滋病毒预防生物医学策略相结合的方法。