The BeT intervention to reduce HIV prevention and care disparities among young transwomen in Rio De Janeiro

BeT 干预措施旨在减少里约热内卢年轻跨性别女性的艾滋病毒预防和护理差异

• 批准号: 10228248
• 负责人: Erin Meek
• 金额: $ 27.51万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10228248
• 关键词: AIDS prevention; Address; Affect; Age; Brazil; Caring; Clinic; Cohort Studies; Collaborations; Communities; Cost efficiency; Country; Cross-Sectional Studies; Data; Development; Discrimination; Enrollment; Epidemic; Evidence based intervention; Face; Frequencies; Fright; Glean; Goals; HIV; HIV Seropositivity; HIV risk; Health; Health Care Seeking Behavior; Health Services Accessibility; Health system; Healthcare Systems; Human immunodeficiency virus test; Income; Individual; Infection; Intervention; Intervention Studies; Investments; Knowledge; Latin America; Longitudinal Studies; Measures; Mexico; Movement; National Institute of Child Health and Human Development; Participant; Patients; Persons; Peru; Phase; Population; Population Study; Prevalence; Prevention; Preventive Intervention; Privatization; Public Health; Randomized; Research; Research Personnel; Resources; Risk; Safety; Sampling; Schedule; Secure; Services; Site; Social Marketing; Socialization; Stigmatization; Structure; System; Testing; Text Messaging; Training; Transcend; Translating; Transportation; Treatment Efficacy; United States National Institutes of Health; Violence; Youth; aged; arm; base; care systems; control trial; cost; data format; digital; efficacy testing; evidence base; experience; follow-up; health literacy; innovation; low and middle-income countries; men who have sex with men; peer; population based; pre-exposure prophylaxis; prevent; prevention service; programs; recruit; research study; response; risk perception; skills; social stigma; transgender; transgender women; treatment arm; uptake

ABSTRACT Our recent research discovered that almost 25% of a population-based sample of young transwomen in Brazil tested positive for HIV. This finding is consistent with research demonstrating that transwomen are the population most severely affected by HIV worldwide and face important barriers to accessing effective prevention and care programs. There is no HIV prevention intervention for young transwomen with evidence of efficacy outside the US. We propose a two-phase combination prevention intervention to address the main barriers to HIV prevention and care found in our research in this resource constrained setting. Stigma prevents young transwomen from accessing HIV prevention and care services, despite the fact that such services are freely available to all Brazilians in the public health system care system (i.e., SUS). Young people's HIV testing levels and care access is uneven. Data from our study show that almost no young transwomen regularly got tested for HIV, and given low testing levels, it is unlikely youth are accessing HIV care. In response to NICHD RFA-HD-18-032, we propose the Brilho e Transcender (BeT, or Shine and Transcend) intervention for young transwomen ages 18-24 years old in Brazil. Our proposed intervention uses expertise gleaned from a US based cohort study of young transwomen and knowledge from our cross-sectional transwomen HIV risk study in Brazil. Our study is comprised of two phases to address stigma in the public health system, intervene to overcome youth challenges with health care systems navigation and to scale the intervention widely if proven efficacious. During the 2-year UG3 phase, we propose to develop, implement and measure a highly visible, community-informed social marketing campaign to reduce anti-trans stigma in four SUS clinics currently implementing national PrEP access efforts that are also part of ImPrEP, which is a 3-country PrEP implementation project focused on transgender individuals and MSM. During the UG3 phase, we will also collect formative data to adapt our ARTAS-based system navigation intervention to the cultural context and HIV prevention and care needs of young transwomen in Brazil. After adaptation, we will conduct a small pilot intervention with 20 youth participants to determine preliminary efficacy and demonstrate our ability to recruit youth in this population. Preliminary data gathered from the RCT in the UG3 phase will be used to refine the intervention and justify movement to the UH3 phase and larger RCT to test efficacy of the intervention. During the UH3 phase, we will conduct a RCT with 150 young transwomen randomized to the BeT intervention or control. The intervention will be a digital systems navigation intervention utilizing peers to address youth-specific barriers to HIV prevention and care- namely, risk perception, system navigation skills and health literacy. The intervention will be intensively implemented over three months with follow-up to twelve months. The control arm will receive unidirectional educational text messages for the same period. We will test whether intervention arm participants have an increase in HIV testing frequency, PrEP uptake and HIV care linkage compared to participants in the control arm. A key innovation of our intervention is that it will be delivered digitally by trained transwomen peers. Interventions that require participants to interact on a particular schedule and in-person present a number of problems for young transwomen who face substantial competing needs and barriers to participation. Our intervention is private, can occur on a schedule convenient to participants, and does not require in-person interaction. The latter advantage is particularly salient for young transwomen who risk threats and abuse in public, especially on transportation. The system-navigation intervention promises multiple advantages over existing interventions that require in-person attendance, including more frequent engagement and lower cost of a digital intervention, alignment with the ways young transwomen socialize and interact, and in addressing safety challenges trans people face with participation in placed-based interventions. With proof of efficacy, the intervention can be rapidly brought to scale as a replicable, sustainable, evidence-based intervention for young transwomen in collaboration with the ImPrEP study and the Brazilian Ministry of Health efforts to increase prevention and care access for transwomen, including youth.

