Strengthening the HIV care continuum for transgender women living with HIV in Malaysia

加强马来西亚感染艾滋病毒的跨性别女性的艾滋病毒护理连续性

• 批准号: 10650426
• 负责人: Jeffrey Allen Wickersham
• 金额: $ 21.81万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10650426
• 关键词: AIDS prevention; Abbreviations; Address; Adherence; Affect; Asia; COVID-19; Caring; Chronic Disease; Client; Communities; Complex; Continuity of Patient Care; Country; Data; Development; Diabetes Mellitus; Diagnosis; Discrimination; Drops; Drug usage; Economics; Employment; Environment; Evidence based intervention; Feasibility Studies; Fostering; Future; Goals; Government; HIV; HIV Seropositivity; HIV antiretroviral; Health; Health Personnel; Health Professional; Health Services; Healthcare; Human immunodeficiency virus test; Income; Individual; Injecting drug user; International; Interpersonal Violence; Intervention; Interview; Knowledge; Laws; Link; Malaysia; Malaysian; Malignant Neoplasms; Measures; Medical; Modeling; Morbidity - disease rate; Muslim population group; Names; Newly Diagnosed; Occupations; Outcome; Patients; Persons; Physicians; Population; Prevalence; Process; Protocols documentation; Public Health; Publishing; Religion; Reporting; Research; Resource-limited setting; Risk; Scientist; Social Work; Source; Stigmatization; System; Testing; Treatment outcome; Trust; Vulnerable Populations; Work; acceptability and feasibility; antiretroviral therapy; care outcomes; care systems; design; empowerment; evidence base; experience; gender affirming care; health care service; heuristics; high risk; improved; innovation; intervention program; men who have sex with men; mortality; peer; pilot test; programs; response; sex; shared decision making; skills; social; social stigma; structural determinants; transgender; transgender women; treatment as usual; treatment services; viral transmission

Project Abstract HIV antiretroviral therapy (ART) is effective at lowering HIV-related mortality among people with HIV (PWH) and reducing onward transmission of the virus. The HIV care continuum has emerged as an internationally recognized framework for measuring and evaluating HIV treatment outcomes. For patients, however, navigating the complex system of HIV care services can be complex and challenging, particularly patients who face multiple layers of social stigma. Transgender women (TGW), for example, experience several unique vulnerabilities to HIV, including structural factors such as discrimination in employment and economic opportunities, steering TGW toward more high-risk occupations, such as sex work. Other structural factors, including civil and religious laws that ban TGW from changing their name or sex on government-issued identification, further limits TGW’s autonomy and ability to safely and effectively navigate social and health care services. In the context of health care, being both HIV-positive and transgender presents a dual-layer of stigma for patients that may lead to suboptimal encounters with health care professionals. Peer navigator programs (PNP), however, have been shown to improve engagement in medical care for people with chronic diseases, including patients with cancer, diabetes, and HIV. Currently, however, no published research has examined the impact of PNP among HIV+ TGW in Malaysia. Thus, in response to PA-20-145, “Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes”, we propose to develop and evaluate a peer navigation intervention (“MyLink+”) to engage (or re-engage) HIV+ TGW in the HIV care continuum. The specific aims of this application are: (1) Using the ADAPT-ITT intervention adaptation framework,20 create an adapted peer navigation program (“MyLink+”) to engage or reengage HIV+ Malaysian TGW in HIV treatment services; (2) To conduct a pilot RCT of the adapted PNP intervention (MyLink+) vs. enhanced treatment-as-usual (TAU+) among HIV+ TGW to measure feasibility, acceptability and preliminary efficacy; and (3) Using data from Aim 2, to conduct dyadic analyses of peers and clients to better understand shared decision-making and linkage to care outcomes. Dyadic effects between peer navigators and patients will be explored using data from baseline (T0) and weeks 12 (T12) and 24 (T24), including trust, compatibility, and perceived quality of peer-client interactions on (re-)engaging in ART. Findings from this research will yield important information about the use of PNP interventions for improving HIV care outcomes in the Malaysian context. Our results will also inform the optimal strategy for deploying PNP among a highly stigmatized and vulnerable population (HIV+ TGW) and illustrate the impact of shared decision-making processes between peer navigators and patients. Furthermore, our results will guide the development of a research protocol for a future R01 and large-scale RCT of the adapted PNP in Malaysia. This research will have widespread implications for the use of peer navigators to improve HIV outcomes among a highly vulnerable population in a unique, international context.

