Addressing violence and HIV cascade of care outcomes among transgender women

解决跨性别女性中的暴力和艾滋病毒护理结果连锁反应

• 批准号: 10077889
• 负责人: Kristi E Gamarel
• 金额: $ 21.31万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10077889
• 关键词: Address; Adherence; Adult; Affect; Birth; Caring; Chronic stress; Color; Communities; Community Health; Continuity of Patient Care; Data; Development; Diagnosis; Discrimination; Drops; Education; Enrollment; Epidemic; Female; Feminine; Future; Gender; Gender Identity; HIV; HIV diagnosis; Health Personnel; Immune; Imprisonment; Individual; Infection; Inflammatory Response; Intervention; Intervention Studies; Interview; Law Enforcement; Length; Link; Mediating; Medical; Michigan; Modeling; Outcome; Participant; Pathway interactions; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Poverty; Prevention program; Public Health; Randomized Controlled Trials; Recording of previous events; Research; Research Design; Resources; Risk; Role; Safety; San Francisco; Screening procedure; Self Efficacy; Services; Sexual and Gender Minorities; Symptoms; Testing; Time; Trauma; United States; Violence; Viral; Viral Load result; acceptability and feasibility; arm; base; care outcomes; cisgender; efficacy trial; empowered; empowerment; evidence base; experience; flexibility; follow-up; health care availability; health care quality; health disparity; implementation intervention; improved; intervention program; male; meetings; partner violence; post intervention; primary outcome; programs; public health relevance; rapid diagnosis; recruit; retention rate; secondary outcome; self esteem; seroconversion; social structure; stressor; substance use; therapy design; transgender; transgender women

PROJECT SUMMARY Transgender (`trans') women of color experience violence in a variety of contexts, including from partners, strangers, law enforcement, healthcare providers, and in public accommodations. Violence is consistently linked with avoiding care, suboptimal ART adherence, and lower odds of viral suppression via pathways including chronic stress, immune inflammatory response, posttraumatic stress disorder (PTSD) symptoms, and substance use. These epidemics are concurrent and mutually reinforcing, constituting a “syndemic” or synergistic interaction that contributes to documented inequities in HIV continuum of care outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in engagement in HIV care. In this R21 exploratory/developmental research application, we propose to adapt and pilot test a culturally-responsive, evidence-based, and trauma-informed intervention to improve engagement in HIV care (primary outcome), reduce PTSD symptoms (secondary outcome), and increase sustained viral suppression (tertiary outcome) among trans women of color living with HIV. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of the intervention, with a focus on the unique aspects of violence, gender affirmation needs, and engagement in HIV care by conducting interviews with trans women of color and key stakeholders to inform the adaptation. Our community advisory board consisting of trans women of color will review all adapted materials. The second aim seeks to examine the feasibility, acceptability, and preliminary efficacy of the adapted intervention in a one-arm pilot with follow-ups immediate and 3-month post- intervention. The third aim seeks to gather qualitative data from one-arm pilot participants to identify strategies to overcome barriers to implementing rigorous randomized controlled trial research designs with trans women of color within limited-resources settings. Study findings will provide the necessary groundwork for a subsequent community-engaged large-scale randomized controlled trial. Findings also have the potential to provide a blueprint to guide future research efforts with trans women of color who are often embedded in close- knit communities with few existing culturally-responsive services.

项目摘要 跨性别者（“跨性别”）有色妇女在各种情况下经历暴力，包括来自合作伙伴， 陌生人，执法，医疗保健提供者和公共住宿。暴力是一贯的 与避免护理，次优的艺术依从性和通过途径降低病毒抑制的几率有关 包括慢性应激，免疫炎症反应，创伤后应激障碍（PTSD）符号和 使用物质。这些发作是并发且相互加强的，构成了“联合性”或 协同互动有助于艾滋病毒的不平等现象。在底特律， 密歇根州，有色人种的跨性别女性是艾滋病毒的“危险最高”群体之一，在 参与艾滋病毒护理。在此R21探索性/发展研究应用程序中，我们建议适应和 试点测试一种具有文化响应，循证和创伤的干预措施，以改善参与 HIV护理（主要结果），减少PTSD症状（次要结果）并增加持续病毒 感染艾滋病毒有色妇女的抑制（第三级结果）。在适应模型的指导下， 我们的第一个目标旨在对干预进行系统的适应，重点是 暴力，性别感情需求和参与艾滋病毒护理 颜色和关键利益相关者，以告知改编。我们的社区顾问委员会由跨性别女性组成 颜色将审查所有改编的材料。第二个目标旨在检查可行性，可接受性和 对单臂飞行员进行的调整干预效率的初步效率 干涉。第三个目标旨在从一臂飞行员参与者那里收集定性数据，以确定策略 克服与跨性别女性实施严格的随机对照试验研究设计的障碍 在限量资源设置中的颜色。研究结果将为A提供必要的基础 随后的社区参与大规模随机对照试验。调查结果也有可能 提供蓝图，以指导未来的研究工作，以有色人种的跨性别妇女近在咫尺 编织社区很少有文化响应的服务。