Increasing PrEP Use in High-Risk Social Networks of African American MSM in Underserved Low-Uptake Cities

在服务不足、使用率低的城市中，增加非洲裔美国男男性接触者高风险社交网络中 PrEP 的使用

• 批准号: 10090689
• 负责人: Yuri A Amirkhanian
• 金额: $ 10万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-21 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10090689
• 关键词: AIDS prevention; Address; Administrative Supplement; Adoption; Alcohol or Other Drugs use; Attention; Attitude; Behavioral; Belief; Birth; Categories; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Code; Communities; Data; Dimensions; Effectiveness; Enrollment; Epidemic; Face; Female; Focus Groups; Funding; Gender; Gender Identity; Goals; HIV; HIV Infections; HIV Seronegativity; Health; Health Care Visit; High Risk Woman; Human immunodeficiency virus test; Incidence; Intervention; Intervention Studies; Interview; Knowledge; Life; Maintenance; Measures; Medical; Methods; Midwestern United States; Minority; Minority Groups; Modality; Participant; Perception; Persons; Phase; Population; Predictive Factor; Prevalence; Prevention Research; Provider; Public Health; Qualitative Methods; Readiness; Recommendation; Recording of previous events; Reporting; Request for Applications; Research; Research Design; Research Methodology; Safety; Sampling; Self Efficacy; Services; Sexual and Gender Minorities; Social Network; Structure; Testing; United States; Visit; Woman; authority; black men who have sex with men; cost; experience; gender minority; gender nonconforming; health assessment; high risk; improved; male; men who have sex with men; minority communities; parent grant; parent project; peer; pre-exposure prophylaxis; preference; psychosocial; racial minority; recruit; response; social stigma; stress resilience; transgender; transgender women; uptake

Abstract Transgender women—especially racial minority transgender women—have HIV prevalence that is far higher than any other population segment in the United States. Nearly two-thirds of transgender women meet CDC criteria for pre-exposure prophylaxis (PrEP) indication but only 5% report ever taking PrEP. Most prior HIV prevention research has lumped together transgender women in a single category with men who have sex with men (MSM) even though these sexual and gender minority (SGM) groups may face different life challenges and have very different needs. Except for a handful of small focus group studies conducted in large cities on the East and West coasts, very little research has systematically explored factors responsible for low PrEP use among transgender women at high risk for contacting HIV infection and identified ways to increase PrEP adoption and sustained use. This proposal—submitted in response to Notice OD-20-032—requests an SGM administrative supplement to add a sample of racial minority transgender women to parent grant R01- NR017574, a project that tests approaches to increase PrEP use among African American MSM in Milwaukee and Cleveland, both Midwestern cities with stark HIV disparities. The supplement will employ a mixed-methods research design with 60 high-risk racial minority transgender women recruited from the community who will be added to the parent grant. During study visits, each woman will participate in a semi-structured in-depth interview to elicit perceptions, understandings, and beliefs about PrEP; concerns and barriers to PrEP use; factors that would facilitate the adoption and sustained use of PrEP; and preferences about PrEP delivery modalities and service access. Interviews will delve into how PrEP can be presented to transgender women in ways that affirm a positive, healthful, and proud sense of gender identity that counteracts the deleterious influence of intersectional stigma. In-depth interviews will be recorded, transcribed, coded, and qualitatively analyzed to identify how best to optimize and tailor interventions to reach and benefit the HIV prevention and health needs of transgender women. Participants will also be administered measures that are being employed in the parent grant to assess HIV testing and health history, sexual practices, substance use, and PrEP use knowledge, attitudes, behavioral intentions, norm perceptions, and self-efficacy, as well as a measure of gender minority stress and resilience validated with transgender and gender nonconforming persons. These quantitative data will be analyzed to identify whether—and how—the HIV prevention needs of racial minority transgender women differ from those of racial minority MSM as well as factors that facilitate or impede PrEP use among transgender women. Findings of this research will improve the field’s understanding of HIV health needs of transgender minority women—a vulnerable, understudied, and underserved SGM community population—and will inform implementation efforts to achieve the goals of the National Plan to End the HIV epidemic.

摘要 跨性别女性，特别是少数种族跨性别女性，艾滋病毒感染率远高于其他女性。 高于美国其他任何一个人口群体。近三分之二的跨性别女性 暴露前预防（PrEP）适应症的CDC标准，但只有5%的人报告曾经服用过PrEP。 艾滋病毒预防研究将变性妇女与有性行为的男子归为一类 尽管这些性和性别少数群体（SGM）可能面临不同的生活 挑战和不同的需求。除了少数几个小型的焦点小组研究， 在东海岸和西海岸的城市，很少有研究系统地探讨造成低收入的因素。 在接触艾滋病毒感染的高风险变性妇女中使用PrEP，并确定了增加 PrEP的采用和持续使用。本提案是根据OD-20-032号通知提交的， SGM行政补充，将少数种族变性妇女的样本添加到父母补助金R 01- NR 017574，一个测试增加密尔沃基非裔美国人MSM使用PrEP方法的项目 和克利夫兰，这两个中西部城市的艾滋病毒感染率差距很大。该补充将采用混合方法 研究设计与60高风险的少数民族变性妇女从社区招募谁将是 添加到家长补助金。在研究访问期间，每位女性将参加一个半结构化的深入研究， 访谈，以了解对PrEP的看法，理解和信念; PrEP使用的担忧和障碍; 促进PrEP采用和持续使用的因素;以及PrEP交付的偏好 模式和服务获取。采访将深入探讨如何PrEP可以呈现给跨性别妇女， 肯定积极，健康和自豪的性别认同感的方式，抵消有害的 交叉柱头的影响。深入访谈将被记录，转录，编码，定性 分析以确定如何最好地优化和调整干预措施，以达到和有益于艾滋病毒预防， 变性妇女的健康需求。参与者还将接受正在采用的措施 在父母补助金中评估艾滋病毒检测和健康史，性行为，物质使用和PrEP使用 知识，态度，行为意图，规范的看法，和自我效能，以及衡量 性别少数的压力和复原力验证与跨性别和性别歧视的人。这些 定量数据将被分析，以确定是否-以及如何-少数民族的艾滋病毒预防需求 跨性别女性不同于少数种族MSM以及促进或阻碍PrEP的因素 在跨性别女性中使用。这项研究的结果将提高该领域对艾滋病毒健康的理解 跨性别少数群体妇女的需求-一个脆弱的，未得到充分研究和服务的SGM社区 并将为实现《消除艾滋病毒/艾滋病国家计划》的目标提供信息。 疫情