Piloting a multi-level intervention to promote viral suppression among transgender women living with HIV

试点多层次干预措施，促进感染艾滋病毒的跨性别女性的病毒抑制

• 批准号: 10548552
• 负责人: CLARE L BARRINGTON
• 金额: $ 27.05万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548552
• 关键词: Address; Adherence; Adult; Affect; Appointment; Area; Behavior Therapy; Belief; Buffers; Caribbean region; Caring; Clinic; Communities; Consultations; Continuity of Patient Care; Control Groups; Counseling; Discrimination; Dominican Republic; Dose; Education; Emotional; Exclusion; Feeling; Focus Groups; Fright; Gender; HIV; Health; Health Status; Health education; Individual; Interruption; Intervention; Interview; Latin America; Modeling; Modification; Outcome; Participant; Pathway interactions; Population; Prevalence; Process; Provider; Randomized; Recommendation; Reporting; Resources; Site; Surveys; Training; Treatment outcome; Trust; Viral; Viral Load result; Work; arm; care outcomes; cisgender; cohesion; comparison intervention; experience; female sex worker; improved; insight; internalized stigma; intervention participants; maltreatment; negative affect; peer; provider intervention; public health relevance; randomized trial; response; scale up; self esteem; sex; social cohesion; social determinants; social stigma; staff intervention; substance use; transgender; transgender women; trend

Project Summary/Abstract: Transgender (trans) women across the globe experience a disproportionate burden of HIV with an estimated global HIV prevalence of 19%. Trans women living with HIV also have worse HIV care and treatment outcomes than cisgender adults, including lower rates of viral suppression. Multilevel responses are needed to improve HIV outcomes among trans women by simultaneously and synergistically addressing individual, provider, and community dynamics. Trans women experience intersectional stigma due to the frequent association between trans identity, HIV, and sex work. These intersecting forms of stigma include internalized stigma in the form of applying negative beliefs and enacted stigma in the form of exclusion and discrimination. Developing social cohesion can be a critical first step in community processes to address stigma. We adapted a multilevel intervention, Abriendo Puertas (Opening Doors), including individual counseling, peer navigation, and community mobilization for trans women living with HIV in the Dominican Republic using an iterative consultation process. We assessed feasibility and initial effects on HIV care and treatment behaviors with 30 trans women living with HIV (no control group) and documented positive trends in ART use (70% to 85%, p=0.03), missed care appointments (35% to 20%, p=0.39) and ART adherence (86% to 96%, p=0.50). Participants emphasized that trusting intervention staff and being treated with respect in individual sessions allowed them to improve self-esteem. Limited trust and cohesion among trans women, however, inhibited more extensive engagement with peer navigation and community activities. In response, we identified two key modifications to strengthen and further tailor the intervention for trans women living with HIV: 1) integrate more gender affirming content, including with providers and 2) focus on building trust among trans women through sequential implementation of individual and then community components. The purpose of the proposed study is to conduct a pilot randomized trial of the GAP model, or Gender-affirming Abriendo Puertas. In Aim 1, we will assess preliminary efficacy of the GAP intervention on viral suppression among trans women randomized to the intervention compared to those randomized to control. We will randomly assign trans women living with HIV to the GAP intervention (n=60) (individual counseling, peer navigation, provider training, and community support building) or control group (n=60). We will conduct baseline, 6, and 12-month surveys and viral load assessments to assess differences across study arms. In Aim 2, we will examine pathways of influence (e.g. decreased stigma, increased cohesion) and experiences with the intervention to identify specific areas for improvement and scale up. We will conduct longitudinal qualitative interviews at baseline, 6, and 12 months with 20 intervention participants and, together with surveys, assess how GAP participation affects pathways between stigma, cohesion, and HIV outcomes. We will also elicit experiences and recommendations from providers and intervention staff in focus groups at 6 (n=2) and 12 months (n=2).

项目概要/摘要： 地球仪各地的跨性别妇女承受着不成比例的艾滋病毒负担， 全球艾滋病毒感染率为19%。感染艾滋病毒的跨性别妇女的艾滋病毒护理和治疗结果也较差 包括较低的病毒抑制率。需要多层次的应对措施来改善 通过同时协同解决个人、提供者和 社区动态跨性别妇女经历交叉耻辱，由于频繁的关联， 跨性别身份、艾滋病和性工作。这些相互交叉的污名形式包括内化的污名， 采用消极的信念，并以排斥和歧视的形式实施污名化。发展社会 凝聚力可以是社区消除成见进程中至关重要的第一步。我们采用了多层次的 干预，Abriendo Puertas（开门），包括个人咨询，同伴导航， 多米尼加共和国感染艾滋病毒的跨性别妇女的社区动员， 协商过程。我们评估了30例艾滋病护理和治疗行为的可行性和初步效果， 感染艾滋病毒的跨性别妇女（无对照组）和记录在案的抗逆转录病毒治疗使用的积极趋势（70%至85%， p=0.03），错过护理预约（35%至20%，p=0.39）和ART依从性（86%至96%，p=0.50）。 与会者强调，信任干预工作人员，并在个别会议上受到尊重， 帮助他们提高自尊。然而，跨性别女性之间有限的信任和凝聚力， 广泛参与同行导航和社群活动。作为回应，我们确定了两个关键 修改，以加强和进一步调整对感染艾滋病毒的跨性别妇女的干预：1）整合更多 性别肯定的内容，包括与供应商和2）注重建立跨性别妇女之间的信任，通过 个人和社区组件的顺序实现。拟议研究的目的 是对差距模型进行一项试点随机试验，或性别确认的Abriendo Puertas。在目标1中，我们 评估差距干预对跨性别女性病毒抑制的初步疗效 随机分配到干预组与随机分配到对照组相比。我们将随机分配跨性别者 接受差距干预的女性艾滋病毒感染者（n=60）（个人咨询，同伴导航，提供者培训， 社区支持建设）或对照组（n=60）。我们将进行基线、6个月和12个月的调查 和病毒载量评估，以评估研究组间的差异。在目标2中，我们将研究 影响（如减少耻辱，增加凝聚力）和经验的干预，以确定 需要改进和扩大的具体领域。我们将在基线进行纵向定性访谈， 6个月和12个月，20名干预参与者，并与调查一起评估GAP参与如何 影响耻辱感、凝聚力和艾滋病毒结果之间的途径。我们还将总结经验， 在6个月（n=2）和12个月（n=2）时，重点小组中提供者和干预工作人员的建议。