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，巴西年轻跨性别女性人口样本中近 25% 艾滋病毒检测呈阳性。这一发现与表明跨性别女性是 全世界受艾滋病毒影响最严重的人群，在获得有效治疗方面面临着重要障碍 预防和护理计划。没有针对年轻跨性别女性的艾滋病毒预防干预措施，有证据表明 在美国境外的功效。我们建议采取两阶段联合预防干预措施来解决主要问题 我们在资源有限的环境中进行的研究发现了艾滋病毒预防和护理的障碍。耻辱可以防止 年轻跨性别女性无法获得艾滋病毒预防和护理服务，尽管事实上此类服务 公共卫生系统护理系统（即 SUS）中的所有巴西人均可免费获得该服务。青少年艾滋病毒检测 水平和护理获取机会参差不齐。我们的研究数据显示，几乎没有年轻的跨性别女性经常接受 进行了艾滋病毒检测，并且由于检测水平较低，青少年不太可能获得艾滋病毒护理。回应 NICHD RFA-HD-18-032，我们建议针对年轻人进行 Brilho e Transcender（BeT，或 Shine and Transcend）干预 巴西 18-24 岁的跨性别女性。我们提议的干预措施利用了从美国收集的专业知识 基于年轻跨性别女性的队列研究以及我们的横断面跨性别女性艾滋病毒风险研究的知识 在巴西。我们的研究分为两个阶段，旨在解决公共卫生系统中的耻辱问题，进行干预 通过医疗保健系统导航克服青年人的挑战，并在得到证实后广泛扩大干预范围 有效。在为期 2 年的 UG3 阶段，我们建议开发、实施和衡量一个高度可见的、 目前在四家 SUS 诊所开展社区知情的社会营销活动，以减少反跨性别歧视 实施国家 PrEP 获取工作，这也是 ImPrEP 的一部分，ImPrEP 是一项涵盖 3 个国家的 PrEP 实施项目的重点是跨性别者和男男性行为者。在UG3阶段，我们还将 收集形成性数据，使我们基于 ARTAS 的系统导航干预适应文化背景， 巴西年轻跨性别女性的艾滋病毒预防和护理需求。适应之后，我们会进行一个小试点 对 20 名青少年参与者进行干预，以确定初步效果并展示我们的能力 在这个人群中招募年轻人。从 UG3 阶段的 RCT 收集的初步数据将用于完善 干预并证明进入 UH3 阶段和更大的 RCT 的合理性，以测试干预的有效性。 在 UH3 阶段，我们将对 150 名年轻跨性别女性进行随机对照试验，随机分配到 BeT 干预或控制。该干预措施将是利用同行的数字系统导航干预 解决青少年艾滋病毒预防和护理方面的特定障碍，即风险认知、系统导航技能 和健康素养。该干预措施将在三个月内集中实施，并跟进至十二个月 几个月。控制臂将接收同一时间段的单向教育短信。我们将测试 干预组参与者的 HIV 检测频率、PrEP 接受率和 HIV 护理是否有所增加 与控制臂中的参与者相比的连接。我们干预措施的一个关键创新是 由受过训练的跨性别女性同伴以数字方式提供。要求参与者进行互动的干预措施 特定的日程安排和面对面的交流给年轻跨性别女性带来了许多问题，她们面临着巨大的挑战。 竞争性需求和参与障碍。我们的干预是私人的，可以按方便的时间表进行 向参与者提供，并且不需要面对面的互动。后者的优势对于年轻人来说尤为突出 跨性别女性在公共场合（尤其是在交通上）面临威胁和虐待的风险。系统导航 与需要亲自出席的现有干预措施相比，干预措施具有多种优势， 包括更频繁的参与和更低的数字干预成本、与年轻人的方式保持一致 跨性别女性进行社交和互动，并通过参与解决跨性别者面临的安全挑战 基于地点的干预措施。有了功效证明，干预措施就可以迅速扩大规模，成为一种有效的干预措施。 与 ImPrEP 合作，为年轻跨性别女性提供可复制、可持续、循证的干预措施 研究和巴西卫生部为增加跨性别女性的预防和护理机会所做的努力， 包括青年。