The BeT intervention to reduce HIV prevention and care disparities among young transwomen in Rio De Janeiro

BeT 干预措施旨在减少里约热内卢年轻跨性别女性的艾滋病毒预防和护理差异

• 批准号: 10252952
• 负责人: Erin Meek
• 金额: $ 24.07万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10252952
• 关键词: AIDS prevention; Address; Affect; Age; Brazil; Caring; Clinic; Cohort Studies; Collaborations; Communities; Cost efficiency; Country; Cross-Sectional Studies; Data; Development; Discrimination; Enrollment; Epidemic; Evidence based intervention; Face; Frequencies; Fright; Glean; Goals; HIV; HIV Seropositivity; HIV risk; Health; Health Care Seeking Behavior; Health Services Accessibility; Health system; Healthcare Systems; Human immunodeficiency virus test; Income; Individual; Infection; Intervention; Intervention Studies; Investments; Knowledge; Latin America; Longitudinal Studies; Measures; Mexico; Movement; National Institute of Child Health and Human Development; Participant; Patients; Persons; Peru; Phase; Population; Population Study; Prevalence; Prevention; Privatization; Public Health; Randomized; Research; Research Personnel; Resources; Risk; Safety; Sampling; Schedule; Secure; Services; Site; Social Marketing; Socialization; Stigmatization; Structure; System; Testing; Text Messaging; Training; Transcend; Translating; Transportation; Treatment Efficacy; United States National Institutes of Health; Violence; Youth; aged; arm; base; care systems; control trial; cost; data format; digital; digital intervention; efficacy testing; evidence base; experience; follow-up; health literacy; innovation; low and middle-income countries; men who have sex with men; peer; population based; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; programs; recruit; research study; response; risk perception; skills; social stigma; transgender; transgender women; treatment arm; uptake

ABSTRACT Our recent research discovered that almost 25% of a population-based sample of young transwomen in Brazil tested positive for HIV. This finding is consistent with research demonstrating that transwomen are the population most severely affected by HIV worldwide and face important barriers to accessing effective prevention and care programs. There is no HIV prevention intervention for young transwomen with evidence of efficacy outside the US. We propose a two-phase combination prevention intervention to address the main barriers to HIV prevention and care found in our research in this resource constrained setting. Stigma prevents young transwomen from accessing HIV prevention and care services, despite the fact that such services are freely available to all Brazilians in the public health system care system (i.e., SUS). Young people's HIV testing levels and care access is uneven. Data from our study show that almost no young transwomen regularly got tested for HIV, and given low testing levels, it is unlikely youth are accessing HIV care. In response to NICHD RFA-HD-18-032, we propose the Brilho e Transcender (BeT, or Shine and Transcend) intervention for young transwomen ages 18-24 years old in Brazil. Our proposed intervention uses expertise gleaned from a US based cohort study of young transwomen and knowledge from our cross-sectional transwomen HIV risk study in Brazil. Our study is comprised of two phases to address stigma in the public health system, intervene to overcome youth challenges with health care systems navigation and to scale the intervention widely if proven efficacious. During the 2-year UG3 phase, we propose to develop, implement and measure a highly visible, community-informed social marketing campaign to reduce anti-trans stigma in four SUS clinics currently implementing national PrEP access efforts that are also part of ImPrEP, which is a 3-country PrEP implementation project focused on transgender individuals and MSM. During the UG3 phase, we will also collect formative data to adapt our ARTAS-based system navigation intervention to the cultural context and HIV prevention and care needs of young transwomen in Brazil. After adaptation, we will conduct a small pilot intervention with 20 youth participants to determine preliminary efficacy and demonstrate our ability to recruit youth in this population. Preliminary data gathered from the RCT in the UG3 phase will be used to refine the intervention and justify movement to the UH3 phase and larger RCT to test efficacy of the intervention. During the UH3 phase, we will conduct a RCT with 150 young transwomen randomized to the BeT intervention or control. The intervention will be a digital systems navigation intervention utilizing peers to address youth-specific barriers to HIV prevention and care- namely, risk perception, system navigation skills and health literacy. The intervention will be intensively implemented over three months with follow-up to twelve months. The control arm will receive unidirectional educational text messages for the same period. We will test whether intervention arm participants have an increase in HIV testing frequency, PrEP uptake and HIV care linkage compared to participants in the control arm. A key innovation of our intervention is that it will be delivered digitally by trained transwomen peers. Interventions that require participants to interact on a particular schedule and in-person present a number of problems for young transwomen who face substantial competing needs and barriers to participation. Our intervention is private, can occur on a schedule convenient to participants, and does not require in-person interaction. The latter advantage is particularly salient for young transwomen who risk threats and abuse in public, especially on transportation. The system-navigation intervention promises multiple advantages over existing interventions that require in-person attendance, including more frequent engagement and lower cost of a digital intervention, alignment with the ways young transwomen socialize and interact, and in addressing safety challenges trans people face with participation in placed-based interventions. With proof of efficacy, the intervention can be rapidly brought to scale as a replicable, sustainable, evidence-based intervention for young transwomen in collaboration with the ImPrEP study and the Brazilian Ministry of Health efforts to increase prevention and care access for transwomen, including youth.

