Transgender-Specific Differentiated HIV Care: An Implementation Science Study

针对变性人的差别化艾滋病毒护理模式： 实施科学研究 项目总结/摘要 尽管艾滋病毒的负担不成比例，但变性人实现病毒抑制的可能性低于 一般人群，对PrEP服务的参与度较低。可干预的参与障碍 艾滋病毒服务中的性别歧视包括基于设施的耻辱和缺乏获得性别肯定护理的机会，包括激素 疗法最近实施了针对变性人的差别化服务提供模式， 在南非的示范项目，提供了一个独特的机会，评估可行的和可接受的 实施战略，并分析纳入性别平等肯定的有效性和成本 将激素疗法和减少耻辱战略纳入变性人的艾滋病毒护理。这种观察， 一项多中心、混合方法的前瞻性实施研究将以性别肯定为指导， RE-AIM（Reach，Effectiveness，Adoption，Implementation，Maintenance） 科学评价框架，以满足以下目标：（1）评估障碍，促进因素，可接受性， * 利用现场观察清单、关键信息提供者 与设施工作人员的访谈，以及与跨性别客户的纵向深入访谈;（2）评估效果 跨性别特异性差异化服务提供的病毒抑制和PrEP依从性-测试 污名和性别肯定作为中介，使用TGP客户的纵向队列，比较 在有跨性别者的跨性别差异化服务提供点登记的跨性别者 在标准服务提供场所登记的人（ART组200人/组，PrEP组100人/组，总共N = 600）; 和（3）估计与跨性别特定的差异化服务提供相关的成本与标准 服务提供地点使用微观成本计算方法来估计每个服务用户的成本， 服务用户在跨性别特定的差异化服务提供站点成功接受治疗， 标准的服务提供地点，以及在全南非成功实施所需的预算。

Transgender-specific Differentiated HIV Care Models: An Implementation Science Study Project Summary/Abstract Despite a disproportionate burden of HIV, transgender people are less likely to achieve viral suppression than the general population and have low engagement in PrEP services. Intervenable barriers to their engagement in HIV services include facility-based stigma and lack of access to gender affirming care, including hormone therapy. Transgender-specific differentiated service delivery models have recently been implemented as demonstration projects in South Africa, providing a unique opportunity to assess feasible and acceptable implementation strategies as well as analyze the effectiveness and cost of integrating gender affirming hormone therapy and stigma-reduction strategies into HIV care for transgender people. This observational, multi-site, mixed methods prospective implementation study will be guided by the Gender Affirmation Framework and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation science evaluation framework to meet the following aims: (1) assess barriers, facilitators, acceptability, and feasibility of transgender-specific differentiated service delivery using site observation checklists, key informant interviews with facility staff, and longitudinal in-depth interviews with transgender clients; (2) evaluate the effect of transgender-specific differentiated service delivery on viral suppression and PrEP adherence - testing stigma and gender affirmation as mediators, using a longitudinal cohort of TGP clients that compares transgender people enrolled at transgender-specific differentiated service delivery sites with transgender people enrolled in standard service delivery sites (200/arm on ART and 100/arm on PrEP for a total N = 600); and (3) estimate the cost associated with transgender-specific differentiated service delivery versus standard service delivery sites using a micro-costing approach to estimate the cost per service user served and per service user successfully treated at transgender-specific differentiated service delivery sites relative to standard service delivery sites, as well as the budget needed for successful South Africa-wide implementation.