Breaking systems barriers for trans women of color living with HIV

为感染艾滋病毒的有色人种跨性别女性打破系统障碍

• 批准号: 10437735
• 负责人: Sean Arayasirikul
• 金额: $ 14.62万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10437735
• 关键词: Address; Adoption; Affect; Businesses; California; Car Phone; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Clinic; Communities; County; Data; Development; Diagnosis; Discrimination; Distress; Ecological momentary assessment; Effectiveness; Ensure; Epidemic; Epidemiology; Exhibits; Face; Foundations; Funding; Gender; Goals; HIV; HIV Infections; Health; Health Insurance Portability and Accountability Act; Healthcare; Hour; Individual; Intervention; Leadership; Link; Low income; Measures; Medical; Mental Health; Mental Health Services; Mental disorders; Monitor; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Prevention; Provider; Public Health; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; San Francisco; Services; Sexual and Gender Minorities; Site; Stress and Coping; Support System; System; Testing; Text Messaging; Time; Trust; United States Health Resources and Services Administration; United States National Institutes of Health; Viral; Visit; Work; barrier to care; care outcomes; community engagement; community-level factor; design; effectiveness implementation study; frontier; health disparity; housing instability; implementation evaluation; implementation framework; improved; innovation; insight; mHealth; next generation; peer; response; scale up; social; social exclusion; substance use; transgender women; women of color

PROJECT ABSTRACT Trans women carry the largest population burden of HIV in San Francisco and have low utilization of mental health and substance use services. Our goal is to use lessons learned in our prior HRSA-funded Special Projects of National Significance to conduct a pilot task-sharing peer delivered mHealth support and navigation intervention for trans women living with HIV. We will work with partners in a San Francisco Department of Public Health (SFDPH) trans health clinic. The SFDPH is a HRSA-funded entity with trans-specific clinics and a host of in-house referrals to trans-competent mental health and substance use services. However, considerable systems barriers exist. Trans clinics have limited clinic hours, and providers have large patient loads wherein medical gender affirmation and HIV care needs must be attended to in short visits. Visit and clinic time and large patient volume leaves providers with little time to ensure continuity in mental health and substance use referrals. To overcome these issues, a peer navigator will deliver mobile and in-person support and navigation to increase substance use and mental health service initiation and engagement among trans women living with HIV in trans health clinics. We will conduct a pre-implementation phase to assess the acceptability and appropriateness of our proposed intervention, and we will conduct a pilot study with 40 trans women living with HIV. The pre-implementation phase will be focused on community engagement, and gathering insight from providers and trans women living with HIV. After the pilot, we will evaluate reach, effectiveness and adoption in the system, by providers and among trans women using the by RE-AIM implementation science framework. If key metrics show improvements, we will work with our SFDPH team to test a scaled-up version of the intervention across clinics sites that serve trans women living with HIV throughout San Francisco. Altogether, the proposed study will establish the foundation for development of a next-generation intervention to reduce the impact of substance use and mental health disorders on trans women living with HIV and improve HIV care outcomes and overall health and wellness of this community that is highly impacted while underserved in the response to HIV.

项目摘要 跨性别妇女承担旧金山艾滋病毒的最大人口负担，精神上的利用率很低 健康和药物使用服务。我们的目标是使用以前的HRSA资助特惠中学到的经验教训 进行国家意义的项目，以进行试验任务共享同行提供MHealth的支持和导航 对艾滋病毒感染的跨性别妇女的干预。我们将与旧金山部门的合作伙伴合作 公共卫生（SFDPH）跨性别诊所。 SFDPH是由跨性别特异性诊所的HRSA资助实体， 一系列内部转介到跨性能的心理健康和药物使用服务。然而， 存在相当大的系统障碍。跨性别诊所的诊所时间有限，提供者的患者大 必须在短期访问中就必须注意医疗性别确认和艾滋病毒护理需求的负载。参观和 诊所时间和大量患者量使提供者的时间很少，以确保心理健康的连续性和 物质使用推荐。为了克服这些问题，同行导航员将提供手机和面对面的支持 和导航以增加跨性别物质使用和精神卫生服务的启动和跨性别 在跨性别诊所中患有艾滋病毒的妇女。我们将进行实施前阶段以评估 我们提出的干预措施的可接受性和适当性，我们将对40次Trans进行试点研究 患有艾滋病毒的妇女。实施前阶段将重点放在社区参与上， 收集艾滋病毒感染者的提供者和跨性别妇女的见解。飞行员之后，我们将评估覆盖范围， 该系统，提供者和跨性别妇女使用Re-Aim的有效性和收养 实施科学框架。如果关键指标显示改进，我们将与我们的SFDPH团队合作 在跨诊所网站上测试干预措施的扩大版本，这些网站为艾滋病毒感染的跨性别女性服务 整个旧金山。总共拟议的研究将建立发展的基础 下一代干预措施以减少物质使用和心理健康障碍对跨性别的影响 患有艾滋病毒的妇女，改善艾滋病毒的护理结果以及这个社区的整体健康和健康 在对艾滋病毒的反应中的服务不足时受到高度影响。