Addressing violence and HIV cascade of care outcomes among transgender women

解决跨性别女性中的暴力和艾滋病毒护理结果连锁反应

• 批准号: 9912488
• 负责人: Kristi E Gamarel
• 金额: $ 19.1万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9912488
• 关键词: Address; Adherence; Adult; Affect; Alcohol or Other Drugs use; Birth; Caring; Chronic stress; Color; Communities; Community Health; Continuity of Patient Care; Data; Development; Diagnosis; Discrimination; Drops; Education; Enrollment; Epidemic; Female; Feminine; Future; Gender; Gender Identity; HIV; HIV diagnosis; Health Personnel; Immune; Imprisonment; Individual; Infection; Inflammatory Response; Intervention; Intervention Studies; Interview; Law Enforcement; Length; Link; Mediating; Medical; Michigan; Modeling; Outcome; Participant; Pathway interactions; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Poverty; Prevention program; Public Health; Randomized Controlled Trials; Recording of previous events; Research; Research Design; Resources; Risk; Role; Safety; San Francisco; Screening procedure; Self Efficacy; Services; Sexual and Gender Minorities; Symptoms; Testing; Time; Trauma; United States; Violence; Viral; Viral Load result; arm; base; care outcomes; cisgender; efficacy trial; empowered; empowerment; evidence base; experience; flexibility; follow-up; health care availability; health care quality; health disparity; improved; intervention program; male; meetings; partner violence; post intervention; primary outcome; programs; public health relevance; rapid diagnosis; recruit; retention rate; secondary outcome; self esteem; seroconversion; social structure; stressor; therapy design; transgender; transgender women

PROJECT SUMMARY Transgender (`trans') women of color experience violence in a variety of contexts, including from partners, strangers, law enforcement, healthcare providers, and in public accommodations. Violence is consistently linked with avoiding care, suboptimal ART adherence, and lower odds of viral suppression via pathways including chronic stress, immune inflammatory response, posttraumatic stress disorder (PTSD) symptoms, and substance use. These epidemics are concurrent and mutually reinforcing, constituting a “syndemic” or synergistic interaction that contributes to documented inequities in HIV continuum of care outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in engagement in HIV care. In this R21 exploratory/developmental research application, we propose to adapt and pilot test a culturally-responsive, evidence-based, and trauma-informed intervention to improve engagement in HIV care (primary outcome), reduce PTSD symptoms (secondary outcome), and increase sustained viral suppression (tertiary outcome) among trans women of color living with HIV. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of the intervention, with a focus on the unique aspects of violence, gender affirmation needs, and engagement in HIV care by conducting interviews with trans women of color and key stakeholders to inform the adaptation. Our community advisory board consisting of trans women of color will review all adapted materials. The second aim seeks to examine the feasibility, acceptability, and preliminary efficacy of the adapted intervention in a one-arm pilot with follow-ups immediate and 3-month post- intervention. The third aim seeks to gather qualitative data from one-arm pilot participants to identify strategies to overcome barriers to implementing rigorous randomized controlled trial research designs with trans women of color within limited-resources settings. Study findings will provide the necessary groundwork for a subsequent community-engaged large-scale randomized controlled trial. Findings also have the potential to provide a blueprint to guide future research efforts with trans women of color who are often embedded in close- knit communities with few existing culturally-responsive services.

项目摘要 有色人种的跨性别妇女在各种情况下遭受暴力，包括来自伴侣的暴力， 陌生人，执法人员，医疗保健提供者和公共场所。暴力一直是 与避免护理、次优ART依从性和通过途径抑制病毒的可能性较低有关 包括慢性应激、免疫炎症反应、创伤后应激障碍（PTSD）症状，以及 物质使用。这些流行病是同时发生的，相互加强，构成一种“综合流行病”或 协同互动，有助于记录艾滋病毒连续护理结果的不公平。在底特律， 在密歇根州，有色人种的跨性别女性是艾滋病毒的“最危险”群体之一， 参与艾滋病护理。在这个R21探索性/开发性研究应用中，我们建议适应和 试点测试一种文化上敏感的，以证据为基础的和创伤知情的干预措施，以提高参与 HIV护理（主要结局），减少PTSD症状（次要结局），并增加持续的病毒感染率。 抑制（三级结局）在有色人种女性艾滋病毒感染者中。在ADAPT-ITT模型的指导下， 我们的第一个目标是对干预措施进行系统的调整，重点关注以下方面的独特性： 暴力，性别肯定的需要，并通过对跨性别妇女进行访谈， 颜色和关键利益相关者通知适应。我们的社区咨询委员会由跨性别女性组成 颜色将审查所有改编的材料。第二个目的是审查可行性、可接受性和 在单臂试点中进行适应性干预的初步疗效，并在术后立即和3个月进行随访。 干预第三个目标是从单臂试点参与者那里收集定性数据，以确定战略 克服对跨性别女性实施严格的随机对照试验研究设计的障碍 在有限的资源设置中的颜色。研究结果将为一项 随后的社区参与的大规模随机对照试验。这些发现也有可能 提供了一个蓝图，以指导未来的研究工作与跨性别妇女的颜色谁往往是嵌入在密切- 在现有的文化敏感服务很少的情况下将社区联系起来。