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: 10641010
• 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/10641010
• 关键词: AIDS prevention; Address; Area; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Caring; Collaborations; Communities; Coping Skills; Data; Diagnostic; Distress; Educational workshop; Effectiveness; Epidemic; Evidence based intervention; Feedback; Feeling; Focus Groups; Foundations; Fright; Future; Gender Identity; Goals; HIV; HIV disparities; 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; Play; Policies; Population; Positioning Attribute; Process; Provider; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Risk; Role; Running; Scholarship; Science; Self Care; Services; Sexual and Gender Minorities; Shame; Social isolation; Source; Stigmatization; Strategic Planning; Substance Use Disorder; 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; Woman; Work; analytical method; behavior change; behavioral health; behavioral response; career; community based participatory research; community engaged research; community organizations; community partnership; comparison intervention; consistent condom use; coping; design; effectiveness testing; effectiveness/implementation trial; evidence base; experience; flexibility; follow-up; gender affirmation; gender minority group; 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; 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.

申请人寻求这个K99/R 00奖，以实现干预科学的研究独立性，重点是 使用基于社区的参与性研究（CBPR）原则，以减少消极的心理和 耻辱感导致的行为后遗症。跨性别（trans-women）女性感染艾滋病毒和物质的风险很高 滥用的部分原因是由污名支撑的三个相互关联的领域的升级：内化的污名， 心理困扰和逃避医疗保健接受和承诺疗法（ACT） 内化的耻辱，心理困扰和治疗参与，从而可能减少物质 滥用和艾滋病毒风险。然而，性别肯定的ACT干预措施对内化的污名， 心理困扰，医疗回避，以及随后的药物滥用和跨性别者的艾滋病毒风险 女人是未知的。同伴主导的干预措施对于减少跨性别女性的孤立感至关重要，分享 处理日常耻辱来源的技能，并鼓励对自己的性别认同感到自豪。ACT是一个有前途的 同伴传递的循证干预作为ACT已经有效地提供了非治疗师之前。 因此，申请人建议修改ACT，以创建性别肯定的健康干预措施（ACT+GA）， 针对跨性别妇女（K99阶段）的药物滥用和艾滋病毒风险，进行ACT+GA的开放试点试验 (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测试（R 00 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跨性别妇女/组）编制ACT+GA手册， 利益相关者的反馈（n = 10-15治疗提供者，组织领导和同行工作人员），然后解决 在开放式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R 00阶段， 女性将被随机分配到ACT+GA（n = 62）或常规治疗（n = 62）。内在的耻辱感， 将在基线、治疗后和治疗后评估心理困扰、医疗回避、物质使用和HIV风险。 干预，并在三个月和六个月的后续行动。协调的培训计划将允许申请人建立 她在CBPR和艾滋病毒在性和性别少数群体（SGM）的差距奖学金的坚实基础 她的主要任务是：（1）为远程保健调整ACT， 由跨性别妇女分娩，（2）早期行为干预开发和测试，（3）学习深度 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实现完全独立方面的持续记录。这将是完成 通过定期会议，指导阅读，实践教程，并支持她在研讨会上的活动， 研讨会和会议。R 00阶段的完成将生成数据以支持未来的R 01应用 在更大范围内测试ACT+GA的有效性和实施。因此，K99/R 00合同将提供 申请人有一个平台，开始她在跨性别健康和干预科学的独立职业生涯。