Staying Connected: Community-engaged research to address the impacts of the COVID-19 Pandemic among transgender women through an m-health prevention program

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ABSTRACT: Staying Connected: Community-engaged research to address the impacts of the COVID-19 Pandemic among transgender women through an mhealth prevention program The COVID-19 pandemic has reminded the world that viral outbreaks are a reality and can quickly generate high levels of mortality and morbidity, overwhelm health-care systems, and produce massive social and economic upheaval. Epidemiological data suggest that COVID-19 will have its most devastating impact on the most vulnerable members of society, and in the process, exacerbate existing health disparities. In the United States, transgender women, and in particular transgender women of color, are particularly at risk for COVID-19 infection due to high levels of HIV infection, substance abuse, depression, anxiety disorders, and social isolation. Research demonstrates that these health disparities and vulnerabilities are connected to the multiple forms of discrimination that shape transgender women’s lives. In this context, the COVID-19 pandemic and accompanying mitigation strategies affect not only COVID-19 transmission and disease, but also transgender women’s adherence to HIV anti-retroviral therapies, utilization of the HIV prevention continuum, financial and housing stability, and anxiety and depression associated with the disruption of gender-affirming care. This proposed administrative supplement will build on our current project, Trans Women Connected (TWC), an mhealth sexual health promotion app for transgender women, by conducting research to gain greater understanding of and ways to respond to these inter-connected and still evolving trans-specific COVID-19 impacts. Specifically, we aim to: 1) Conduct rapid formative research to examine the impact of COVID-19 and mitigation strategies, including unintended negative consequences, on transgender women through focus groups, expert advisors, and an engaged community advisory board; 2) Develop a culturally tailored, community- strengths and cognitive behavior theory informed module of interactive COVID-19 educational activities for integration into the overall TWC mobile app. The skills-building activities seek to support COVID-19 mitigation strategies, reduce COVID-19 morbidity and mortality, and in general, improve health care utilization, increase self-care and resilience, and promote connectedness among transgender women, thereby leading to improved overall mental and physical health; and 3) Evaluate the impact of the COVID-19 module as part of the larger parent grant 2-arm cluster randomized controlled trial with 450 transgender women. This evaluation will enable us to collect data on COVID-19 and the impact of the mhealth module on transgender women over a 12-month time period likely encompassing relaxation of distancing measures, possible second and third waves of infections and additional periods of lockdown, and potentially, the emergence of a vaccine. The project offers the possibility of unprecedented insights into effects of the COVID-19 pandemic on the health, connectedness, and behaviors of one of the most vulnerable and socially marginalized populations in the US.