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（U.S.），跨性别妇女（TW）是受艾滋病毒影响最严重的人群之一 感染艾滋病毒感染在美国TW中的高流行率是由结构性疾病驱动和/或伴随着结构性疾病。 限制获得艾滋病毒预防、护理和卫生服务的障碍。尽管有研究表明， 为了描述TW中HIV流行的特征，大多数研究都是横断面设计， 包括较小样本量，通常将TW归入更广泛的风险群体，例如与 男人这些做法阻碍了确定可接受的、有效的招募和研究方法， 在TW中使用，并防止时间评估，因果推理和研究结果的普遍性， TW人口。迄今为止，对艾滋病毒的发病率没有可靠的估计，也没有采取干预措施， 预防TW感染HIV的有效性。拟议的美国队列研究将解决 通过建立横跨美国东部和南部的TW的多站点纵向队列， （波士顿、纽约市、巴尔的摩-华盛顿、亚特兰大和迈阿密大都市区），以描述艾滋病毒特征 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 为艾滋病毒血清转化者提供护理。该队列将包括一个种族/民族和文化多样性的样本， TW，通过使用技术注入的招聘和保留方法来支持。具体目标是：1） 确定新的、技术注入的招募方法招募艾滋病毒感染者的效率和可接受性， 未感染的TW纳入前瞻性队列。2)描述人口统计学、社会经济学、行为学和 在东部和南部的TW的第一个多中心队列中，未感染艾滋病毒的TW的身心健康状况 3）为了估计美国东部和南部高风险地区TW中的HIV发病率， 发病率，以及相关的个人，社会和结构性风险因素。4)估计艾滋病预防 在未感染艾滋病毒的参与者中的连续体，以及在新感染艾滋病毒的TW中的艾滋病毒护理连续体。 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感染者为横断面对照组。这些数据将用于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。艾滋病毒- 将对未感染队列进行至少24个月的随访，以估计艾滋病毒的发病率、趋势和风险因素， 艾滋病毒感染。血清转化的队列受试者将再随访6个月，以评估 艾滋病毒护理连续体的预期参与。研究结果将提供关键的流行病学 为TW未来的艾滋病毒预防研究提供了一个平台， 可以探讨这些问题，并为制定基于证据和可接受的艾滋病毒干预措施提供信息 以减少美国TW人群中的艾滋病毒感染。