American Cohort to Study HIV Acquisition among Transgender Women in High Risk Areas

美国队列研究高风险地区跨性别女性的艾滋病毒感染情况

• 批准号: 10471073
• 负责人: Sari Reisner
• 金额: $ 10.37万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-21 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471073
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; American; Ancillary Study; Area; Baltimore; Behavioral; Biological; Blood; Boston; Caring; Cohort Studies; Collection; Continuity of Patient Care; Country; Cross-Sectional Studies; Data; Development; Eligibility Determination; Enrollment; Environment; Epidemic; Epidemiology; Exposure to; Funding; Future; General Population; Guidelines; HIV; HIV Infections; HIV risk; Health; Health Services; High Prevalence; Hormone use; Incidence; Individual; Infrastructure; Intervention; Intervention Studies; Laboratories; Longitudinal cohort; Measures; Mental Health; Meta-Analysis; Methods; New York City; Outcome; Participant; Patient Self-Report; Phase; Population; Population Intervention; Populations at Risk; Prevalence; Prevention; Prevention Research; Principal Investigator; Productivity; Prospective cohort; Research; Research Priority; Risk; Risk Factors; Sample Size; Sampling; Sampling Biases; Site; Specimen; Structure; Subgroup; Technology; Testing; Time; United States; United States National Institutes of Health; Validation; Viral Load result; Visit; Washington; Woman; base; behavioral health; biobehavior; care systems; cohort; comparison group; design; evidence base; follow-up; high risk; improved; men who have sex with men; metropolitan; new technology; physical conditioning; placebo group; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; prospective; racial and ethnic; recruit; response; screening; self testing; social; social structure; socioeconomics; success; testing services; transgender women; transmission process; trend

Abstract: In the United States (U.S.), transgender women (TW) are one of the populations most affected by HIV infection. The high prevalence of HIV infection among U.S. TW is driven by, and/or concomitant with, structural barriers that limit access to HIV prevention, care, and health services. Despite an emergence of research to characterize the HIV epidemic among TW, the majority of studies are cross-sectional designs and typically include small sample sizes, often subsuming TW among broader risk groups, such as men who have sex with men. These practices have thwarted identification of acceptable, effective recruitment and study methods for use among TW and prevented temporal assessment, causal inference, and generalizability of study findings to the TW population. To date, there is no robust estimate of HIV incidence and no intervention with evidence of efficacy for the prevention of HIV acquisition among TW. The proposed American Cohort study will address these limitations by establishing a multi-site, longitudinal cohort of TW spanning eastern and southern U.S. (Boston, New York City, Baltimore-Washington, Atlanta, and Miami metropolitan areas) to characterize HIV incidence and risk factors for HIV acquisition, access to biobehavioral HIV prevention methods, and linkage to care for those who HIV seroconvert. The cohort will include a racially/ethnically and culturally diverse sample of TW, supported by the use of technology-infused recruitment and retention methods. The specific aims are: 1) To determine the efficiency and acceptability of novel, technology-infused recruitment methods to enroll HIV- uninfected TW into a prospective cohort. 2) To describe the demographic, socioeconomic, behavioral, and physical and mental health profiles of HIV-uninfected TW in the first, multi-site cohort of TW in the eastern and southern U.S. 3) To estimate HIV incidence among TW in high-risk eastern and southern U.S. areas, trends in incidence, and associated individual, social, and structural risk factors. 4) To estimate the HIV Prevention Continuum among HIV-uninfected participants, and the HIV Care Continuum among newly HIV-infected TW. To achieve these aims we will recruit 1,750 TW who will be enrolled in either a HIV-uninfected cohort or an HIV-infected cross-sectional comparison group. These data will be used to assess differences between cohort participants and the wider population and for cross-sectional incidence estimation at enrollment. The HIV- uninfected cohort will be followed for at least 24 months to estimate HIV incidence, trends, and risk factors for HIV acquisition. Cohort participants who seroconvert will be followed for an additional 6 months to assess prospective engagement in the HIV Care Continuum. Study findings will provide critical epidemiologic parameters for future HIV prevention research among TW, provide a platform upon which other research questions can be explored, and inform the development of evidence-based and acceptable HIV interventions to reduce HIV acquisition among TW in the U.S.

摘要： 在美国，变性人妇女(TW)是受艾滋病毒影响最大的人群之一 感染。美国TW中艾滋病毒感染的高流行率是由结构性因素推动和/或伴随的 限制获得艾滋病毒预防、护理和卫生服务的障碍。尽管出现了一项研究 描述TW中艾滋病毒流行的特征，大多数研究都是横断面设计，通常 包括较小样本量，通常将TW归入更广泛的风险群体，例如与之发生性关系的男性 男人。这些做法阻碍了确定可接受的、有效的招聘和研究方法 在TW和预防时间评估、因果推理和研究结果的概括性之间的使用 台湾州的人口。到目前为止，没有关于艾滋病毒发病率的可靠估计，也没有证据表明干预措施 台湾区妇女预防HIV感染的效果。拟议的美国队列研究将解决 这些限制是通过建立一个横跨美国东部和南部的多地点纵向TW队列来实现的。 (波士顿、纽约市、巴尔的摩-华盛顿、亚特兰大和迈阿密大都会地区)来表征艾滋病毒 艾滋病毒感染的发病率和风险因素，获得生物行为艾滋病毒预防方法的机会，以及与 照顾那些艾滋病毒血清转换的人。该队列将包括种族/民族和文化多样性的样本 TW，通过使用技术灌输的招聘和保留方法提供支持。具体目标是：1) 为了确定新的、注入技术的招募方法来招募艾滋病毒的效率和可接受性- 将未感染的TW纳入预期队列。2)描述人口统计、社会经济、行为和 东部和东部第一批未感染HIV的TW人群的身心健康状况 3)为了估计美国东部和南部高危地区TW地区的艾滋病毒发病率， 发病率，以及相关的个人、社会和结构性风险因素。4)评估艾滋病预防工作 在未感染艾滋病毒的参与者中继续开展艾滋病毒护理活动，在新感染艾滋病毒的台湾妇女中开展艾滋病毒护理活动。 为了实现这些目标，我们将招募1,750名TW，他们将被纳入未感染艾滋病毒的队列或 HIV感染横断面对照组。这些数据将被用来评估队列之间的差异 参与者和更广泛的人群，并在登记时进行横断面发病率估计。艾滋病病毒-- 将对未感染的队列进行至少24个月的跟踪，以评估艾滋病毒的发病率、趋势和风险因素 艾滋病病毒的获取。血清转换的队列参与者将被再跟踪6个月以进行评估 预期参与艾滋病毒护理连续体。研究结果将提供关键的流行病学 为TW中未来的HIV预防研究提供参数，为其他研究提供平台 可以探索问题，并为发展以证据为基础和可接受的艾滋病毒干预措施提供信息 减少美国TW人群中艾滋病病毒的感染。