A Gender-Affirming Stigma Intervention to Improve Substance Misuse and HIV Risk among Transgender Women

性别肯定耻辱干预措施可改善跨性别女性的药物滥用和艾滋病毒风险

• 批准号: 10543347
• 负责人: Arryn Aleia Guy
• 金额: $ 17.99万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10543347
• 关键词: AIDS prevention; Address; Area; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Caring; Communities; Coping Skills; Data; Distress; Educational workshop; Effectiveness; Epidemic; Evidence based intervention; Feedback; Feeling; Focus Groups; Foundations; Fright; Future; Gender; Gender Identity; Goals; HIV; HIV risk; Hazardous Substances; Health; Health Personnel; Healthcare; High Risk Woman; Human immunodeficiency virus test; Hybrids; Individual; Intervention; Interview; Learning; Life; Manuals; Mentors; Mentorship; Methods; Modeling; Modification; Needs Assessment; Outcome; Persons; Phase; Plant Roots; Play; Policies; Population; Positioning Attribute; Process; Provider; Randomized; Randomized Controlled Trials; Reading; Reporting; Research; Research Personnel; Risk; Role; Running; Scholarship; Science; Self Care; Services; Shame; Social isolation; Source; Stigmatization; Strategic Planning; System; Testing; Theoretical model; Therapeutic Intervention; Thinking; Training; United States; United States Dept. of Health and Human Services; United States National Institutes of Health; Victimization; Violence; Women' s Group; Work; analytical method; base; behavior change; behavioral health; behavioral response; career; community based participatory research; community engaged research; community partnership; consistent condom use; design; effectiveness implementation trial; effectiveness testing; evidence base; experience; flexibility; follow-up; health inequalities; high risk; improved; internalized stigma; marginalized population; meetings; mindfulness; model design; peer; physical assault; pilot test; pilot trial; post intervention; programs; psychologic; psychological distress; recruit; scale up; sex; sexual assault; skills; social health determinants; social stigma; substance misuse; substance use; symposium; telehealth; therapy development; transgender; transgender women; transmission process; treatment as usual; tutoring; usability; user centered design

The applicant seeks this K99/R00 award to achieve research independence in intervention science, with a focus on using community-based participatory research (CBPR) principles to reduce the negative psychological and behavioral sequela that result from stigma. Transgender (trans) women are at high risk for HIV and substance misuse due in part to elevations in three interrelated areas underpinned by stigma: internalized stigma, psychological distress, and healthcare avoidance. Acceptance and Commitment Therapy (ACT) improves internalized stigma, psychological distress, and treatment engagement and may thereby reduce substance misuse and HIV risk. However, the effects of a gender affirming ACT intervention on internalized stigma, psychological distress, healthcare avoidance, and subsequent substance misuse and HIV risk among trans women are unknown. Peer-led interventions are essential to decrease trans women’s sense of isolation, share skills for coping with daily sources of stigma, and encourage pride in one’s gender identity. ACT is a promising evidence-based intervention for peer delivery as ACT has been effectively delivered by non-therapists before. The applicant thus proposes to adapt ACT to create a gender-affirming wellness intervention (ACT+GA) that targets substance misuse and HIV risk among trans women (K99 phase), conduct an open pilot trial of ACT+GA (K99 phase), and then run a rigorous test of its effectiveness, acceptability, appropriateness, and feasibility (R00 phase). During the K99 phase, she will collaborate with her mentorship team and the assembled community- advisory board to develop the ACT+GA manual based on focus group (k = 4-6, n = 4-6 trans women/group) and stakeholder feedback (n = 10-15 treatment providers, organizational leaders, and peer staff), and then address any necessary refinements identified during open pilot testing (n = 10 trans women). During the R00 phase, trans women will be randomly assigned to ACT+GA (n = 62) or treatment-as-usual (n = 62). Internalized stigma, psychological distress, healthcare avoidance, substance use, and HIV risk will be assessed at baseline, post- intervention, and at three and six-month follow-up. The coordinated training plan will allow the applicant to build on her strong foundation in CBPR and scholarship of HIV disparities in sexual and gender minoritized (SGM) populations, developing new skills in three areas critical to her independence: (1) adaptation of ACT for telehealth delivery by trans women, (2) early phase behavioral intervention development and testing, (3) depth of learning and application of qualitative and longitudinal quantitative methods. During the K99 Phase, her mentorship team will draw on its sustained track record in mentoring junior scholars to full independence. This will be accomplished through regular meetings, directed readings, hands-on tutorials, and support of her activity in workshops, seminars, and conferences. Completion of the R00 phase will generate data to support a future R01 application to test the effectiveness and implementation of ACT+GA on a larger scale. The K99/R00 award will thus provide the applicant with a platform to launch her independent career in transgender health and intervention science.

申请者寻求K99/R00奖，以实现干预科学研究的独立性，重点是 运用基于社区的参与性研究(CBPR)原则减少负性心理和心理障碍 因耻辱而导致的行为后遗症。变性人妇女感染艾滋病毒和毒品的风险很高 误用的部分原因是由耻辱支撑的三个相互关联的领域的高度：内在化的耻辱， 心理困扰和逃避医疗保健。接受和承诺疗法(ACT)有所改善 内在化的耻辱、心理困扰和治疗参与度，因此可能会减少实质内容 滥用和艾滋病毒风险。然而，性别肯定ACT干预对内化污名的影响， 跨性别者中的心理困扰、逃避医疗保健以及随后的药物滥用和艾滋病毒风险 女人是不为人知的。同伴带头的干预对于减少变性妇女的孤立感、分享 应对日常耻辱来源的技能，并鼓励人们对自己的性别认同感到自豪。ACT是一个很有前途的 之前，非治疗师已经有效地提供了以循证为基础的干预措施，用于作为ACT的同伴分娩。 因此，申请人建议修改ACT，以创建性别肯定的健康干预(ACT+GA)， 针对跨性别女性的药物滥用和艾滋病毒风险(K99阶段)，进行ACT+GA的开放试点试验 (K99阶段)，然后对其有效性、可接受性、适当性和可行性进行严格测试(R00 阶段)。在K99阶段，她将与她的导师团队和聚集的社区合作- 咨询委员会根据重点群体(k=4-6，n=4-6跨性别妇女/群体)编制ACT+GA手册和 利益相关者反馈(n=10-15个治疗提供者、组织领导人和同行员工)，然后解决 在公开试点测试期间发现的任何必要的改进(n=10名变性妇女)。在R00阶段，TRANS 妇女将被随机分配到ACT+GA组(n=62)或照常治疗组(n=62)。内在化的耻辱， 心理困扰、医疗保健回避、药物使用和艾滋病毒风险将在基线、后评估 干预，以及三个月和六个月的随访。协调的培训计划将允许申请者建立 关于她在CBPR方面的坚实基础和关于艾滋病毒在性别和性别方面的差异的学术研究(SGM) 在三个对她的独立性至关重要的领域发展新技能：(1)使ACT适应远程保健 跨性别妇女分娩，(2)早期行为干预发展和测试，(3)学习深度 运用定性和纵向定量相结合的方法。在K99阶段，她的指导团队 将利用其在指导初级学者实现完全独立方面的持续记录。这将会实现的 通过定期会议、定向阅读、实践教程以及对她在研讨会上的活动的支持， 研讨会和会议。R00阶段的完成将生成数据以支持未来的R01应用 在更大范围内测试ACT+GA的有效性和实施情况。因此，K99/R00奖将提供 申请者有一个平台，可以开始她在变性人健康和干预科学领域的独立职业生涯。