Tcher, Take Charge: Increasing PrEP Awareness, Uptake, and Adherence Through Health Care Empowerment and Addressing Social Determinants of Health Among Racially Diverse Trans Women in the Deep South

Tcher，负责：通过医疗保健赋权提高 PrEP 意识、采用率和依从性，并解决南方腹地多元化跨性别女性健康的社会决定因素

• 批准号: 10328021
• 负责人: Narquis Barak
• 金额: $ 69.5万
• 依托单位: NEW ORLEANS AIDS TASK FORCE, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10328021
• 关键词: AIDS prevention; Address; Adherence; Annual Reports; Awareness; Bisexual; Caring; Centers for Disease Control and Prevention (U.S.); Charge; Clinic; Communities; Community Health; Cost efficiency; Cross-Over Studies; Data; Deep South; Ecological momentary assessment; Effectiveness; Environment; Evidence based intervention; Face; Gays; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV/STD; Health; Health Services Accessibility; Healthcare; Hearing; Intervention; Investments; Letters; Life; Louisiana; Measures; Media Campaign; Mediating; Methods; Modeling; Outcome; Participant; Persons; Population; Population Study; Randomized; Reporting; Research; Research Design; Research Personnel; Running; Sampling; San Francisco; Savings; Social support; Testing; Text; Time; Trust; Viral; Woman; Work; base; cis-male; community clinic; community engagement; design; digital; digital intervention; empowerment; evidence base; experience; high risk; improved; innovation; mHealth; member; men; motivational enhancement therapy; novel; peer; population based; pre-exposure prophylaxis; prevention service; psychological distress; racial diversity; recruit; response; social health determinants; social media; social stigma; substance use; surveillance data; surveillance study; therapy design; transgender; transgender women; uptake; web site

Abstract Trans women are highly underserved in the response to HIV, especially in the deep south. Southern states are disproportionately impacted by HIV. Among states in the deep south, which face the vast majority of new HIV infections, HIV diagnosis rates in Louisiana were second only to Georgia. In New Orleans, our team conducted the first population- base HIV surveillance study of trans women and 46% tested positive for HIV. These findings are consistent with the most recent Louisiana Department of Health (LDH) STD/HIV annual report in 2018 that identified Black gay/bisexual men and transgender women as bearing the largest burden of HIV of any population in Louisiana. Despite the impact of HIV on trans women in New Orleans, no evidence-based PrEP interventions or efforts are underway to meet community needs. In response to RFA-MH-21-151 Strengthening HIV Prevention Efforts for Women in the Southern U.S., our team proposes to test the T'Cher, Take Charge intervention to increase PrEP awareness, uptake, and adherence among trans women in New Orleans. T'Cher builds off the work conducted to inform and implement the first population-based study of trans women in 2019 with the adaptation of two evidence-based interventions for trans women recently completed by investigators. The intervention will include a social media campaign to increase PrEP awareness among trans women. It will also include peer navigation to build trust among trans people and provide PrEP navigation. We will tailor the peer navigation model from the Stay Study to be implemented digitally and enhanced using Health eNav methods. Namely, we will also use motivational interviewing and EMAs to increase health care empowerment and address social determinants of health barriers to PrEP uptake and adherence. We will recruit 200 trans women to participate in our study using methods proven successful in our prior HIV research with trans women. Trans women will be engaged in the intervention for 12 months, providing enough time to address barriers to PrEP and support adherence. The goals of this proposed T'Cher, Take Charge intervention are: (1) To develop, implement and measure the impact of a T'Cher, Take Charge social media campaign on PrEP awareness among trans women in New Orleans, LA using a population-based sample of trans women; (2) To test the impact of the T'Cher, Take Charge digital mHealth peer navigation model on increasing PrEP uptake and adherence among trans women in New Orleans, LA, using a randomized stepped wedge cross-over study design; and, (3) To assess changes in health care empowerment and support for social determinants of health as mediating factors in PrEP uptake and adherence. Our goal is to used lessons learned to adapt promising trans-specific HIV interventions to meet the HIV prevention needs of trans women in New Orleans, Louisiana. With evidence of effectiveness, we are prepared to test the intervention at scale throughout Louisiana to strengthen PrEP access and utilization among trans women Louisiana and throughout the deep south.

抽象的 跨性别女性在艾滋病毒应对方面的服务严重不足，尤其是在南方腹地。南部各州是 受艾滋病毒影响尤为严重。在面临绝大多数新艾滋病毒感染的南部腹地各州中， 路易斯安那州的艾滋病毒诊断率仅次于乔治亚州。在新奥尔良，我们的团队进行了第一次人口统计—— 对跨性别女性进行的基础艾滋病毒监测研究显示，46% 的艾滋病毒检测呈阳性。这些发现与大多数人的观点一致 路易斯安那州卫生部 (LDH) 最近发布的 2018 年 STD/HIV 年度报告指出，黑人同性恋/双性恋男性和 变性妇女是路易斯安那州所有人口中艾滋病毒负担最重的人群。尽管艾滋病毒对 在新奥尔良的跨性别女性中，目前还没有基于证据的 PrEP 干预措施或努力来满足社区需求。在 为了回应 RFA-MH-21-151 加强美国南部妇女的艾滋病毒预防工作，我们的团队建议 测试“T'Cher, Take Charge”干预措施，以提高跨性别女性的 PrEP 意识、采用率和依从性 新奥尔良。 T'Cher 建立了为告知和实施第一项基于人口的跨性别研究而开展的工作 2019 年女性，调整了最近完成的两项针对跨性别女性的循证干预措施 调查人员。干预措施将包括一场社交媒体活动，以提高跨性别女性的 PrEP 意识。它 还将包括同伴导航，以在跨性别者之间建立信任并提供 PrEP 导航。我们将为同行量身定制 停留研究中的导航模型将以数字方式实施，并使用健康电子导航方法进行增强。也就是说，我们 还将利用动机访谈和 EMA 来增强医疗保健赋权并解决社会决定因素 PrEP 摄取和依从性的健康障碍。我们将招募 200 名跨性别女性参与我们的研究，使用 我们之前针对跨性别女性的艾滋病毒研究已证明该方法是成功的。跨性别女性将参与干预 12 个月，提供足够的时间来解决 PrEP 障碍并支持依从性。本提议的目标 T'Cher, Take Charge 干预措施包括： (1) 制定、实施和衡量 T'Cher, Take Charge 的影响 使用基于人口的样本，提高洛杉矶新奥尔良跨性别女性的 PrEP 意识的社交媒体活动 跨性别女性； (2) 测试 T'Cher, Take Charge 数字 mHealth 对等导航模型对增长的影响 使用随机阶梯楔形交叉研究，路易斯安那州新奥尔良的跨性别女性对 PrEP 的采用和依从性 设计; (3) 评估医疗保健赋权的变化以及对健康问题社会决定因素的支持作为中介 PrEP 摄取和依从性的因素。我们的目标是利用吸取的经验教训来适应有前途的跨特异性艾滋病毒 旨在满足路易斯安那州新奥尔良跨性别女性艾滋病毒预防需求的干预措施。有证据表明 有效性，我们准备在路易斯安那州大规模测试干预措施，以加强 PrEP 的获取和 路易斯安那州和整个南方腹地的跨性别女性的利用情况。