Transgender Men and HIV in Uganda: PrEP Uptake and Persistence

乌干达的跨性别男性与艾滋病毒：PrEP 的采用和坚持

• 批准号: 10092257
• 负责人: Andrew Mujugira
• 金额: $ 10万
• 依托单位: INFECTIOUS DISEASES INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092257
• 关键词: AIDS prevention; Adherence; Administrative Supplement; Africa South of the Sahara; African; Alcohol consumption; Anal Sex; Behavior; Behavioral; Birth; Blood; Caring; Characteristics; Chlamydia trachomatis; Clinic; Cluster randomized trial; Communicable Diseases; Communities; Counseling; Data; Discrimination; Drug usage; Employment; Face; Feedback; Female; Funding; Future; Gender Identity; Goals; HIV; HIV Seronegativity; HIV risk; Health; Hormone use; Hormones; Immunoassay; Individual; Institutes; Interview; Interviewer; Lateral; Measures; Mental Depression; Mental Health; Methods; Modeling; Neisseria gonorrhoeae; Parents; Participant; Pattern; Perception; Pharmaceutical Preparations; Policies; Policy Maker; Population; Prevalence; Prevention; Prevention Research; Preventive Intervention; Psychiatrist; Publishing; Qualitative Methods; Questionnaires; Reporting; Research; Research Infrastructure; Resources; Respondent; Risk; Risk Assessment; Risk Behaviors; STI prevention; Sampling; Services; Sex Behavior; Sexual Health; Sexual and Gender Minorities; Sexually Transmitted Diseases; Spottings; Tenofovir; Testing; Time; Trichomonas vaginalis; Uganda; United States National Institutes of Health; Urine; Vagina; Visit; Woman; Work; base; behavior test; cisgender; cohort; common treatment; condoms; contextual factors; data resource; design; effectiveness testing; experience; gender dysphoria; high risk; infection risk; male; men; men who have sex with men; neglect; partner violence; peer; peer networks; point of care; pre-exposure prophylaxis; prevention evaluation; prevention service; primary outcome; programs; randomized trial; recruit; response; risk perception; scale up; sex; sexual HIV transmission; sexual health intervention; sexual risk behavior; sexual risk taking; social; social stigma; transgender; transgender men; transgender women; uptake; willingness

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.

项目总结/摘要 跨性别男性（跨性别男性;出生时被指定为女性，但被认定为男性）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别女性发生性关系（出生于 女性，识别为女性），这被认为是低风险的性活动。来自资源丰富环境的新数据 表明跨性别男性经常面临许多与跨性别女性相同的高风险（跨性别女性;分配 出生时为男性，但被认定为女性）。跨性别男性与跨性别女性的性行为参与率相似 工作并与顺性男性进行无保护的接受性阴道和/或肛交。此外，他们报告说， 高风险的性行为，包括不经常使用避孕套，这使他们有感染艾滋病毒的风险， 性传播感染（STIs）。全球对跨性别男性的艾滋病毒风险知之甚少，也没有公布数据 可以从撒哈拉以南的非洲获得。在与跨性别者社区的合作中，我们正在测试 跨性别妇女的同伴艾滋病毒自我检测、性传播感染自我采样和暴露前预防（PrEP） 乌干达的一项随机分组试验（R34 MH 121084）。利用本RCT的资源， 补充建议通过受访者驱动抽样招募一个新的50名跨性别男性队列。我们将使用 混合方法，以更深入地了解跨性别男性的性健康体验和风险行为 在乌干达。在社会生态模型的指导下，我们将对多达20位跨性别男性进行深度访谈 了解影响性风险的个人，人际，社区和社会背景因素 行为和艾滋病毒/性传播感染风险（目标1）。在目标2中，我们将描述跨性别者中艾滋病毒和性传播感染的流行率和风险， 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，伴侣 暴力，性别焦虑，男性激素使用和愿意采取PrEP。在目标3中，我们将评估PrEP 艾滋病毒阴性的跨性别男子与艾滋病毒风险之间的吸收和持久性。参与者将获得PrEP， 每月随访12个月。在每季度的访问中，参与者将收到集成的后续步骤依从性 咨询和药物水平的反馈使用床旁尿替诺福韦侧流免疫测定。免费检测 和治疗常见的可治愈性传播感染（淋病奈瑟菌、沙眼衣原体和滴虫 将提供）。主要结果是：1）PrEP吸收，2）6个月和12个月时的持续性， 通过每季度收集的干血斑中的替诺福韦水平来测量。跨性别男性使用PrEP的评估将 帮助提高艾滋病毒服务的利用率，包括艾滋病毒和性传播感染检测以及PrEP， 艾滋病毒感染。同时评估跨性别女性的预防摄入量（在父母R34试验中）， 跨性别者（在本行政补编中）是优化预防工作的一种有效和及时的方法 为跨性别者准备的来自跨性别男性的试点数据将提供独特的有价值的信息，为未来的规模扩大提供信息。 艾滋病毒预防综合干预措施。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 撒哈拉以南非洲的跨性别男性的风险。该项目得到乌干达卫生部的支持。