抽象的 我们最近的研究发现，巴西几乎有25％的基于人群的年轻跨性别者样本 艾滋病毒呈阳性。这一发现与研究表明，跨性别者是 人口最严重受艾滋病毒的影响，面临着有效的重要障碍 预防和护理计划。年轻的跨性别者没有预防艾滋病毒的干预措施 美国以外的功效。我们提出了两阶段的预防干预措施，以解决主要 在我们的研究中，在这种资源限制的环境中发现了预防艾滋病毒和护理的障碍。污名可以预防 尽管此类服务是 公共卫生系统护理系统（即SUS）的所有巴西人免费使用。年轻人的艾滋病毒测试 水平和护理访问不平衡。我们研究的数据表明，几乎没有年轻的跨性别者经常得到 接受了艾滋病毒的测试，并且鉴于测试水平较低，青年不太可能获得艾滋病毒护理。回应NICHD RFA-HD-18-032，我们向年轻人提出了Brilho e Transcender（BET或Shine and Sprencend）的干预措施 巴西18-24岁的跨性别者。我们提出的干预使用了从美国收集的专业知识 基于我们横断面跨性别的艾滋病毒风险研究的年轻跨性别者和知识的基础研究 在巴西。我们的研究由两个阶段组成，以解决公共卫生系统中的污名，干预至 通过医疗保健系统导航克服青年挑战，如果证明 有效。在2年的UG3阶段，我们建议开发，实施和测量高度可见的， 社区信息的社会营销活动，以减少目前四个SUS诊所的抗经际交易污名 实施也是IMPREP的一部分的国家预备访问工作，这是一个三个国家的预备 实施项目的重点是变性人和MSM。在UG3阶段，我们也将 收集形成性数据以使我们基于ARTA的系统导航干预适应文化背景和 巴西年轻跨性别者的艾滋病毒预防和护理需求。改编后，我们将进行小型飞行员 与20名青年参与者进行干预以确定初步疗效，并证明我们的能力 在这个人群中招募青年。在UG3阶段从RCT收集的初步数据将用于完善 干预并证明向UH3阶段的运动和更大的RCT的运动以检验干预措施的功效。 在UH3阶段，我们将使用随机分配到BET的150年幼小的transwomen进行RCT 干预或控制。干预将是利用同行的数字系统导航干预措施 解决针对预防艾滋病毒的青年特定障碍，即风险感知，系统导航技能 和健康素养。该干预将在三个月内进行深入实施，随访至十二 月份。控制臂将在同一时期接收单向教育短信。我们将测试 干预臂参与者的艾滋病毒测试频率是否增加 与对照组的参与者相比，联系。我们干预的关键创新是 由训练有素的跨性别同龄人以数字方式交付。需要参与者进行互动的干预措施 特定的时间表和面对面给面对实质的年轻跨性别者带来了许多问题 竞争需求和参与障碍。我们的干预是私人的，可以在时间表方便的情况下进行 给参与者，不需要面对面的互动。后一种优势对于年轻人特别重要 跨性别者在公开场合冒着威胁和虐待，尤其是在运输方面。系统游动 干预承诺比需要亲自出席的现有干预措施具有多个优势， 包括更频繁的参与度和较低的数字干预成本，与年轻的方式保持一致 跨性别者社交和互动，并在应对安全挑战时，跨性别者面对参与 放置基于干预措施。有疗效证明，可以迅速将干预措施作为一个 与Imprep合作，可复制，可持续，基于证据的干预措施 研究和巴西卫生部为增加跨性别者的预防和护理机会而努力， 包括青年。