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Addressing violence and HIV cascade of care outcomes among transgender women

解决跨性别女性中的暴力和艾滋病毒护理结果连锁反应

基本信息

批准号：
10077889
负责人：
Kristi E Gamarel
金额：
$ 21.31万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-01 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10077889
关键词：
Address Adherence Adult Affect Birth Caring Chronic stress Color Communities Community Health Continuity of Patient Care Data Development Diagnosis Discrimination Drops Education Enrollment Epidemic Female Feminine Future Gender Gender Identity HIV HIV diagnosis Health Personnel Immune Imprisonment Individual Infection Inflammatory Response Intervention Intervention Studies Interview Law Enforcement Length Link Mediating Medical Michigan Modeling Outcome Participant Pathway interactions Patient Self-Report Population Post-Traumatic Stress Disorders Poverty Prevention program Public Health Randomized Controlled Trials Recording of previous events Research Research Design Resources Risk Role Safety San Francisco Screening procedure Self Efficacy Services Sexual and Gender Minorities Symptoms Testing Time Trauma United States Violence Viral Viral Load result acceptability and feasibility arm base care outcomes cisgender efficacy trial empowered empowerment evidence base experience flexibility follow-up health care availability health care quality health disparity implementation intervention improved intervention program male meetings partner violence post intervention primary outcome programs public health relevance rapid diagnosis recruit retention rate secondary outcome self esteem seroconversion social structure stressor substance use therapy design transgender transgender women

项目摘要

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 avoiding care, suboptimal ART adherence, and lower odds of viral suppression via pathways including chronic stress, immune inflammatory response, 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 continuum of care outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in engagement in HIV care. In this R21 exploratory/developmental research application, we propose to adapt and pilot test a culturally-responsive, evidence-based, and trauma-informed intervention to improve engagement in HIV care (primary outcome), reduce PTSD symptoms (secondary outcome), and increase sustained viral suppression (tertiary outcome) among trans women of color living with HIV. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of the intervention, with a focus on the unique aspects of violence, gender affirmation needs, and engagement in HIV care 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, acceptability, and preliminary efficacy of the adapted intervention in a one-arm pilot with follow-ups immediate and 3-month post- intervention. The third aim 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 within limited-resources settings. Study findings will provide the necessary groundwork for a subsequent community-engaged large-scale randomized controlled trial. Findings also have the potential to provide a blueprint to guide future research efforts with trans women of color who are often embedded in close- knit communities with few existing culturally-responsive services.

项目总结