Transgender Men and HIV in Uganda: PrEP Uptake and Persistence

乌干达的跨性别男性与艾滋病毒：PrEP 的采用和坚持

• 批准号: 10092257
• 负责人: Andrew Mujugira
• 金额: $ 10万
• 依托单位: INFECTIOUS DISEASES INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092257
• 关键词: AIDS prevention; Adherence; Administrative Supplement; Africa South of the Sahara; African; Alcohol consumption; Anal Sex; Behavior; Behavioral; Birth; Blood; Caring; Characteristics; Chlamydia trachomatis; Clinic; Cluster randomized trial; Communicable Diseases; Communities; Counseling; Data; Discrimination; Drug usage; Employment; Face; Feedback; Female; Funding; Future; Gender Identity; Goals; HIV; HIV Seronegativity; HIV risk; Health; Hormone use; Hormones; Immunoassay; Individual; Institutes; Interview; Interviewer; Lateral; Measures; Mental Depression; Mental Health; Methods; Modeling; Neisseria gonorrhoeae; Parents; Participant; Pattern; Perception; Pharmaceutical Preparations; Policies; Policy Maker; Population; Prevalence; Prevention; Prevention Research; Preventive Intervention; Psychiatrist; Publishing; Qualitative Methods; Questionnaires; Reporting; Research; Research Infrastructure; Resources; Respondent; Risk; Risk Assessment; Risk Behaviors; STI prevention; Sampling; Services; Sex Behavior; Sexual Health; Sexual and Gender Minorities; Sexually Transmitted Diseases; Spottings; Tenofovir; Testing; Time; Trichomonas vaginalis; Uganda; United States National Institutes of Health; Urine; Vagina; Visit; Woman; Work; base; behavior test; cisgender; cohort; common treatment; condoms; contextual factors; data resource; design; effectiveness testing; experience; gender dysphoria; high risk; infection risk; male; men; men who have sex with men; neglect; partner violence; peer; peer networks; point of care; pre-exposure prophylaxis; prevention evaluation; prevention service; primary outcome; programs; randomized trial; recruit; response; risk perception; scale up; sex; sexual HIV transmission; sexual health intervention; sexual risk behavior; sexual risk taking; social; social stigma; transgender; transgender men; transgender women; uptake; willingness

PROJECT SUMMARY/ABSTRACT Transgender men (trans men; assigned female sex at birth but identify as male) are generally thought to be at low risk of HIV acquisition, typically because of the assumption that they have sex with cisgender women (born female, identify as female) which is considered low risk sexual activity. Emerging data from resource-rich settings show that trans men often face many of the same high risks as transgender women (trans women; assigned male sex at birth but identify as female). Trans men report similar rates to trans women of engagement in sex work and engage in unprotected receptive vaginal and/or anal sex with cisgender men. Additionally, they report high sexual risk-taking behaviors including inconsistent condom use which puts them at risk of HIV and other sexually transmitted infections (STIs). Little is known about HIV risk in trans men globally, and no published data are available from sub-Saharan Africa. In partnership with the trans community, we are testing the effectiveness of peer-delivered HIV self-testing, STI self-sampling and pre-exposure prophylaxis (PrEP) for trans women in Uganda in a cluster randomized trial (R34 MH121084). Leveraging the resources of this RCT, this administrative supplement proposes to recruit a new cohort of 50 trans men through respondent driven sampling. We will use mixed methods to gain a deeper understanding of the sexual health experiences and risk behaviors of trans men in Uganda. Guided by the Social Ecological Model, we will conduct in-depth interviews with up to 20 trans men to understand individual, interpersonal, community and social contextual factors that influence sexual risk behaviors and HIV/STI risk (Aim 1). In Aim 2, we will characterize HIV and STI prevalence and risk among trans men by conducting a behavioral HIV risk assessment including sexual practices, alcohol and drug use, partner violence, gender dysphoria, male hormone use and willingness to take PrEP. In Aim 3, we will evaluate PrEP uptake and persistence among HIV-negative trans men with HIV risk. Participants will be offered PrEP and followed monthly for 12 months. At quarterly visits, participants will receive integrated next steps adherence counseling and drug level feedback using a point-of-care urine tenofovir lateral-flow immunoassay. Free testing and treatment of common curable STIs (Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis) will be provided. Primary outcomes are: 1) PrEP uptake, and 2) persistence at 6 and 12 months as measured by tenofovir levels in dried blood spots collected quarterly. Assessment of PrEP use by trans men will help increase the utilization of HIV services, including HIV and STI testing and PrEP, with a goal of decreasing HIV acquisition. Simultaneous evaluation of prevention uptake among trans women (in the parent R34 trial) and trans men (in this administrative supplement) is an efficient and timely approach to optimizing prevention delivery for trans people. Pilot data from trans men will provide uniquely valuable information to inform future scale-up of combination HIV prevention interventions. This will be the first study, to our knowledge, to assess HIV and STI risk among trans men in sub-Saharan Africa. This project is supported by the Uganda Ministry of Health.

