Reducing HIV Health Disparities among African American Transgender Women: An mHealth Approach to Improving Prevention, Testing, and Treatment Outcomes

项目总结/摘要 在美国，五分之一的跨性别女性（TGW）感染了艾滋病毒。负担特别沉重 为非裔美国人。虽然16%的美国TGW是黑人，但2009-2014年TGW的所有新病例中有一半以上是黑人。 都是非裔美国人此外，非裔美国人TGW经历了种族主义的复杂互动， 性别歧视和跨性别恐惧症，导致整个艾滋病毒相关结果的健康差异。 尽管非裔美国人TGW明显需要有效的艾滋病毒资源，但没有CDC定义的证据- 基于干预措施（EBI）存在于这一组。我们打算用Shine来满足这一需求，Shine是一个文化定制的， 理论驱动的移动的干预黑色TGW。信息-动机-行为技能（IMB） 该模型将指导开发针对用户艾滋病毒状况的行为改变信息。超出 信息，动机和技能，独特的社会文化背景也影响TGW的执行能力 艾滋病相关行为。为了说明这一点，我们将通过解决一个 黑人TGW的关键心理需求：性别肯定。根据性别肯定模式， 对性别认同确认的需要往往导致TGW从事与艾滋病毒预防背道而驰的行为 和治疗目标。为了进一步改善艾滋病毒的结果，Shine将减少艾滋病毒行为造成的障碍， 性别肯定需要并授权黑人TGW以更健康的方式肯定其性别。 Shine将是非洲裔美国人TGW的第一个基于理论的移动的干预， 量身定制，并赋予权力。所有用户都将收到与艾滋病毒有关的信息，激励和技能建设 短信更多的信息将提供获得性别平等肯定的战略。这些短信 将由三种类型的基于网络的视频补充：脚本小插曲，无脚本的同行叙述， 教育指导。这些视频的链接将被整合到信息中，并将增强跨 在我们的IMB框架内对性别平等的具体理解。一种基于创新理论的艾滋病毒 行为干预，旨在克服非裔美国人TGW面临的独特障碍; 解决了整个艾滋病毒护理连续体的要素;这是以一种授权，教育， 并吸引被污名化的人群;这依赖于一种技术， 最终用户在有意义地减少艾滋病毒差异方面具有巨大潜力。 第一阶段的结果有力地支持了该计划的可行性和潜在的有效性， 超过第一阶段提案中建立的可用性基准。在第二阶段，我们将完成 开发Shine并在215名非洲裔美国人的随机对照试验中测试其有效性 TGW参与者将被随机分配接受Shine或移动的艾滋病毒教育材料。 随机分配前和6个月后参与者的艾滋病毒传播复合风险，艾滋病毒 将评估预防和治疗行为、这些行为的障碍以及性别肯定需求。

PROJECT SUMMARY/ABSTRACT One in five transgender women (TGW) in the U.S. is infected with HIV. The burden is particularly onerous for African Americans. While 16% of U.S. TGW are Black, over half of all new cases in TGW from 2009-2014 were among African Americans. Further, African American TGW experience a complex interaction of racism, sexism, and transphobia that leads to health disparities across the entire spectrum of HIV-related outcomes. Despite the clear need for effective HIV resources for African American TGW, no CDC-defined evidence- based interventions (EBIs) exist for this group. We intend to meet this need with Shine, a culturally-tailored, theoretically-driven mobile intervention for Black TGW. The Information-Motivation-Behavioral Skills (IMB) model will guide the development of behavior change messages tailored to a user’s HIV status. Beyond information, motivation, and skills, a unique socio-cultural context also influences TGW’s ability to perform HIV-related behaviors. To account for this, we will contextualize the IMB-based HIV content by addressing a key intrapsychic need among Black TGW: gender affirmation. According to the Model of Gender Affirmation, a need for gender identity validation often leads TGW to engage in behaviors that are counter to HIV prevention and treatment goals. To further improve HIV outcomes, Shine will reduce barriers to HIV behaviors caused by gender affirmation needs and empower Black TGW to affirm their gender in healthier ways. Shine will be the first mobile intervention for African American TGW that is theory-based, individually- tailored, and empowering. All users will receive HIV-related informational, motivational, and skill-building text messages. Additional messaging will provide strategies for gaining gender affirmation. These text messages will be supplemented by three types of web-based videos: scripted vignettes, unscripted peer narratives, and educational instruction. Links to these videos will be integrated into the messaging and will enhance the trans- specific understanding of gender affirmation within our IMB framework. An innovative theory-based HIV behavioral intervention designed to overcome the unique barriers facing African American TGW; that addresses elements across the entire HIV care continuum; that is delivered in a way that empowers, educates, and engages a stigmatized population; and that relies on a technology that is part of the everyday lives of target end-users has the significant potential to meaningfully reduce HIV disparities. The results of Phase I strongly support the feasibility and potential effectiveness of the program – far exceeding the usability benchmarks established in the Phase I proposal. In Phase II, we will complete development of Shine and test its effectiveness in a randomized controlled trial with 215 African American TGW. Participants will be randomly assigned to receive either Shine or mobile HIV education materials. Before and 6 months after random assignment participants’ composite risk for HIV transmission, HIV preventive and treatment behaviors, barriers to those behaviors, and gender affirmation needs will be assessed.