项目摘要 HIV抗逆转录病毒疗法(ART)有效地降低了HIV感染者(PWH)和 减少病毒的进一步传播。艾滋病毒护理连续体已经成为国际公认的 衡量和评价艾滋病毒治疗结果的框架。然而，对于患者来说，在复杂的系统中导航 艾滋病毒护理服务的多样性可能是复杂和具有挑战性的，尤其是面临多层社会污名的患者。 例如，变性人妇女(TGW)对艾滋病毒有几个独特的脆弱性，包括结构性因素 例如在就业和经济机会方面的歧视，引导TGW转向更高风险的职业， 比如性工作。其他结构性因素，包括禁止TGW更名的民事和宗教法律或 政府颁发的身份证明上的性行为，进一步限制了TGW的自主性和安全有效地导航社会的能力 和医疗保健服务。在卫生保健方面，艾滋病毒阳性和变性人都是双重的 对病人的耻辱，这可能导致与医疗保健专业人员的不佳接触。对等导航器程序(PnP)， 然而，已被证明可以提高慢性病患者(包括患者)的医疗参与度 癌症、糖尿病和艾滋病毒。然而，目前还没有发表的研究考察PNP对HIV+患者的影响 马来西亚的TGW。因此，针对PA-20-145，《在艾滋病毒预防、检测、遵守和保留方面的创新以优化 HIV预防和护理连续结果“，我们建议开发和评估同伴导航干预 (“MyLink+”)让(或重新让)HIV+TGW参与到HIV护理的连续过程中。本申请的具体目标是： (1)使用Adapt-ITT干预适应框架，20创建适应后的同行导航计划(“MyLink+”) 让艾滋病毒+马来西亚TGW参与艾滋病毒治疗服务；(2)对调整后的PNP进行一项试点随机对照试验 在HIV+TGW之间进行干预(MyLink+)与加强照常治疗(TAU+)比较，以衡量可行性和可接受性 和初步效果；以及(3)使用来自目标2的数据，对同行和客户进行二元分析，以更好地 了解共同决策和与护理结果的联系。同行导航员和患者之间的二元效应将 使用基线(T0)、第12周(T12)和第24周(T24)的数据进行探索，包括信任、兼容性和感知 在(重新)参与艺术方面的同行-客户互动的质量。这项研究的发现将产生重要的信息 关于使用即插即用干预措施改善马来西亚艾滋病毒护理结果的情况。我们的结果也将 告知在高度污名化和易受伤害人群(艾滋病毒+TGW)中部署PNP的最佳战略和 说明同行导航员和患者之间共享决策过程的影响。此外，我们的结果 将指导马来西亚为未来的R01和经调整的PNP的大规模RCT制定研究方案。 这项研究将对使用同伴导航器来改善高度感染艾滋病毒的人群的结果具有广泛的影响 在独特的国际背景下的弱势群体。

项目成果

Drivers of Active Amphetamine-Type Stimulant Use among Transgender Women in Malaysia: A Cross-Sectional Study.

马来西亚跨性别女性使用活性苯丙胺类兴奋剂的驱动因素：一项横断面研究。

• DOI: 10.21203/rs.3.rs-3607148/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: JadKarim,Luzan;Galka,Jonathan;Shrestha,Roman;Mazzeo,Rosanna;Restar,Arjee;Gautam,Kamal;Azwa,Iskandar;Wickersham,JeffreyA
• 通讯作者: Wickersham,JeffreyA