A multicomponent intervention to address gender-based violence in HIV prevention for women

采取多方干预措施解决妇女艾滋病毒预防中基于性别的暴力问题

• 批准号: 10005664
• 负责人: Kristi E Gamarel
• 金额: $ 20.9万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-20 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005664
• 关键词: AIDS prevention; Address; Adherence; Affect; Alcohol or Other Drugs use; Caring; Chronic stress; Clinical Trials; Color; Communities; Community Developments; Community Health; Data; Development; Diagnosis; Drops; Education; Educational Curriculum; Enrollment; Epidemic; Future; Gender; Gender Identity; HIV; HIV diagnosis; HIV risk; Health Educators; Health Personnel; Healthcare Systems; Human immunodeficiency virus test; Imprisonment; Individual; Intervention; Interview; Law Enforcement; Length; Link; Medical; Mental Health; Methods; Michigan; Modeling; Outcome; Participant; Pathway interactions; Patient Self-Report; Phase; Population; Post-Traumatic Stress Disorders; Poverty; Preventive Intervention; Process; Protocols documentation; Public Health; Randomized Controlled Trials; Research; Research Design; Risk; Safety; Science; Screening procedure; Sexual and Gender Minorities; Surveys; Symptoms; System; Testing; Trauma; Treatment Efficacy; United States; Violence; Woman; Work; arm; base; community clinic; condoms; efficacy trial; evidence base; experience; follow-up; gender-based violence; health care settings; health disparity; improved; multi-component intervention; peer; post intervention; pre-exposure prophylaxis; prevention efficacy trial; prevention service; primary outcome; programs; racism; recruit; retention rate; screening; secondary outcome; sexual violence; social; social stigma; therapy design; transgender; transgender women; transmission process; violence prevention

PROJECT SUMMARY Transgender (`trans') women of color experience violence in a variety of contexts, including from partners, strangers, law enforcement, healthcare providers, and in public accommodations. Violence is consistently linked with HIV transmission risk and avoiding HIV prevention services via pathways including chronic stress, posttraumatic stress disorder (PTSD) symptoms, and substance use. These epidemics are concurrent and mutually reinforcing, constituting a “syndemic” or synergistic interaction that contributes to documented inequities in HIV Prevention Continuum outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in sustained engagement in HIV prevention services. In this R21 exploratory/developmental research application, we propose to adapt, integrate, and pilot test a culturally-relevant evidence-based trauma-informed violence prevention intervention to improve HIV Prevention Continuum outcomes. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of three interventions and integrate these components into a trauma-informed combination prevention intervention for TWOC, with a focus on HIV Prevention Continuum outcomes by conducting interviews with trans women of color and key stakeholders to inform the adaptation. Our community advisory board consisting of trans women of color will review all adapted materials. The second aim seeks to examine the feasibility and acceptability of the trauma-informed combination prevention intervention in a one-arm pilot with follow-ups immediate and 3-month post-intervention. The primary outcome is improvements in HIV Prevention Continuum outcomes and the secondary outcomes are mental health and substance use. The project also seeks to gather qualitative data from one-arm pilot participants to identify strategies to overcome barriers to implementing rigorous randomized controlled trial research designs with trans women of color. Study findings will provide the necessary groundwork for a community-engaged efficacy trial in a subsequent, large-scale clinical trial.

项目摘要 有色人种的跨性别妇女在各种情况下遭受暴力，包括来自伴侣的暴力， 陌生人，执法人员，医疗保健提供者和公共场所。暴力一直是 与艾滋病毒传播风险和通过包括慢性压力在内的途径避免艾滋病毒预防服务有关， 创伤后应激障碍（PTSD）症状和物质使用。这些流行病是同时发生的， 相互加强，构成一个“共同的”或协同的相互作用，有助于记录 艾滋病毒预防连续性成果的不平等。在密歇根州的底特律，有色人种的跨性别女性是 艾滋病毒“高危”群体，在持续参与艾滋病毒预防服务方面存在显著差异。在 对于R21探索性/开发性研究应用，我们建议进行调整、集成和试点测试 文化相关的循证创伤知情暴力预防干预措施，以改善艾滋病毒预防 连续性结果。在ADAPT-ITT模型的指导下，我们的第一个目标是进行系统的适应 并将这些组成部分整合到创伤知情的综合预防中 TWOC的干预措施，重点是通过与以下人员进行访谈， 有色人种的跨性别妇女和主要利益攸关方为适应提供信息。我们的社区咨询委员会由 将审查所有改编的材料。第二个目的是研究可行性， 在一个有随访的单组试点中，创伤知情联合预防干预的可接受性 干预后即刻和3个月。主要成果是改善艾滋病毒预防连续性 结果和次要结果是心理健康和物质使用。该项目还旨在收集 来自单臂试点参与者的定性数据，以确定克服实施障碍的战略 对有色人种跨性别女性进行严格的随机对照试验研究设计。研究结果将提供 这是在随后的大规模临床试验中进行社区参与的有效性试验的必要基础。