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 跨性别女性在旧金山承担着最大的艾滋病毒人口负担，并且心理利用率低 健康和药物使用服务。我们的目标是利用之前 HRSA 资助的特别计划中吸取的经验教训 具有国家意义的项目进行试点任务共享同行提供的移动医疗支持和导航 对感染艾滋病毒的跨性别女性进行干预。我们将与旧金山部门的合作伙伴合作 公共卫生 (SFDPH) 跨性别健康诊所。 SFDPH 是一个由 HRSA 资助的实体，拥有跨性别诊所和 大量内部转介到跨能力的心理健康和药物使用服务。然而， 存在相当大的系统障碍。跨性别诊所的门诊时间有限，而且医疗服务提供者的患者人数较多 其中医疗性别肯定和艾滋病毒护理需求必须在短期访问中得到满足。参观并 诊所时间和大量患者数量使提供者几乎没有时间来确保心理健康和治疗的连续性 物质使用转介。为了克服这些问题，同行导航员将提供移动和现场支持 和导航，以增加跨性别者的物质使用和心理健康服务的启动和参与 跨性别健康诊所中感染艾滋病毒的妇女。我们将进行预实施阶段来评估 我们提议的干预措施的可接受性和适当性，我们将针对 40 名跨性别者进行试点研究 感染艾滋病毒的妇女。实施前阶段将重点关注社区参与，以及 从感染艾滋病毒的提供者和跨性别女性那里收集见解。试点结束后，我们将评估覆盖范围， 该系统的有效性和采用率，由提供者和跨性别女性使用 RE-AIM 实施科学框架。如果关键指标有所改善，我们将与 SFDPH 团队合作 在为感染艾滋病毒的跨性别女性提供服务的诊所中测试扩大版的干预措施 整个旧金山。总而言之，拟议的研究将为开发 下一代干预措施，以减少物质使用和精神健康障碍对变性人的影响 感染艾滋病毒的妇女并改善艾滋病毒护理结果以及该社区的整体健康和福祉 艾滋病毒应对工作受到严重影响，但服务不足。