An online HIV self-testing intervention with online-to-offline linkage to care for transgender women

在线艾滋病自检干预，线上线下联动，关爱跨性别女性

• 批准号: 10772677
• 负责人: Roman Shrestha
• 金额: $ 10万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10772677
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Administrative Supplement; Affect; Asia; Attitude; Award; Behavior Therapy; Caring; Cellular Phone; Clinical Services; Collaborations; Communities; Computers; Continuity of Patient Care; Counseling; Country; Diagnostic Reagent Kits; Discrimination; Drug usage; Economics; Employment; Environment; Epidemic; Evidence based intervention; Exclusion; Face; Fostering; Government; HIV; HIV Infections; Health; Health Personnel; Human immunodeficiency virus test; Hybrids; Individual; Infection; Injecting drug user; Interpersonal Violence; Intervention; Laws; Legal; Malaysia; Malaysian; Medical; Mental Depression; Mental Health; Modeling; Names; Occupations; Online Systems; Outcome; Parents; Phase; Population; Prevalence; Prevention; Professional counselor; Research; Resources; Risk; Risk Behaviors; Sampling; Service delivery model; Services; Sexual Transmission; Sexual and Gender Minorities; Study models; Tablets; Technology; Testing; Time; Work; acceptability and feasibility; antiretroviral therapy; cost effective; distrust; eHealth; empowerment; experience; gender affirming care; gender minority group; health care service; health inequalities; high risk; implementation context; implementation determinants; implementation science; improved; innovation; interest; laptop; low and middle-income countries; men who have sex with men; pilot trial; pre-exposure prophylaxis; preference; prevention service; response; scale up; self testing; service delivery; sex; social; social stigma; structural determinants; substance use; testing services; theories; tool; transgender women; treatment as usual; uptake; usability; web platform; willingness

Abstract Globally, transgender women (TGW) are disproportionately impacted by the HIV epidemic, with an estimated HIV prevalence of 19.1%. Malaysia, one of SE Asia's fastest-growing economies, is witnessing a rapid transition to its HIV epidemic. Malaysia has an estimated 80,000 TGW in-country, of which 12.4% are living with HIV. TGW experience numerous unique vulnerabilities to HIV, including discrimination in employment and economic opportunities, steering many TGW into high-risk occupations, such as sex work. High levels of stigma and discrimination against TGW by healthcare providers can foster a hostile environment toward TGW, complicating efforts to scale-up of HIV testing and prevention services among trans women, including preexposure prophylaxis (PrEP). Modeling studies suggest that increased HIV testing and uptake of PrEP is the most impactful and cost-effective strategy for reducing new infections. Despite this, only 37% of TGW in Malaysia have ever been HIV tested. HIV self-testing (HIVST) may be particularly impactful among TGW in Malaysia, where anti-trans stigma persists. Although willingness to use HIVST is high (48%) among Malaysian TGW, its use is still minimal due to a lack of access to HIVST kits, concerns related to misinterpreting results, and missed opportunities for counseling and linkage to care. In this context, eHealth represents an innovative platform to transform the face of HIV service delivery (i.e., HIVST and linkage to care). Leveraging eHealth technology for HIV services delivery is ideal given that nearly all (>93.6%) TGW use online technology (e.g., smartphone, tablet, computer) and indicate a strong preference for a web-based platform for HIVST. As such, HIVST with real-time e-counseling (eHIVST), integrated with online-to-offline (O2O) linkage to prevention and treatment, offers an innovative and empowering approach that could transform TGW's uptake of HIV testing and engagement in the broader HIV care continuum. This proposal – submitted in response to the Notice of Special Interest (Administrative Supplements for Research on Sexual and Gender Minority Populations; NOT-OD-22-032) – requests an SGM administrative supplement to add a sample of TGW to parent award (R34MH130233), a project that focuses on developing and testing a web-based platform, called Jom-TestPlus, that will incorporate an O2O service delivery model with eHIVST that facilitates rapid linkage to the HIV prevention and treatment continuum for men who have sex with men (MSM) in Malaysia. Expanding Jom-TestPlus to include TGW represents a significant opportunity to leverage existing resources from the parent award to address HIV and other health inequities among broader SGM populations. If successful, Jom-TestPlus will serve as a model that can easily be adapted for various health outcomes and healthcare services delivery in these populations and other LMICs.

摘要 在全球范围内，跨性别妇女（TGW）受到艾滋病毒流行病的不成比例的影响， 估计艾滋病毒感染率为19.1%。马来西亚是东南亚增长最快的经济体之一， 向艾滋病蔓延过渡。马来西亚国内估计有80，000 TGW，其中12.4%居住在 感染了艾滋病毒TGW经历了许多独特的艾滋病毒脆弱性，包括就业歧视 和经济机会，引导许多TGW进入高风险职业，如性工作。高水平的 医疗保健提供者对TGW的污名化和歧视可能会助长对TGW的敌对环境， 使在跨性别妇女中扩大艾滋病毒检测和预防服务的努力复杂化， 暴露前预防（PrEP）。模拟研究表明，增加艾滋病毒检测和PrEP的摄入是 减少新感染的最有效和最具成本效益的战略。尽管如此，马来西亚只有37%的TGW 曾经接受过艾滋病毒检测。艾滋病毒自我检测（HIVST）可能对马来西亚的TGW特别有影响， 反跨性别歧视依然存在虽然马来西亚TGW中使用HIVST的意愿很高（48%），但其 由于缺乏获得HIVST试剂盒的途径，与误解结果有关的担忧，以及错过了 提供咨询和与护理挂钩的机会。在这种情况下，eHealth是一个创新平台， 改变提供艾滋病毒服务的面貌（即，艾滋病毒/艾滋病和艾滋病与护理的联系）。利用电子健康技术 艾滋病毒服务的提供是理想的，因为几乎所有（>93.6%）的TGW都使用在线技术（例如，智能手机、平板电脑 计算机），并表示强烈倾向于基于网络的艾滋病毒/艾滋病防治平台。因此，HIVST与实时 电子咨询（eHIVST），结合线上到线下（O2O）的预防和治疗联系，提供了一个 创新和授权的方法，可以改变TGW的艾滋病毒检测和参与 更广泛的艾滋病毒护理连续体。本提案-针对特别关注通知提交 （性和性别少数群体研究的行政补充; NOT-OD-22-032） 要求SGM行政补充，以将TGW样本添加到母公司合同（R34 MH 130233）中， 该公司专注于开发和测试一个名为Jom-TestPlus的基于网络的平台，该平台将整合O2O 一种具有eHIVST的服务提供模式，促进与艾滋病毒预防和治疗连续体的快速联系 与男性发生性关系的男性（MSM）扩展Jom-TestPlus以包括TGW代表了 利用家长奖现有资源解决艾滋病毒和其他健康问题的重要机会 更广泛的SGM人群之间的不平等。如果成功的话，Jom-TestPlus将成为一个很容易被 适应这些人群和其他中低收入国家的各种健康结果和医疗保健服务提供。