Strengthening the HIV care continuum for transgender women living with HIV in Malaysia

加强马来西亚感染艾滋病毒的跨性别女性的艾滋病毒护理连续性

• 批准号: 10484525
• 负责人: Jeffrey Allen Wickersham
• 金额: $ 20.03万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10484525
• 关键词: AIDS prevention; Abbreviations; Address; Adherence; Affect; Asia; COVID-19; Caring; Chronic Disease; Client; Communities; Complex; Continuity of Patient Care; Country; Data; Development; Diabetes Mellitus; Diagnosis; Discrimination; Drops; Drug usage; Economics; Employment; Environment; Evidence based intervention; Face; Feasibility Studies; Fostering; Future; Gender; Goals; Government; HIV; HIV Seropositivity; HIV antiretroviral; Health; Health Personnel; Health Professional; Healthcare; Human immunodeficiency virus test; Income; Individual; Injecting drug user; International; Interpersonal Violence; Intervention; Interview; Knowledge; Laws; Lead; Link; Malaysia; Malaysian; Malignant Neoplasms; Measures; Medical; Modeling; Morbidity - disease rate; Muslim population group; Names; Newly Diagnosed; Occupations; Outcome; Patients; Persons; Physicians; Population; Prevalence; Process; Protocols documentation; Public Health; Publishing; Religion and Spirituality; Reporting; Research; Resource-limited setting; Risk; Scientist; Social Health Services; Source; Stigmatization; System; Testing; Treatment outcome; Trust; Vulnerable Populations; Work; acceptability and feasibility; antiretroviral therapy; care outcomes; care systems; design; evidence base; experience; health care service; heuristics; high risk; improved; innovation; intervention program; men who have sex with men; mortality; peer; pilot test; programs; response; sex; shared decision making; skills; social; social stigma; transgender; transgender women; treatment as usual; treatment services; viral transmission

Project Abstract HIV antiretroviral therapy (ART) is effective at lowering HIV-related mortality among people with HIV (PWH) and reducing onward transmission of the virus. The HIV care continuum has emerged as an internationally recognized framework for measuring and evaluating HIV treatment outcomes. For patients, however, navigating the complex system of HIV care services can be complex and challenging, particularly patients who face multiple layers of social stigma. Transgender women (TGW), for example, experience several unique vulnerabilities to HIV, including structural factors such as discrimination in employment and economic opportunities, steering TGW toward more high-risk occupations, such as sex work. Other structural factors, including civil and religious laws that ban TGW from changing their name or sex on government-issued identification, further limits TGW’s autonomy and ability to safely and effectively navigate social and health care services. In the context of health care, being both HIV-positive and transgender presents a dual-layer of stigma for patients that may lead to suboptimal encounters with health care professionals. Peer navigator programs (PNP), however, have been shown to improve engagement in medical care for people with chronic diseases, including patients with cancer, diabetes, and HIV. Currently, however, no published research has examined the impact of PNP among HIV+ TGW in Malaysia. Thus, in response to PA-20-145, “Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes”, we propose to develop and evaluate a peer navigation intervention (“MyLink+”) to engage (or re-engage) HIV+ TGW in the HIV care continuum. The specific aims of this application are: (1) Using the ADAPT-ITT intervention adaptation framework,20 create an adapted peer navigation program (“MyLink+”) to engage or reengage HIV+ Malaysian TGW in HIV treatment services; (2) To conduct a pilot RCT of the adapted PNP intervention (MyLink+) vs. enhanced treatment-as-usual (TAU+) among HIV+ TGW to measure feasibility, acceptability and preliminary efficacy; and (3) Using data from Aim 2, to conduct dyadic analyses of peers and clients to better understand shared decision-making and linkage to care outcomes. Dyadic effects between peer navigators and patients will be explored using data from baseline (T0) and weeks 12 (T12) and 24 (T24), including trust, compatibility, and perceived quality of peer-client interactions on (re-)engaging in ART. Findings from this research will yield important information about the use of PNP interventions for improving HIV care outcomes in the Malaysian context. Our results will also inform the optimal strategy for deploying PNP among a highly stigmatized and vulnerable population (HIV+ TGW) and illustrate the impact of shared decision-making processes between peer navigators and patients. Furthermore, our results will guide the development of a research protocol for a future R01 and large-scale RCT of the adapted PNP in Malaysia. This research will have widespread implications for the use of peer navigators to improve HIV outcomes among a highly vulnerable population in a unique, international context.

项目摘要 HIV抗逆转录病毒疗法（ART）可有效降低HIV患者（PWH）和 减少病毒的向前传播。艾滋病毒护理继续以国际认可 测量和评估HIV治疗结果的框架。但是，对于患者，浏览复杂系统 艾滋病毒护理服务可能是复杂和挑战的，尤其是面临多层社会污名的患者。 例如，变性妇女（TGW）经历了几个独特的艾滋病毒漏洞，包括结构性因素 例如歧视就业和经济机会，将TGW转向更高风险的占领， 例如性工作。其他结构性因素，包括禁止TGW改名或 在政府发行的身份下进行性行为，进一步限制了TGW的自主权和安全有效地导航社会的能力 和医疗服务。在医疗保健的背景下，艾滋病毒阳性和跨性别者都表现出 可能导致与医疗保健专业人员相遇的患者的污名。对等导航器程序（PNP）， 但是，已证明可以改善慢性疾病患者的医疗服务，包括患者 癌症，糖尿病和艾滋病毒。但是，目前，尚无公开研究检查PNP对HIV+的影响 马来西亚的TGW。这是对PA-20-145的回应，“预防艾滋病毒，测试，遵守和保留方面的创新以优化 我们建议开发和评估同行导航干预措施 （“ MyLink+”）参与HIV护理连续体中的HIV+ TGW。本应用程序的具体目的是： （1）使用Aftapt-ITT干预适应框架，20创建一个适应的同行导航程序（“ MyLink+”） 参与或重新接触HIV+马来西亚TGW在HIV治疗服务中； （2）进行适应PNP的试点RCT HIV+TGW之间的干预（myLink+）与增强的治疗方法（TAU+），以衡量可接受性 和初步效率； （3）使用AIM 2中的数据进行对同行和客户的二元分析以更好 了解共同的决策和与护理结果的联系。同伴导航员与患者之间的二元作用将 使用基线（T0）和第12周（T12）和24（T24）的数据进行探索，包括信任，兼容性和感知到 （重新）参与艺术的同伴客户互动的质量。这项研究的发现将产生重要信息 关于在马来西亚环境中使用PNP干预措施改善HIV护理结果。我们的结果也将 告知在高度污名和脆弱的人群（HIV+ TGW）和 说明了同伴导航员和患者之间共享决策过程的影响。此外，我们的结果 将指导制定马来西亚改装PNP的未来R01和大规模RCT的研究方案。 这项研究将对使用同伴导航员在高度高度改善艾滋病毒结局方面具有广泛的影响 在独特的国际环境中脆弱的人口。