项目摘要/摘要 跨性别男人（跨性别男人；出生时分配的女性，但被认为是男性）通常被认为是 艾滋病毒收购的低风险，通常是因为她们与sisgender妇女发生性关系（出生 女性，被认为是女性），该女性被认为是低风险性活动。来自资源丰富的设置的新兴数据 表明跨性别男人经常面临与跨性别女性相同的许多高风险（跨性别女性；分配 出生时男性，但被认为是女性）。跨性别男性报告与跨性别女性的类似率 与sisgender男人一起工作并从事无保护的阴道和/或肛交。此外，他们报告 高性冒险行为，包括不一致的避孕套，使他们处于艾滋病毒和其他的风险 性传播感染（STIS）。关于全球跨性别男性的艾滋病毒风险知之甚少，没有公开的数据 可从撒哈拉以南非洲获得。与跨性别社区合作，我们正在测试有效性 对同伴分配的艾滋病毒自我测试，STI自杀和预防前预防（PREP） 乌干达在一项群集随机试验中（R34 MH121084）。利用此RCT的资源，此管理 补充建议通过受访者驱动的抽样来招募50名跨性别男子的新队列。我们将使用 混合方法以更深入地了解跨性别的性健康经历和风险行为 在乌干达。在社会生态模型的指导下，我们将对多达20个跨性别者进行深入的访谈 了解影响性风险的个人，人际，社区和社会背景因素 行为和HIV/STI风险（AIM 1）。在AIM 2中，我们将表征trans之间的艾滋病毒和性传播感染患病率和风险 通过进行行为艾滋病毒风险评估，包括性行为，酒精和吸毒，伴侣 暴力，性别烦躁不安，男性激素使用和准备准备。在AIM 3中，我们将评估准备 艾滋病毒风险的艾滋病毒阴性跨性别男性的吸收和持久性。参与者将获得准备和 随后每月持续12个月。在季度访问中，参与者将获得综合的下一步依从性 咨询和药物水平的反馈使用护理点尿中的甲状腺外侧流动免疫测定法。免费测试 以及常见的可治愈性传播疾病（淋病奈瑟氏菌 将提供阴道）。主要结果是：1）准备摄取，2）在6和12个月的持久性 每季度收集的干血点中通过替诺福韦水平测量。评估跨性别人士的准备使用 帮助增加艾滋病毒服务的利用，包括艾滋病毒和性传播感染测试和准备，目的是减少 艾滋病毒收购。同时评估跨性别妇女之间的预防吸收（在父母R34试验中）和 跨性别者（在此行政补充中）是一种有效且及时的方法来优化预防交付 对于跨性别者。来自跨性别者的试验数据将提供独特的有价值信息，以告知未来的规模 联合艾滋病毒预防干预措施。据我们所知，这将是评估艾滋病毒和STI的第一项研究 撒哈拉以南非洲的跨性别男子之间的风险。该项目得到乌干达卫生部的支持。