Breaking systems barriers for trans women of color living with HIV

项目摘要 变性女性是旧金山艾滋病病毒携带者最多的人群，精神使用率低 健康和物质使用服务。我们的目标是利用从以前的HRSA资助的特别行动中学到的经验教训 具有国家意义的项目，以开展试点任务共享同行，提供移动健康支持和导航 对携带艾滋病毒的变性妇女的干预。我们将与旧金山部门的合作伙伴合作 公共卫生(SFDPH)跨卫生诊所。SFDPH是一个由HRSA资助的实体，拥有跨专业诊所和 许多内部转介到跨能力心理健康和药物使用服务。然而， 存在相当大的制度障碍。跨性别诊所的诊所时间有限，而提供者的病人很多 在短期访问中，必须满足医疗性别确认和艾滋病毒护理需求的负荷。参观和 诊所的时间和大量的病人使提供者几乎没有时间来确保心理健康和 药物使用转诊。为了克服这些问题，对等导航员将提供移动和面对面的支持 和导航，以增加药物使用和心理健康服务的启动和参与 跨性别健康诊所的艾滋病毒携带者妇女。我们会进行实施前阶段，以评估 我们建议的干预措施的可接受性和适当性，我们将与40名TRANS进行初步研究 感染艾滋病毒的妇女。实施前阶段将侧重于社区参与，以及 从艾滋病毒携带者和变性妇女那里收集见解。试行结束后，我们将评估REACH， 使用RE-AIM的系统、提供者和跨性别妇女的有效性和领养情况 实施科学框架。如果关键指标显示出改善，我们将与SFDPH团队合作 在为感染艾滋病毒的变性妇女提供服务的诊所网站上测试放大版的干预措施 在整个旧金山。综上所述，拟议的研究将为制定 减少药物使用和精神健康障碍对TRANS的影响的下一代干预 并改善这个社区的艾滋病毒护理成果和整体健康状况 在应对艾滋病毒方面受到高度影响，但服务不足。

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.