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

减少非裔美国跨性别女性之间的艾滋病毒健康差异：改善预防、检测和治疗结果的移动医疗方法

• 批准号: 10226064
• 负责人: Samantha L. Leaf
• 金额: $ 24.73万
• 依托单位: ISA ASSOCIATES, INC.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10226064
• 关键词: AIDS prevention; Address; Adherence; Advocate; African American; Behavior; Behavior Therapy; Behavioral; Benchmarking; Birth; Caring; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Cognitive; Collaborations; Color; Communities; Complex; Consultations; Continuity of Patient Care; Development; Discrimination; Education; Effectiveness; Effectiveness of Interventions; Elements; Evidence based intervention; Exhibits; Frequencies; Fright; Gender; Gender Identity; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV risk; Health; Incentives; Individual; Instruction; Intervention; Link; Literature; Marketing; Medical; Modeling; Motivation; Online Systems; Outcome; Participant; Persons; Pharmaceutical Preparations; Phase; Population; Prevention; Preventive treatment; Program Effectiveness; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Behaviors; Self Care; Sex Bias; Social Environment; Social support; Stigmatization; Techniques; Technology; Test Result; Testing; Text Messaging; Theoretical model; Treatment outcome; United States; Validation; Viral; Woman; base; behavior change; black women; burden of illness; condomless anal sex; condoms; design; effectiveness testing; empowered; experience; field study; health disparity; hormone therapy; improved; innovation; interest; intersectionality; mHealth; male; peer; pre-exposure prophylaxis; programs; prototype; racism; sex; skills; social; social culture; social exclusion; tailored messaging; theories; therapy design; transgender; transgender women; transmission process; transphobia; uptake; usability

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.

项目摘要/摘要 美国五分之一的变性妇女（TGW）感染了艾滋病毒。伯恩特别繁重 对于非裔美国人。美国TGW的16％是黑色的，在2009 - 2014年中，TGW的所有新案件中有一半以上 在非裔美国人中。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会导致整个与HIV相关结果的健康差异。 尽管明确需要为非裔美国人TGW有效的艾滋病毒资源，但没有CDC定义的证据 - 该组存在基于干预措施（EBI）。我们打算用Shine（一种文化的泰国人）来满足这一需求 黑色TGW的理论驱动移动干预。信息动机行为技能（IMB） 模型将指导为用户的艾滋病毒状况量身定制的行为变更消息的发展。超过 信息，动机和技能，独特的社会文化背景也会影响TGW的表现能力 与HIV相关的行为。为此，我们将通过解决一个基于IMB的艾滋病毒内容的情况将 Black TGW中的关键内部需求：性别肯定。根据性别肯定的模型 性别认同验证的需求通常会导致TGW参与与预防HIV相反的行为 和治疗目标。为了进一步改善艾滋病毒的结果，光泽将减少艾滋病毒行为的障碍 性别肯定的需求并赋予黑色TGW以更健康的方式确认其性别。 Shine将是非裔美国人TGW的第一次移动干预，这是基于理论的，单独的 - 量身定制和授权。所有用户都将获得与HIV相关的信息，动机和技能建设 短信。其他消息传递将为获得性别影响提供策略。这些短信 将以三种类型的基于Web的视频进行补充：脚本化的小插图，无脚本的同伴叙述和 教育说明。这些视频的链接将集成到消息传递中，并将增强转换 在IMB框架内对性别肯定的具体理解。创新的基于理论的艾滋病毒 旨在克服非裔美国人TGW面临的独特障碍的行为干预；那 解决整个艾滋病毒护理中的元素仍在继续；这是以赋予，教育， 并参与受污名的人群；这取决于目标的技术一部分 最终用户具有有意义地减少HIV差异的巨大潜力。 第一阶段的结果强烈支持该计划的可行性和潜在有效性 - 远 超过在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 在与215个非裔美国人的随机对照试验中开发光泽并测试其有效性 TGW。参与者将被随机分配接受Shine或移动HIV教育材料。 随机分配参与者对艾滋病毒传播的综合风险后，艾滋病毒的综合风险后6个月 将评估预防和治疗行为，这些行为的障碍以及性别感情需求。