Enhanced COhort methods for HIV Research and Epidemiology (ENCORE) among transgender women in the United States

美国跨性别女性的艾滋病毒研究和流行病学增强队列方法 (ENCORE)

• 批准号: 10537314
• 负责人: Sari Reisner
• 金额: $ 176.23万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-09 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10537314
• 关键词: AIDS prevention; Address; Adherence; Age; Alcohol abuse; Area; Attention; Automobile Driving; Black race; Caring; Cessation of life; Cities; Clinical Trials; Communities; Coupled; Data; Development; Disease; Drug usage; Economics; Enhancement Technology; Enrollment; Ensure; Epidemic; Epidemiology; Ethnic Origin; Event; Formulation; Future; Gender; HIV; HIV Seronegativity; HIV Seropositivity; HIV risk; Health; Healthcare; High Risk Woman; Homicide; Hybrids; Imprisonment; Incidence; Individual; Intervention; Latinx; Measures; Mental Health; Mental disorders; Methods; Modeling; Monitor; Overdose; Participant; Patient Self-Report; Pattern; Persons; Policies; Population; Population Heterogeneity; Populations at Risk; Prevalence; Prevention; Prevention Research; Prevention strategy; Race; Reporting; Research; Research Support; Risk; Risk Factors; Role; Sampling; Selection Bias; Sister; Site; Social isolation; Suicide; Technology; Testing; Time; Unemployment; United States; Vulnerable Populations; Work; base; cohort; contextual factors; demographics; digital; distrust; effectiveness testing; ethnic diversity; evidence base; experience; follow-up; health disparity; literacy; mathematical model; men who have sex with men; mortality; multidisciplinary; multilevel analysis; national surveillance; neglect; new technology; novel; personalized approach; pre-exposure prophylaxis; preventive intervention; psychosocial; racial and ethnic; recruit; scale up; sex; social; social disparities; social structure; substance use; syndemic; transgender women; trend; uptake; violence victimization; virtual

In the United States, transgender women (TW) are disproportionately impacted by HIV and are prioritized in the US national strategy to end the epidemic. Multiple individual, interpersonal, and structural vulnerabilities fuel the HIV epidemic among TW, as well as fuel syndemic conditions (co-occurring and reinforcing diseases or other health conditions, such as HIV, substance use, and mental health disorder, that are often a consequence of social inequity). National cohorts are critical to monitoring epidemic trends and how major events (e.g., epidemics, policy change, new biomedical interventions) impact HIV and other health conditions; this is particularly important for TW who are often excluded from national surveillance efforts. The objective of this proposal is to use a novel, hybrid “community hub”-supported digital cohort (“hub-supported digital cohort”) model to evaluate HIV incidence, risk factors, and syndemic conditions among TW in the US (N=3,000). In this model, on-the-ground community “hubs” will support enrollment and retention of a racially/ethnically and culturally diverse, nationwide digital cohort. We will refine optimal digital cohort methods while examining the impact of structural and psychosocial syndemic experiences on HIV incidence and parameterizing mathematical models to identify targets for future multi-level combination HIV prevention interventions. The specific aims are: 1) Determine the efficiency and acceptability of using a novel, hub-supported digital cohort model to enroll and retain a sample of racially/ethnically diverse TW for HIV research. 2) Estimate the prevalence and characterize patterns of syndemic experiences among TW. 3) Estimate HIV incidence in TW, followed every 6 months for at least 24 months to identify tailored approaches for combination, multi-disciplinary HIV prevention interventions. 3.1) Examine the effect of syndemic experiences and contextual structural factors on HIV incidence among TW in the US. 3.2) Characterize the PrEP continuum among TW and associations with HIV incidence over time, including uptake of newly emerging formulations, longitudinal patterns of HIV risk and adherence, and the role of syndemic classes and contextual factors in the PrEP continuum PrEP uptake, adherence, and retention. 4.) Develop dynamic models of multi-level combination HIV prevention interventions and scale-up among TW to simulate the impact of evaluated interventions on HIV incidence through 2030, corresponding to the National HIV strategy. There is a need to refine and evaluate hybrid digital cohort models with attention to mitigating selection bias and attrition of vulnerable populations – an area of research particularly important for an epidemic underscored by social and health disparities. Our explicit efforts to develop a hybrid cohort model center on equity to support research participation across diverse populations and provide representative and generalizable data. Study findings will provide critical epidemiologic parameters for future HIV prevention research, provide a platform for exploration of other research questions, and inform the development of evidence-based and acceptable HIV interventions to reduce HIV acquisition among transgender women in the US.

在美国，跨性别妇女（TW）受到艾滋病毒的影响不成比例，并在艾滋病毒/艾滋病领域得到优先考虑。 美国结束疫情的国家战略。多个个体、人际关系和结构性脆弱性助长了 艾滋病毒在台湾地区流行，以及助长综合性疾病（同时发生和加重疾病或其他疾病） 健康状况，如艾滋病毒，物质使用和精神健康障碍，往往是由于 社会不平等）。国家队列对于监测流行趋势以及重大事件（例如， 流行病，政策变化，新的生物医学干预措施）影响艾滋病毒和其他健康状况;这是 这对TW尤其重要，因为他们经常被排除在国家监测工作之外。的目的 建议使用一种新型的混合“社区中心”支持的数字队列（“中心支持的数字队列”） 评估美国TW人群（N= 3，000）中HIV发病率、风险因素和共患病状况的模型。在这 在这种模式下，实地社区“中心”将支持登记和保留一个种族/族裔和 多元文化的全国性数字群体我们将完善最佳的数字队列方法，同时检查 结构和心理社会共患病经历对HIV发病率的影响及数学参数化 为今后的多层次综合艾滋病毒预防干预确定目标的模式。具体目标是： 1)确定使用新型中心支持的数字队列模型进行招募的效率和可接受性， 保留种族/民族多样化的TW样本用于艾滋病毒研究。2)估计患病率并描述 TW之间的发病经验模式。3)估计TW的艾滋病毒发病率，每6个月随访一次， 至少需要24个月的时间，以确定针对性的综合、多学科艾滋病毒预防干预措施。 3.1)检验流行病经历和背景结构因素对TW中HIV发病率的影响 在美国. 3.2)描述TW之间的PrEP连续性以及随时间推移与艾滋病毒发病率的关联， 包括新出现的制剂的吸收，艾滋病毒风险和依从性的纵向模式，以及 在PrEP连续体PrEP吸收，坚持和保留中的流行病类别和背景因素。4.） 制定多层次联合艾滋病毒预防干预的动态模式，并在TW中扩大规模， 模拟到2030年评估的干预措施对艾滋病毒发病率的影响，与国家计划相对应 艾滋病毒战略。有必要完善和评估混合数字队列模型，同时注意减轻 选择偏差和脆弱人群的流失-这是一个对流行病特别重要的研究领域 社会和健康不平等。我们开发混合队列模型的明确努力集中在 公平，以支持不同人群的研究参与，并提供具有代表性和普遍性的 数据研究结果将为未来的艾滋病预防研究提供关键的流行病学参数， 探索其他研究问题的平台，并为循证医学和 可接受的艾滋病毒干预措施，以减少美国跨性别妇女感染艾滋病毒。