Transgender Men and HIV in Uganda: PrEP Uptake and Persistence

项目摘要/摘要 变性人(变性人；出生时被指定为女性，但自称为男性)通常被认为是 感染艾滋病毒的风险低，通常是因为假设他们与顺性妇女(出生)发生了性关系 女性，识别为女性)，这被认为是低风险的性行为。来自资源丰富环境的新兴数据 表明跨性别者经常面临与跨性别者女性相同的高风险(跨性别者； 出生时为男性，但认同为女性)。跨性男性报告的性行为参与率与跨性女性相似 与顺性男性工作并进行无保护的接受性阴道和/或肛交。此外，他们还报告说 高风险性行为，包括不一致地使用避孕套，使他们面临感染艾滋病毒和其他疾病的风险 性传播感染(STI)。关于全球跨性别者感染艾滋病毒的风险知之甚少，也没有公布的数据 可从撒哈拉以南非洲地区购买。我们正在与跨性别者社区合作，测试其有效性 年对变性妇女进行同伴递送的艾滋病毒自我检测、性传播感染自我抽样和暴露前预防(PrEP)的情况 乌干达进行了整群随机试验(R34 MH121084)。利用该RCT的资源，该管理 附录建议通过受访者驱动的抽样招募50名跨性别者的新队列。我们将使用 用混合方法更深入地了解跨性别者的性健康经历和危险行为 在乌干达。在社会生态模型的指导下，我们将对多达20名跨性别者进行深入采访 了解个人、人际、社区和社会背景因素对性风险的影响 行为与艾滋病毒/性传播感染风险(目标1)。在目标2中，我们将描述艾滋病毒和性传播感染在性传播疾病中的流行情况和风险 男性通过进行行为艾滋病毒风险评估，包括性行为、酒精和药物使用、性伴侣 暴力、性别焦虑症、男性激素使用和服用PrEP的意愿。在目标3中，我们将评估PrEP 艾滋病毒阴性、有艾滋病毒风险的跨性别者的感染和持久性。参与者将获得PrEP和 每月随访12个月。在季度访问中，参与者将获得完整的Next Steps遵守 咨询和药物水平反馈使用护理点尿替诺福韦横向流动免疫分析。免费测试 和治疗常见的可治愈的性传播感染(淋球菌、沙眼衣原体和滴虫 阴道)将被提供。主要结果是：1)PrEP摄取，以及2)持续6个月和12个月AS 以每季度收集的干血斑中的替诺福韦水平衡量。变性人使用PrEP的评估将 帮助增加艾滋病毒服务的利用率，包括艾滋病毒和性传播感染检测和预防接种计划，目标是减少 艾滋病病毒的获取。同时评估变性妇女中的预防感染(在父母R34试验中)和 变性人(在本行政副刊中)是优化预防提供的一种有效和及时的方法 对跨性别者来说。来自变性人的试点数据将提供独特的有价值的信息，为未来的扩大提供信息 组合艾滋病毒预防干预措施。据我们所知，这将是第一项评估艾滋病毒和性传播感染的研究 撒哈拉以南非洲跨性别者的风险。该项目得到乌干达卫生部的支持。

PROJECT SUMMARY/ABSTRACT Transgender men (trans men; assigned female sex at birth but identify as male) are generally thought to be at low risk of HIV acquisition, typically because of the assumption that they have sex with cisgender women (born female, identify as female) which is considered low risk sexual activity. Emerging data from resource-rich settings show that trans men often face many of the same high risks as transgender women (trans women; assigned male sex at birth but identify as female). Trans men report similar rates to trans women of engagement in sex work and engage in unprotected receptive vaginal and/or anal sex with cisgender men. Additionally, they report high sexual risk-taking behaviors including inconsistent condom use which puts them at risk of HIV and other sexually transmitted infections (STIs). Little is known about HIV risk in trans men globally, and no published data are available from sub-Saharan Africa. In partnership with the trans community, we are testing the effectiveness of peer-delivered HIV self-testing, STI self-sampling and pre-exposure prophylaxis (PrEP) for trans women in Uganda in a cluster randomized trial (R34 MH121084). Leveraging the resources of this RCT, this administrative supplement proposes to recruit a new cohort of 50 trans men through respondent driven sampling. We will use mixed methods to gain a deeper understanding of the sexual health experiences and risk behaviors of trans men in Uganda. Guided by the Social Ecological Model, we will conduct in-depth interviews with up to 20 trans men to understand individual, interpersonal, community and social contextual factors that influence sexual risk behaviors and HIV/STI risk (Aim 1). In Aim 2, we will characterize HIV and STI prevalence and risk among trans men by conducting a behavioral HIV risk assessment including sexual practices, alcohol and drug use, partner violence, gender dysphoria, male hormone use and willingness to take PrEP. In Aim 3, we will evaluate PrEP uptake and persistence among HIV-negative trans men with HIV risk. Participants will be offered PrEP and followed monthly for 12 months. At quarterly visits, participants will receive integrated next steps adherence counseling and drug level feedback using a point-of-care urine tenofovir lateral-flow immunoassay. Free testing and treatment of common curable STIs (Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis) will be provided. Primary outcomes are: 1) PrEP uptake, and 2) persistence at 6 and 12 months as measured by tenofovir levels in dried blood spots collected quarterly. Assessment of PrEP use by trans men will help increase the utilization of HIV services, including HIV and STI testing and PrEP, with a goal of decreasing HIV acquisition. Simultaneous evaluation of prevention uptake among trans women (in the parent R34 trial) and trans men (in this administrative supplement) is an efficient and timely approach to optimizing prevention delivery for trans people. Pilot data from trans men will provide uniquely valuable information to inform future scale-up of combination HIV prevention interventions. This will be the first study, to our knowledge, to assess HIV and STI risk among trans men in sub-Saharan Africa. This project is supported by the Uganda Ministry of Health.