Improving HIV testing and PrEP for transgender women through mHealth

通过移动医疗改善跨性别女性的艾滋病毒检测和 PrEP

• 批准号: 10258220
• 负责人: Roman Shrestha
• 金额: $ 25.43万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-28 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10258220
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Asia; Attitude; Behavior Therapy; Caring; Cellular Phone; Clinic; Clinical; Clinical Services; Complex; Country; Custom; Data; Decision Making; Development; Discrimination; Drug usage; Economics; Employment; Environment; Epidemic; Evidence based intervention; Exclusion; Focus Groups; Fostering; Gender; General Population; Government; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health Services; Healthcare; Hearing; Human immunodeficiency virus test; Individual; Infection; Injecting drug user; Interpersonal Violence; Intervention; Laws; Learning; Legal; Malaysia; Malaysian; Medical; Mental Depression; Mental Health; Mobile Health Application; Modeling; Names; Occupations; Population; Populations at Risk; Prevalence; Privatization; Process; Provider; Randomized Controlled Trials; Religion and Spirituality; Research; Risk; Risk Behaviors; Services; Sexual Health; Sexual Transmission; Socialization; Strategic Planning; Structure; Study models; Testing; Time; Vulnerable Populations; Work; acceptability and feasibility; base; care systems; cost effective; design; distrust; empowered; experience; health care service; health management; high risk; improved; information gathering; innovation; mHealth; men who have sex with men; mobile application; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; prototype; response; scale up; screening; service delivery; sex; social; social stigma; statistics; substance use; testing services; testing uptake; theories; tool; transgender women; treatment as usual; trial comparing; uptake; usability

Abstract Despite decades of evidence-based interventions, including the 90/90/90 strategy, the HIV epidemic in Malaysia remains volatile. With over 100,000 cumulative HIV cases, Malaysia's rapidly expanding HIV epidemic is the fifth largest in the Asia-Pacific region and is concentrated within the most-at-risk populations. Originally driven by people who inject drugs, the majority of new infections today (>90%) are attributed to sexual transmission, many of which occur among transgender women (TGW). TGW are disproportionately impacted by HIV worldwide, with an estimated global prevalence of 19%. In Malaysia, an estimated 12.4% of TGW are living with HIV. TGW experience multi-level 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 pre-exposure prophylaxis (PrEP). Modeling studies suggest 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. Similarly, while PrEP is recommended in Malaysia's National Strategic Plan to End AIDS (2016-2030), only 1 in 5 TGW has ever heard of PrEP. However, after learning about PrEP, more than 80% of TGW in Malaysia say they would take it. To scale-up of HIV testing and PrEP among TGW, innovative strategies are needed to rapidly overcome the complex barriers preventing uptake. In settings where anti-trans stigma is pervasive, such as Malaysia, mHealth may provide an empowering alternative approach to service delivery for TGW. An effective platform for reaching vulnerable and hidden populations, mHealth can overcome barriers associated with traditional clinic-based care by designing customized models of care tailored to the needs of vulnerable populations. Through confidential screening, rapid referrals to trans-friendly providers, and tools that facilitate access to gender-affirming health care needs, mHealth is a promising platform that can be leveraged for intervening around HIV prevention. Thus, we propose to develop and test a new clinic-affiliated app, called MyLink2care, to deliver an integrated HIV prevention intervention for TGW in Malaysia. Specifically, we propose to: 1) adapt, expand, and refine an existing mobile application by conducting formative research with TGW and clinical stakeholders to develop a prototype of the MyLink2Care app to undergo usability testing, followed by development of the beta version of the app; 2) conduct “beta testing” of the MyLink2Care app to assess its usability and acceptability; and 3) assess preliminary feasibility and acceptability of the MyLink2care app within a pilot, randomized-controlled trial, compared with treatment-as-usual for engagement in HIV prevention.

抽象的 尽管有数十年的基于证据的干预措施，包括90/90/90策略，但HIV流行 马来西亚仍然波动。马来西亚的艾滋病毒迅速扩大，有超过100,000例累积艾滋病毒病例 流行病是亚太地区第五大，集中在最风险的人群中。 最初是由注射毒品的人驱动的，今天的大多数新感染（> 90％）归因于 性传播，其中许多发生在变性妇女（TGW）中。 TGW不成比例 受艾滋病毒在全球范围内的影响，估计全球患病率为19％。在马来西亚，估计有12.4％ TGW患有艾滋病毒。 TGW体验了艾滋病毒的多层次脆弱性，包括歧视 就业和经济机会，将许多TGW转向高风险的占领，例如性工作。 医疗保健提供者对TGW的高污名和歧视可以促进敌对的环境 迈向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， 包括暴露前预防（PREP）。建模研究表明，增加了HIV测试和吸收 PREP是减少新感染的最具影响力和成本效益的策略。尽管如此，只有37％ 马来西亚的TGW曾经对HIV进行了测试。同样，虽然在马来西亚国家建议进行准备 结束艾滋病的战略计划（2016-2030），只有五分之一的TGW曾经听说过Prep。但是，学习后 关于准备，马来西亚超过80％的TGW表示他们会接受。扩大艾滋病毒测试和准备 在TGW中，需要创新策略来快速克服防止吸收的复杂障碍。在 抗trans污名无处不在的环境，例如马来西亚，MHealth可能会提供授权 TGW的替代服务交付方法。一个有效的平台，用于接触脆弱和隐藏 人口，MHealth可以通过设计来克服与传统诊所护理相关的障碍 根据弱势群体的需求量身定制的定制护理模型。通过机密筛选， 快速转介到跨型友好的提供商，以及促进获得性别肯定医疗保健需求的工具， MHealth是一个有望的平台，可以利用围绕艾滋病毒预防的干预。那，我们 开发和测试一个新的诊所附属应用程序（称为MyLink2Care）的建议，以提供综合的艾滋病毒 马来西亚TGW的预防干预。特别是，我们建议：1）适应，扩展和完善 现有的移动应用程序通过与TGW和临床利益相关者进行形成性研究来开发 MyLink2Care应用程序的原型进行可用性测试，然后开发Beta版本 应用； 2）对MyLink2Care应用程序进行“ Beta测试”，以评估其可用性和可接受性； 3） 评估在飞行员，随机控制中的MyLink2Care应用程序的初步可行性和可接受性 试验，与治疗与预防艾滋病毒预防的治疗相比。