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

摘要： 在美国 (U.S.)，跨性别女性 (TW) 是受艾滋病毒影响最严重的人群之一 感染。美国台湾地区艾滋病毒感染率高是由结构性因素驱动和/或伴随而来的 限制获得艾滋病毒预防、护理和保健服务的障碍。尽管出现了研究 为了描述台湾地区艾滋病毒流行的特征，大多数研究都是横断面设计，通常 包括小样本量，通常将 TW 纳入更广泛的风险群体中，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 TW 中的使用并阻止了时间评估、因果推理和研究结果的普遍性 台湾人口。迄今为止，尚无对艾滋病毒发病率的可靠估计，也没有证据表明存在干预措施 预防台湾人感染艾滋病毒的功效。拟议的美国队列研究将解决 通过建立一个横跨美国东部和南部的多地点、纵向的 TW 队列来克服这些局限性。 （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）描述艾滋病毒的特征 HIV 感染的发病率和风险因素、获得 HIV 生物行为预防方法以及与 照顾艾滋病毒血清转化者。该队列将包括种族/民族和文化多样化的样本 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） 确定采用新型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 纳入前瞻性队列。 2) 描述人口统计、社会经济、行为和 东部和南部地区第一批多地点台湾人队列中未感染艾滋病毒的台湾人的身心健康状况 美国南部 3) 为了估计美国东部和南部高风险地区台湾人的艾滋病毒发病率， 发病率以及相关的个人、社会和结构性风险因素。 4) 评估艾滋病毒预防情况 未感染艾滋病毒的参与者中的连续体，以及新感染艾滋病毒的台湾人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 名台湾人，他们将被纳入未感染艾滋病毒的队列或 HIV感染者的横断面比较组。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以及入组时的横断面发病率估计。艾滋病毒- 未感染人群将被跟踪至少 24 个月，以估计 HIV 发病率、趋势和危险因素 艾滋病毒感染。血清转化的队列参与者将被额外跟踪 6 个月以进行评估 前瞻性地参与艾滋病毒护理连续体。研究结果将提供重要的流行病学信息 台湾地区未来艾滋病毒预防研究的参数，为其他研究提供一个平台 可以探讨问题，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 减少美国台湾地区艾滋病毒感染率

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.