摘要 我们最近的研究发现，在巴西的年轻变性女性中， 艾滋病毒检测呈阳性这一发现与研究表明变性女性是 世界各地受艾滋病毒影响最严重的人口，在获得有效的 预防和护理方案。没有针对年轻变性妇女的艾滋病毒预防干预措施， 美国以外的功效。我们提出了一个两阶段的综合预防干预措施，以解决主要的 我们的研究发现，在这种资源有限的情况下，艾滋病毒预防和护理面临着巨大的障碍。耻辱感阻止了 青年变性妇女无法获得艾滋病毒预防和护理服务，尽管这些服务 向公共卫生系统保健系统中的所有巴西人免费提供（即，SUS）。年轻人的艾滋病毒检测 水平和获得护理的机会不均衡。我们的研究数据显示，几乎没有年轻的变性人经常得到 由于艾滋病毒检测水平较低，青年人不太可能获得艾滋病毒护理。关于NICHD RFA-HD-18-032，我们建议对年轻人进行Brilho e Transcender（BeT，或Shine和Transcend）干预 年龄在18-24岁之间的变性人。我们提议的干预措施使用了从美国一家 基于年轻跨性别女性的队列研究和我们跨性别女性艾滋病毒风险研究的知识 在巴西.我们的研究包括两个阶段，以解决公共卫生系统中的污名，干预， 通过医疗保健系统导航克服青年人面临的挑战，并在得到证实的情况下广泛扩大干预措施 灵验。在为期2年的UG 3阶段，我们建议制定、实施和衡量一个高度可见的、 目前，在四个单一卫生系统诊所开展了社区知情的社会营销活动，以减少反跨性别歧视 实施国家PrEP接入工作，这也是ImPrEP的一部分，ImPrEP是一个3国PrEP 执行项目侧重于变性人和男男性行为者。在UG 3阶段，我们还将 收集形成性数据，使我们基于ARTAS的系统导航干预适应文化背景， 巴西年轻变性妇女的艾滋病毒预防和护理需求。适应后，我们将进行小试点 20名青年参与者的干预，以确定初步疗效，并证明我们的能力， 在这个人群中招募年轻人。从UG 3期RCT中收集的初步数据将用于完善 干预措施，并证明进入UH 3期和更大的RCT以测试干预措施的有效性。 在UH 3阶段，我们将对150名年轻的跨性别女性进行随机对照试验， 干预或控制。干预将是一个数字系统导航干预，利用同行， 解决青年在艾滋病毒预防和护理方面的具体障碍-即风险观念、系统导航技能 和健康素养。干预措施将在三个月内密集实施，后续行动将持续到12个月。 个月对照组将在同一时期接收单向教育短信。我们将测试 干预组参与者的艾滋病毒检测频率、PrEP吸收率和艾滋病毒护理是否增加 我们干预的一个关键创新是， 由受过训练的变性人同行以数字方式提供。需要参与者在一个 特别的时间表和亲自提出了一些问题，年轻的transwomen谁面临大量的 竞争性需求和参与障碍。我们的干预是私人的，可以在方便的时间表上进行 参与者，并且不需要亲自互动。后一个优势对年轻人来说尤其突出。 在公共场合，特别是在交通工具上，易变性妇女面临威胁和虐待的风险。系统导航 与需要亲自参与的现有干预措施相比，干预措施具有多种优势， 包括更频繁的参与和更低的数字干预成本， 跨性别女性的社交和互动，并在解决安全挑战跨人面临的参与， 基于位置的干预。有了有效性的证明，干预措施可以迅速扩大规模， 与ImPrEP合作，为年轻的变性妇女提供可复制、可持续、基于证据的干预措施 研究和巴西卫生部努力增加变性妇女获得预防和护理的机会， 包括青年。