Addressing Economic Marginalization to Improve HIV Prevention and Care Outcomes Among Gender Minorities in the United States

7.项目摘要 该职业发展奖的目的是为候选人提供必要的培训， 一个独立的调查员1）推进关于社会和经济因素如何影响的科学知识 在边缘化、优先健康差距人群中塑造艾滋病毒风险和结果，以及2）设计 * 采取有效干预措施，减少艾滋病毒流行率，改善性和性别方面的健康和福祉 少数民族人口。研究目的跨性别和非二元人群经历重大的经济 在美国，艾滋病毒/艾滋病流行病的负担不成比例地沉重。指导 综合资产理论和社会生态框架，并使用多阶段混合方法， 候选人计划进行必要的以社区为基础的参与性形成性研究，以告知 调整经济赋权干预措施，以改善艾滋病毒预防和护理成果， 首先，PI将在美国建立一个强大的 社区合作委员会（CCB）由目标人群的主要成员组成。与商业罪案调查科及 在导师团队的指导下，PI将最终确定研究设计和方案，并通过当前的 试点研究结果。接下来，PI将进行定量（调查，N=390）和定性（访谈，n=36） 为实现目标1而开展的研究：估计并从质量上描述同时发生的各种形式的经济困难， 被定义为经济边缘化，与TGSM中的艾滋病毒结果相关。综合目标1结果 和CCB指导将为研究目标2提供信息：调整艾滋病毒经济赋权干预措施， 在调整干预措施后，目标3是：评估可接受性 和适应性干预的可行性，并生成初步数据，以通知试点的R 01应用 使用等待列表对照设计，用42 TGSM进行测试，然后用CCB改进干预。拟议 研究建立在AFFIRM项目（R 01 HD 079603/ R 01 HL 151559 A1; PI：Bockting）在纽约市、弗朗西斯科和亚特兰大，并进一步推进NIH艾滋病毒战略 目标是“推进创新研究，以确定和实施有效的战略，以减轻潜在的艾滋病毒- 相关的医疗和社会不平等，损害了患有或面临风险者的健康和福祉 艾滋病病毒。”本研究旨在支持PI的培训目标。培训目标成为 作为独立调查员，候选人需要在四个核心领域接受额外培训： 参与式研究;资产理论;定量方法;以及如何适应，测试，评估和完善社会 采取行为干预措施，以改善重点人群的艾滋病毒结果。由艾滋病中心主办， 哥伦比亚大学和纽约州立精神病研究所，候选人将从事密切的指导， 课程作业、指导性阅读、研讨会、工作组和实践研究，以实现这些培训目标。

7. PROJECT ABSTRACT The purpose of this career development award is to provide the candidate with the training necessary to become an independent investigator 1) advancing scientific knowledge about how social and economic factors are shaping HIV risk and outcomes among marginalized, priority health disparity populations, and 2) designing effective interventions that reduce HIV prevalence and improve health and well-being within sexual and gender minority populations. Research Aims Transgender and nonbinary people experience significant economic hardships and disproportionately shoulder the burden of the HIV/AIDS epidemic in the United States. Guided by an integrated asset theory and social ecological framework, and using a multistage mixed methods approach, the candidate plans to conduct community-based paticipatory formative research necessary to inform the adaptation of an economic empowerment intervention to improve HIV prevention and care outcomes among transgender and nonbinary people who have sex with men (TGSM) in the U.S. First, the PI will establish a robust Community Collaborative Board (CCB) comprised of key members of the target populations. With the CCB and under the guidance of the mentorship team, the PI will finalize study design and protocol, informed by current pilot study findings. Next, the PI will undertake quantitative (surveys, N=390) and qualitative (interviews, n=36) research to achieve Aim 1: to estimate and qualitatively describe how co-occurring forms of economic hardship, defined as economic marginality, are associated with HIV outcomes among TGSM. Integrated Aim 1 findings and CCB guidance will inform study Aim 2: adaptation of an HIV economic empowerment intervention for economically marginalized TGSM in the U.S. After adapting the intervention, Aim 3 is: to assess acceptability and feasibility of the adapted intervention and generate preliminary data to inform an R01 application by pilot testing with 42 TGSM using a waitlist control design, then refining the intervention with the CCB. The proposed research builds from the infrastructure and community ties developed by Project AFFIRM (R01HD079603/ R01HL151559A1; PI: Bockting) in New York City, San Francisco, and Atlanta and furthers the NIH HIV strategic goal to “advance innovative research to identify and implement effective strategies to mitigate underlying HIV- associated medical and social inequalities that diminish the health and well-being of persons living with or at risk for HIV.”1,p.12 This research is designed to support the training goals of the PI. Training Goals To become an independent investigator, the candidate requires additional training in four core areas: community-based participatory research; asset theory; quantitative methods; and how to adapt, test, assess, and refine socio- behavioral interventions to improve HIV outcomes among key populations. Hosted by The HIV Center at Columbia University and New York State Psychiatric Institute, the candidate will engage in close mentorship, coursework, directed readings, workshops, workgroups, and hands-on research to achieve these training goals.