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.

申请人寻求此 K99/R00 奖项以实现干预科学的研究独立性，重点是 关于使用基于社区的参与性研究（CBPR）原则来减少负面心理和 因耻辱而产生的行为后遗症。跨性别女性感染艾滋病毒和物质的风险很高 误用部分是由于耻辱所支撑的三个相互关联的领域的抬高：内在的耻辱， 心理困扰和逃避医疗保健。接受与承诺疗法（ACT）改善 内在的耻辱、心理困扰和治疗参与度，可能因此减少实质内容 滥用和艾滋病毒风险。然而，性别肯定行动干预对内在耻辱的影响， 跨性别者的心理困扰、医疗保健回避以及随后的药物滥用和艾滋病毒风险 女性则未知。同伴主导的干预对于减少跨性别女性的孤立感至关重要，分享 应对日常耻辱的技能，并鼓励对自己的性别认同感到自豪。 ACT是一个有前途的 ACT 等同伴传递的循证干预措施以前曾由非治疗师有效地进行过。 因此，申请人建议采用 ACT 来创建性别肯定健康干预措施 (ACT+GA)， 针对跨性别女性的药物滥用和艾滋病毒风险（K99 阶段），开展 ACT+GA 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的测试（R00 阶段）。在 K99 阶段，她将与她的导师团队和聚集的社区合作 - 咨询委员会根据焦点小组（k = 4-6，n = 4-6 跨性别女性/小组）制定 ACT+GA 手册 利益相关者的反馈（n = 10-15 治疗提供者、组织领导者和同事），然后解决 在公开试点测试期间确定的任何必要的改进（n = 10 名跨性别女性）。在 R00 阶段，反式 女性将被随机分配接受 ACT+GA (n = 62) 或照常治疗 (n = 62)。内化的耻辱， 将在基线、治疗后评估心理困扰、逃避医疗保健、物质使用和艾滋病毒风险 干预，以及三个月和六个月的随访。协调一致的培训计划将使申请人能够建立 凭借她在 CBPR 方面的坚实基础以及对性别和性别少数群体中艾滋病毒差异的学术研究 (SGM) 人口，在对她的独立性至关重要的三个领域发展新技能：(1) ACT 适应远程医疗 跨性别女性分娩，(2) 早期行为干预开发和测试，(3) 学习深度 以及定性和纵向定量方法的应用。在K99阶段，她的导师团队 将利用其在指导初级学者完全独立方面的持续记录。这将实现 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 更大规模地测试ACT+GA的有效性和实施情况。 K99/R00 奖项将因此提供 申请人拥有一个平台来开展她在跨性别健康和干预科学方面的独立职业生涯。