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: 10676883
• 负责人: CLARE L BARRINGTON
• 金额: $ 25.93万
• 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/10676883
• 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; 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; Woman; Work; arm; care outcomes; cisgender; cohesion; comparison intervention; experience; female sex worker; gender affirmation; improved; insight; internalized stigma; intervention participants; maltreatment; negative affect; peer; 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).

项目摘要/摘要： 全球跨性别女性承受着不成比例的艾滋病毒负担，据估计 全球艾滋病毒感染率为 19%。感染艾滋病毒的跨性别女性的艾滋病毒护理和治疗结果也较差 与顺性别成年人相比，包括病毒抑制率较低。需要多层次的响应来改进 通过同时协同地解决个人、提供者和 社区动态。由于跨性别女性之间的频繁联系，跨性别女性会遭受交叉耻辱。 跨性别身份、艾滋病毒和性工作。这些交叉形式的耻辱包括以下形式的内在耻辱： 采用消极信念并以排斥和歧视的形式表现出耻辱。发展社会 凝聚力可能是解决耻辱问题的社区进程中关键的第一步。我们采用了多层次的 干预，Abriendo Puertas（敞开的门），包括个人咨询、同伴导航和 使用迭代方法对多米尼加共和国感染艾滋病毒的跨性别妇女进行社区动员 咨询过程。我们评估了 30 名艾滋病毒护理和治疗行为的可行性和初步影响 感染艾滋病毒的跨性别女性（无对照组）并记录了 ART 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）。 参与者强调，信任干预人员并在个别会议中受到尊重 使他们能够提高自尊。然而，跨性别女性之间有限的信任和凝聚力阻碍了更多 广泛参与同行导航和社区活动。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女性的干预措施：1）整合更多 肯定性别的内容，包括提供者的内容；2) 注重通过以下方式在跨性别女性之间建立信任： 按顺序实施个人组件，然后是社区组件。拟议研究的目的 是对 GAP 模型或性别肯定 Abriendo Puertas 进行一项试点随机试验。在目标 1 中，我们将 评估 GAP 干预措施对跨性别女性病毒抑制的初步效果 随机分配到干预组与随机分配到对照组进行比较。我们将随机分配反式 感染艾滋病毒的女性接受 GAP 干预（n=60）（个人咨询、同伴导航、提供者培训、 和社区支持建设）或对照组（n=60）。我们将进行基线调查、6 个月调查和 12 个月调查 和病毒载量评估，以评估研究组之间的差异。在目标 2 中，我们将研究以下途径： 影响力（例如减少耻辱，增加凝聚力）和干预经验来识别 需要改进和扩大规模的具体领域。我们将在基线进行纵向定性访谈， 6 个月和 12 个月，对 20 名干预参与者进行调查，评估 GAP 参与情况 影响耻辱、凝聚力和艾滋病毒结果之间的途径。我们还将汲取经验和 焦点小组中提供者和干预人员在 6 个月 (n=2) 和 12 个月 (n=2) 时的建议。