Culturally relevant intervention development for incarcerated transgender women

描述（由申请人提供）：本研究的目的是开发和试点测试一个文化相关的，理论驱动的适应以证据为基础的干预项目开始，以改善监禁后的跨性别（“跨”）妇女的医疗保健参与。调整后的干预措施（跨START）将侧重于改善与四个保健领域（艾滋病毒、药物使用、心理健康和与变性有关的医疗保健）的联系和参与，以满足每个参与者自我确定的需求。监禁是一个重要的跨性别妇女健康问题，对跨性别妇女的影响不成比例，监禁的循环与高水平的物质使用、精神疾病和艾滋病毒相互作用，在跨性别妇女中产生了更高的疾病负担。被逮捕的跨性别妇女更有可能报告精神疾病，使用药物，从事危险的性行为，并在释放后需要跨性别敏感服务。在健康、释放后服务需求和参与医疗保健的预测因素方面的性别差异要求采取针对性别的战略。对START项目的这一调整将纳入一个创新的、针对变性人的理论模式，即性别肯定模式。未满足的性别肯定需求预示着艾滋病毒变性妇女感染艾滋病毒的风险和艾滋病毒感染者的治疗失败，获得性别肯定与更好的心理健康有关。此外，获得性别肯定支持感染艾滋病毒的跨性别妇女的联系，参与和保留护理。使用ADAPT-ITT策略来指导适应过程，我们将与15-20名被关押在旧金山弗朗西斯科县监狱（SFCJ）的跨性别女性进行定性访谈，在释放之前和之后。我们还将与5-10名在SFCJ和社区中与这一人群合作的关键利益相关者进行定性访谈。一旦修改后的材料最终确定，我们将进行一项试点随机对照试验，以测试修改后的干预措施的可行性和可接受性，以及方案和程序，为未来的全面随机对照试验提供信息，以了解修改后的干预措施的有效性。为了实现这一目标，我们将50名被监禁至少一周的跨性别女性随机分为跨性别START（适应性START项目课程加常规治疗）或常规治疗（TAU）。我们预计，干预暴露后，相对于对照组，跨START参与者将报告更高的艾滋病毒检测率（在基线的艾滋病毒-妇女）和更高的艾滋病毒医疗预约出勤率（对于艾滋病毒阳性的跨性别妇女）。此外，干预参与者将报告：a）与药物滥用治疗，精神卫生保健和与跨性别有关的医疗保健（在将这些确定为需求的参与者中）的联系和参与程度更高。根据可行性和可接受性试验的数据，我们将利用资金进行更大规模的功效研究， 调整后的课程，目标是为准备释放到社区的被监禁变性妇女制定可复制的、与文化相关的、基于证据的健康促进干预措施。

DESCRIPTION (provided by applicant): The purpose of this study is to develop and pilot test a culturally relevant, theory-driven adaptation of the evidence-based intervention Project START to improve post-incarceration health care engagement among transgender ('trans') women. The adapted intervention (Trans START) will focus on improving linkage to and engagement in four health care domains (HIV, substance use, mental health, and transgender-related medical care), responsive to each participant's self-identified needs. Incarceration is a significant publi health issue that disproportionately impacts trans women, and the cycle of incarceration interacts with high levels of substance use, mental illness, and HIV to produce an elevated burden of disease among trans women. Trans women who have been arrested are more likely to report mental illness, using substances, engaging in risky sex, and needing trans-sensitive services upon release. Gender differences in health, post-release service needs, and predictors of engagement in healthcare call for gender-specific strategies. This adaptation of Project START will incorporate an innovative, transgender-specific theoretical model, the Model of Gender Affirmation. Unmet need for gender affirmation predicts HIV risk among HIV- trans women and treatment failure among those who are living with HIV, and access to gender affirmation is related to better mental health. Furthermore, access to gender affirmation supports linkage, engagement, and retention in care among trans women who are living with HIV. Using the ADAPT-ITT strategy to guide the adaptation process, we will conduct qualitative interviews with 15-20 trans women who are incarcerated in the San Francisco County Jail (SFCJ), prior to and after release. We will also conduct qualitative interviews with 5-10 key stakeholders who work with this population in SFCJ and in the community. Once the adapted materials are finalized, we will conduct a pilot randomized controlled trial to test the feasibility and acceptability of the adapted intervention, as well as the protocols and procedures, to inform a future full-scale randomized controlled trial for efficacy of the adapted intervention. To accomplish this aim, we will randomize 50 trans women who have been incarcerated for a minimum of one week to either Trans START (adapted Project START curriculum plus treatment as usual) or treatment as usual alone (TAU). We expect that following intervention exposure, relative to control group, Trans START participants will report higher rates of HIV testing (among HIV- women at baseline) and higher HIV medical appointment attendance (for HIV-positive trans women). Moreover, intervention participants will report: a) higher levels of linkage to and engagement in substance abuse treatment, mental health care, and transgender-related medical care (among participants who identify these as needs). With the data from the feasibility and acceptability pilot, we will leverage funding to conduct a larger efficacy study of the adapted curriculum with the goal of producing a replicable, culturally relevant, evidence-based health promotion intervention for incarcerated trans women who are preparing for release into the community.