Integration of Gender-Affirming Primary Care and Peer Navigation With HIV Prevention and Treatment Services to Improve the Health of Transgender Women: Protocol for a Prospective Longitudinal Cohort Study
Integration of Gender-Affirming Primary Care and Peer Navigation With HIV Prevention and Treatment Services to Improve the Health of Transgender Women: Protocol for a Prospective Longitudinal Cohort Study
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DOI：
10.2196/14091
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发表时间：
2019-06-01
影响因子：
1.7
通讯作者：
Reisner, Sari L.
中科院分区：
文献类型：
--
作者：
Lama, Javier R.;Mayer, Kenneth H.;Reisner, Sari L.
背景：迫切需要公共卫生战略来改善跨性别妇女之间的艾滋病毒差异，包括解决社区优先考虑的健康需求的整体干预方法。激素治疗是许多变性妇女在医学上获得性别肯定的主要方法。同伴导航已被证明是有效的，可使艾滋病毒感染者参与并保持在稳定的初级医疗保健中。目的：本研究旨在评估一种综合创新艾滋病服务提供模式的可行性和可接受性，该模式旨在通过将性别肯定初级保健和同伴导航与艾滋病预防和治疗服务相结合，改善艾滋病预防和护理。方法：在秘鲁利马实施了一项为期12个月的非随机单组队列研究，研究对象为成年个体，出生时被指定为男性，无论是否开始或完成医学性别确认，不知道自己的艾滋病毒血清状态或感染艾滋病毒但未参与艾滋病毒治疗。艾滋病毒阴性的参与者每季度接受一次艾滋病毒检测，并接受接触前预防。hiv阳性的参与者开始抗逆转录病毒治疗，并每季度进行一次血浆HIV-1 RNA和外周血CD4+淋巴细胞计数监测。所有参与者都接受了女性化激素治疗，并接受了依从性咨询和使用相关教育。同伴健康导航通过在家中、工作场所或社交场所访问参与者，或通过社交媒体和电话与他们联系，促进了护理的保留。结果：患者招募于2016年10月开始，2017年3月结束。该队列于2018年3月结束随访。目前正在进行数据分析。结论：提高跨性别妇女获得艾滋病毒预防和治疗服务机会的创新和文化敏感战略对于减轻这一关键人群的艾滋病毒流行负担至关重要。这一干预措施的结果将为未来的政策和研究提供信息，包括在一项随机对照试验中评估其疗效。
Background: Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary method by which many transgender women medically achieve gender affirmation. Peer navigation has been shown to be effective to engage and retain underserved populations living with HIV in stable primary medical care.Objective: This study aims to assess the feasibility and acceptability of an integrated innovative HIV service delivery model designed to improve HIV prevention and care by combining gender-affirming primary care and peer navigation with HIV prevention and treatment services.Methods: A 12-month, nonrandomized, single-arm cohort study was implemented in Lima, Peru, among adult individuals, assigned a male sex at birth, who identified themselves as transgender women, regardless of initiation or completion of medical gender affirmation, and who were unaware of their HIV serostatus or were living with HIV but not engaged in HIV treatment. HIV-negative participants received quarterly HIV testing and were offered to initiate pre-exposure prophylaxis. HIV-positive participants were offered to initiate antiretroviral treatment and underwent quarterly plasma HIV-1 RNA and peripheral CD4+ lymphocyte cell count monitoring. All participants received feminizing hormone therapy and adherence counseling and education on their use. Peer health navigation facilitated retention in care by visiting participants at home, work, or socialization venues, or by contacting them by social media and phone.Results: Patient recruitment started in October 2016 and finished in March 2017. The cohort ended follow-up on March 2018. Data analysis is currently underway.Conclusions: Innovative and culturally sensitive strategies to improve access to HIV prevention and treatment services for transgender women are vital to curb the burden of HIV epidemic for this key population. Findings of this intervention will inform future policies and research, including evaluation of its efficacy in a randomized controlled trial.