Improving HIV testing and PrEP for transgender women through mHealth

通过移动医疗改善跨性别女性的艾滋病毒检测和 PrEP

• 批准号: 10258220
• 负责人: Roman Shrestha
• 金额: $ 25.43万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-28 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10258220
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Asia; Attitude; Behavior Therapy; Caring; Cellular Phone; Clinic; Clinical; Clinical Services; Complex; Country; Custom; Data; Decision Making; Development; Discrimination; Drug usage; Economics; Employment; Environment; Epidemic; Evidence based intervention; Exclusion; Focus Groups; Fostering; Gender; General Population; Government; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health Services; Healthcare; Hearing; Human immunodeficiency virus test; Individual; Infection; Injecting drug user; Interpersonal Violence; Intervention; Laws; Learning; Legal; Malaysia; Malaysian; Medical; Mental Depression; Mental Health; Mobile Health Application; Modeling; Names; Occupations; Population; Populations at Risk; Prevalence; Privatization; Process; Provider; Randomized Controlled Trials; Religion and Spirituality; Research; Risk; Risk Behaviors; Services; Sexual Health; Sexual Transmission; Socialization; Strategic Planning; Structure; Study models; Testing; Time; Vulnerable Populations; Work; acceptability and feasibility; base; care systems; cost effective; design; distrust; empowered; experience; health care service; health management; high risk; improved; information gathering; innovation; mHealth; men who have sex with men; mobile application; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; prototype; response; scale up; screening; service delivery; sex; social; social stigma; statistics; substance use; testing services; testing uptake; theories; tool; transgender women; treatment as usual; trial comparing; uptake; usability

Abstract Despite decades of evidence-based interventions, including the 90/90/90 strategy, the HIV epidemic in Malaysia remains volatile. With over 100,000 cumulative HIV cases, Malaysia's rapidly expanding HIV epidemic is the fifth largest in the Asia-Pacific region and is concentrated within the most-at-risk populations. Originally driven by people who inject drugs, the majority of new infections today (>90%) are attributed to sexual transmission, many of which occur among transgender women (TGW). TGW are disproportionately impacted by HIV worldwide, with an estimated global prevalence of 19%. In Malaysia, an estimated 12.4% of TGW are living with HIV. TGW experience multi-level vulnerabilities to HIV, including discrimination in employment and economic opportunities, steering many TGW into high-risk occupations, such as sex work. High levels of stigma and discrimination against TGW by healthcare providers can foster a hostile environment toward TGW, complicating efforts to scale-up of HIV testing and prevention services among trans women, including pre-exposure prophylaxis (PrEP). Modeling studies suggest increased HIV testing and uptake of PrEP is the most impactful and cost-effective strategy for reducing new infections. Despite this, only 37% of TGW in Malaysia have ever been HIV tested. Similarly, while PrEP is recommended in Malaysia's National Strategic Plan to End AIDS (2016-2030), only 1 in 5 TGW has ever heard of PrEP. However, after learning about PrEP, more than 80% of TGW in Malaysia say they would take it. To scale-up of HIV testing and PrEP among TGW, innovative strategies are needed to rapidly overcome the complex barriers preventing uptake. In settings where anti-trans stigma is pervasive, such as Malaysia, mHealth may provide an empowering alternative approach to service delivery for TGW. An effective platform for reaching vulnerable and hidden populations, mHealth can overcome barriers associated with traditional clinic-based care by designing customized models of care tailored to the needs of vulnerable populations. Through confidential screening, rapid referrals to trans-friendly providers, and tools that facilitate access to gender-affirming health care needs, mHealth is a promising platform that can be leveraged for intervening around HIV prevention. Thus, we propose to develop and test a new clinic-affiliated app, called MyLink2care, to deliver an integrated HIV prevention intervention for TGW in Malaysia. Specifically, we propose to: 1) adapt, expand, and refine an existing mobile application by conducting formative research with TGW and clinical stakeholders to develop a prototype of the MyLink2Care app to undergo usability testing, followed by development of the beta version of the app; 2) conduct “beta testing” of the MyLink2Care app to assess its usability and acceptability; and 3) assess preliminary feasibility and acceptability of the MyLink2care app within a pilot, randomized-controlled trial, compared with treatment-as-usual for engagement in HIV prevention.

摘要 尽管采取了数十年的循证干预措施，包括90/90/90战略， 马来西亚仍然动荡不安。马来西亚的艾滋病毒感染病例累计超过10万例， 这一流行病是亚太区域第五大流行病，集中在最高危人群中。 最初是由注射毒品的人驱动的，今天大多数新感染（>90%）归因于 性传播，其中许多发生在变性妇女（TGW）中。TGW不成比例地 艾滋病毒在全球范围内受到影响，估计全球流行率为19%。在马来西亚，估计12.4%的 TGW是艾滋病毒携带者。TGW经历了多层次的艾滋病毒脆弱性，包括在 就业和经济机会，引导许多过渡期妇女从事高风险职业，如性工作。 医疗保健提供者对TGW的高度污名化和歧视可能会助长敌对环境 对TGW，复杂的努力，扩大艾滋病毒检测和预防服务的跨性别妇女， 包括暴露前预防（PrEP）。模拟研究表明，增加艾滋病毒检测和吸收 PrEP是减少新感染的最有效和最具成本效益的策略。尽管如此，只有37%的 马来西亚的TGW曾经接受过艾滋病毒检测。同样，虽然PrEP在马来西亚国家 在《消除艾滋病战略计划（2016-2030）》中，只有五分之一的TGW听说过PrEP。 关于PrEP，马来西亚超过80%的TGW表示他们会接受。为了扩大艾滋病毒检测和PrEP的规模， 在TGW中，需要创新战略，以迅速克服阻碍吸收的复杂障碍。在 在反跨性别歧视普遍存在的环境中，如马来西亚，mHealth可能会提供一种增强权能的方式， 为TGW提供服务的替代方法。一个有效的平台， 人口，mHealth可以克服与传统的基于诊所的护理相关的障碍， 根据弱势群体的需要制定的护理模式。通过保密筛选， 快速转介到对变性人友好的提供者，以及便利获得确认性别平等的保健需求的工具， 移动健康是一个很有前途的平台，可以用来干预艾滋病毒的预防。因此我们 建议开发和测试一个新的诊所附属应用程序，称为MyLink 2care，以提供综合的艾滋病毒 马来西亚TGW的预防干预。具体而言，我们建议：1）适应，扩大和完善 现有的移动的应用程序，与TGW和临床利益相关者一起进行形成性研究， MyLink 2Care应用程序的原型进行可用性测试，然后开发测试版 应用程序; 2）对MyLink 2Care应用程序进行“beta测试”，以评估其可用性和可接受性;以及3） 评估MyLink 2care应用程序在试点随机对照中的初步可行性和可接受性 试验，与常规治疗相比，参与艾滋病毒预防。