ENTRUST - economic navigation and strengthening to realize unrestricted services for transgender women

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Background: Transgender women commonly live in poverty and have among the highest risk for substance use and HIV transmission, yet existing programs fail to address how structural factors such as socio-economic status and social marginalization are significant barriers to care and survival. The study objective is to evaluate the effect of a novel intervention called ‘ENTRUST’ (economic navigation and strengthening to realize unrestricted services for transgender women) that will combine group-based financial skill-building training with adapted screening, brief intervention and referral to treatment (SBIRT) counseling. Study aims are: Aim 1: To develop and pretest ENTRUST, an HIV status-neutral intervention consisting of group-based financial skill-building training with adapted SBIRT to increase social cohesion and financial skills (e.g., budgeting, financial goals setting) among transgender women, and facilitate linkage to substance use and HIV care/PrEP. The ADAPT-ITT framework will be used to create ENTRUST and pretest it in a sample of n=10 Aim 2: To conduct a pilot RCT among (n=80) transgender women to evaluate acceptability, feasibility, and preliminary efficacy of ENTRUST on a) linkage to substance use and HIV care/PrEP; b) economic strengthening and social cohesion. Participants will be randomized to the ENTRUST intervention arm (adapted SBIRT + economic navigation and strengthening) or the standard of care (adapted SBIRT) wait-listed control. To assess social cohesion, as well as other outcomes associated with linking to substance use and HIV care/PrEP and economic strengthening, Photovoice will be used to document and exhibit participant’s experiences. Aim 3: To examine the implementation of ENTRUST in group settings as guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Sequential, explanatory mixed methods will be used to evaluate participant’s perspectives on key implementation outcomes of acceptability, feasibility, and satisfaction and their interventional experiences, and, perceptions of programmatic sustainability. PI Cyrus, a trained social epidemiologist with a history of community engaged research, will lead a team of experts on health economics, microfinance, and sustainable economic interventions; implementation science and RCT evaluation; intervention implementation in group/community settings; development and implementation of substance use and HIV interventions in transgender populations; and advanced statistical methods. Significance: ENTRUST has the potential to shift regional and national policy by providing evidence of trans women’s needs and sustainable and practical approaches that can improve their overall health and productivity. In alignment with NIDA and Office of SGM research priorities, the proposed study will overcome structural and psychosocial barriers to facilitate trans women linking to substance use and HIV care/PrEP to reduce substance misuse and HIV incidence. The study adheres to the national HIV public health targets set forth by the 2019 presidential directives of Ending the HIV Epidemic (EHE) and the Office of AIDS Research priorities.