Breaking systems barriers for trans women of color living with HIV

项目摘要 在旧金山弗朗西斯科，跨性别妇女携带艾滋病毒的人口负担最大， 保健和药物使用服务。我们的目标是利用我们以前的HRSA资助的特别 具有国家意义的项目，以进行试点任务共享同行提供mHealth支持和导航 对感染艾滋病毒的跨性别妇女进行干预。我们将与合作伙伴在一个弗朗西斯科部门， 公共卫生（SFDPH）跨健康诊所。SFDPH是一个由HRSA资助的实体，拥有跨专业诊所， 一系列内部转介到跨能力精神健康和物质使用服务。然而，在这方面， 存在相当大的制度障碍。跨诊所的门诊时间有限，提供者有大量的病人 医疗性别确认和艾滋病毒护理需求必须在短期访问中得到满足。访视和 门诊时间和大量的病人数量使提供者几乎没有时间确保心理健康的连续性， 药物使用转介。为了克服这些问题，同行导航员将提供移动的和面对面的支持 和导航，以增加跨性别者的物质使用和心理健康服务的启动和参与 艾滋病毒感染者在跨健康诊所。我们会在实施前阶段评估 我们建议的干预措施的可接受性和适当性，我们将进行一项试点研究，40跨 感染艾滋病毒的妇女。实施前阶段将侧重于社区参与， 收集来自提供者和感染艾滋病毒的跨性别妇女的见解。试播结束后，我们将评估覆盖范围， 系统的有效性和采用率，由供应商和跨性别妇女使用RE-AIM 实施科学框架。如果关键指标有所改善，我们将与SFDPH团队合作， 在为感染艾滋病毒的跨性别女性提供服务的诊所中测试扩大版的干预措施 整个弗朗西斯科。总的来说，拟议的研究将为发展一个 下一代干预措施，以减少物质使用和精神健康障碍对跨性别者的影响 妇女感染艾滋病毒，并改善艾滋病毒护理成果和这个社区的整体健康和福祉， 在应对艾滋病毒方面受到严重影响，但服务不足。

PROJECT ABSTRACT Trans women carry the largest population burden of HIV in San Francisco and have low utilization of mental health and substance use services. Our goal is to use lessons learned in our prior HRSA-funded Special Projects of National Significance to conduct a pilot task-sharing peer delivered mHealth support and navigation intervention for trans women living with HIV. We will work with partners in a San Francisco Department of Public Health (SFDPH) trans health clinic. The SFDPH is a HRSA-funded entity with trans-specific clinics and a host of in-house referrals to trans-competent mental health and substance use services. However, considerable systems barriers exist. Trans clinics have limited clinic hours, and providers have large patient loads wherein medical gender affirmation and HIV care needs must be attended to in short visits. Visit and clinic time and large patient volume leaves providers with little time to ensure continuity in mental health and substance use referrals. To overcome these issues, a peer navigator will deliver mobile and in-person support and navigation to increase substance use and mental health service initiation and engagement among trans women living with HIV in trans health clinics. We will conduct a pre-implementation phase to assess the acceptability and appropriateness of our proposed intervention, and we will conduct a pilot study with 40 trans women living with HIV. The pre-implementation phase will be focused on community engagement, and gathering insight from providers and trans women living with HIV. After the pilot, we will evaluate reach, effectiveness and adoption in the system, by providers and among trans women using the by RE-AIM implementation science framework. If key metrics show improvements, we will work with our SFDPH team to test a scaled-up version of the intervention across clinics sites that serve trans women living with HIV throughout San Francisco. Altogether, the proposed study will establish the foundation for development of a next-generation intervention to reduce the impact of substance use and mental health disorders on trans women living with HIV and improve HIV care outcomes and overall health and wellness of this community that is highly impacted while underserved in the response to HIV.