A multi-level approach to improve HIV prevention and care for transgender women of color

改善跨性别有色人种女性艾滋病毒预防和护理的多层次方法

• 批准号: 10767072
• 负责人: Kristi E Gamarel
• 金额: $ 113.28万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10767072
• 关键词: multi; level; approach; improve; HIV

ABSTRACT In the United States, transgender (`trans') women have high rates of new HIV diagnoses, with Black, Latina, and other trans women of color representing the majority of these cases. The HIV prevention and care continua emphasize the need for reducing HIV transmission risk via regular HIV testing, consistent condom use, and linkages to HIV prevention and care, such as pre-exposure prophylaxis (PrEP) among HIV-negative individuals and antiretroviral therapy (ART) and viral suppression among people living with HIV. However, there is substantial drop-off at each step of these continua with trans women falling far behind in terms of PrEP use and viral suppression. Trans women of color experience intersectional stigma that results in unmet gender affirmation needs, which have been linked to disparities in HIV prevention and continua outcomes. Building on extensive formative work, this project seeks to test the efficacy of the Let’s Be intervention, which is an integration of evidence-based, trauma-informed HIV prevention and treatment interventions, all of which have demonstrated feasibility, acceptability, and preliminary efficacy with trans women. Let’s Be is an HIV status- neutral intervention designed to mitigate the adverse health sequelae of intersectional stigma (including HIV stigma) thereby reducing sexual risk behaviors, increasing HIV prevention uptake (PrEP use), and treatment outcomes (viral suppression). Let’s Be works at both the group- and individual-levels, comprising two peer-led components via telehealth: 1) the previously tested Sheroes status-neutral intervention, and 2) previously tested individual-level peer navigation adapted from the Healthy Divas intervention. We propose a hybrid type 1 effectiveness-implementation study focused primarily on testing the efficacy of Let’s Be, while secondarily but simultaneously gleaning important lessons during implementation. Our primary outcome is PrEP adherence/viral suppression and our secondary outcome is a composite indicator of HIV risk that acknowledges there is not a singular effective prevention strategy that is appropriate or desired by all transgender women. We will recruit and randomize 250 trans women of color from San Francisco, California and Detroit, Michigan (stratified by city and HIV status), following participants for 12 months and collecting biological (i.e., dried blood spots to measure PrEP use or viral load) and behavioral data. Our community advisory boards composed of trans women of color will provide ongoing consultation. Our hybrid type 1 effectiveness-implementation design will inform implementation considerations to scale up Let’s Be to other EHE jurisdictions, if effective. Findings will provide critical insights into the efficacy evaluation of an urgently needed trauma-informed multi-level status-neutral intervention delivered via telehealth in reducing disparities among trans women of color, one of the highest priority HIV prevention populations in the United States.

摘要 在美国，变性人女性的艾滋病毒新诊断率很高，黑人、拉丁裔、 和其他有色人种女性代表了这些案件的大部分。艾滋病的预防和护理 Continua强调，需要通过定期艾滋病毒检测、始终如一的避孕套来降低艾滋病毒传播风险 在艾滋病毒阴性者中使用，以及与艾滋病毒预防和护理的联系，如暴露前预防(PrEP) 艾滋病毒携带者的个人和抗逆转录病毒治疗(ART)和病毒抑制。然而， 在这些连续的过程中，每一步都有显著的下降，跨性女性在PrEP方面远远落后 使用和病毒抑制。有色人种的跨性女性经历了交叉的耻辱，导致了未被满足的性别 肯定需要，这与艾滋病毒预防和持续成果方面的差异有关。在基础上建设 广泛的形成性工作，这个项目寻求测试让我们成为干预措施的有效性，这是一个 整合循证、创伤知情的艾滋病毒预防和治疗干预措施，所有这些干预措施都有 证明了变性妇女的可行性、可接受性和初步疗效。让我们成为一名艾滋病病毒感染者- 旨在减轻交叉耻辱(包括艾滋病毒)的不良健康后遗症的中性干预措施 耻辱)，从而减少性危险行为，增加艾滋病毒预防吸收(PrEP使用)和治疗 结果(病毒抑制)。让我们同时在小组和个人层面上工作，由两个同行领导的 远程健康组件：1)之前测试的Sheros状态中立干预，以及2)之前 测试了改编自健康天后干预的个人级别的同龄人导航。我们提出了一种混合型 1有效性-实施研究主要侧重于测试让我们成为的有效性，而次要的是 同时在执行过程中吸取重要教训。我们的主要成果是PrEP 依从性/病毒抑制和我们的次要结果是艾滋病毒风险的综合指标 认识到没有一种唯一有效的预防战略是适当的或所有人都希望的 变性女性。我们将从加利福尼亚州旧金山招募250名有色人种女性并将其随机分配 和密歇根州底特律(按城市和艾滋病毒状况分层)，跟踪参与者12个月并收集 生物学(即测量PrEP使用或病毒载量的干血迹)和行为数据。我们的社区 由有色人种变性妇女组成的咨询委员会将提供持续的咨询。我们的混合动力型1 有效性-实施设计将指导实施考虑因素，以扩大规模-让我们来看看其他 每个司法管辖区，如果有效的话。研究结果将为紧急情况下的疗效评估提供关键的见解 通过远程医疗提供所需的创伤信息多层次状态中立干预，以减少差异 在有色人种的变性妇女中，这是美国最优先预防艾滋病毒的人群之一。