Staying Connected: Community-engaged research to address the impacts of the COVID-19 Pandemic among transgender women through an m-health prevention program

摘要：保持联系：社区参与的研究，以应对新冠肺炎的影响 通过移动健康预防计划在变性女性中流行 新冠肺炎大流行提醒世界，病毒爆发是现实，可以迅速产生高 死亡率和发病率，使卫生保健系统不堪重负，并产生巨大的社会和经济 剧变。流行病学数据表明，新冠肺炎将对大多数人造成最具破坏性的影响 在这一过程中，弱势社会成员的健康状况将进一步恶化。在美国， 变性人女性，特别是有色人种变性人女性，特别有可能感染新冠肺炎 由于高水平的艾滋病毒感染、药物滥用、抑郁、焦虑症和社会孤立。 研究表明，这些健康差距和脆弱性与多种形式的 塑造变性女性生活的歧视。在此背景下，新冠肺炎大流行和 伴随而来的缓解战略不仅影响新冠肺炎的传播和疾病，还影响变性人 妇女坚持艾滋病毒抗逆转录病毒疗法，利用艾滋病毒预防连续体，财政和 住房稳定，以及与性别肯定护理中断相关的焦虑和抑郁。这 拟议的行政补充将建立在我们目前的项目--跨性别女性互联(TWC)的基础上，以及 面向变性女性的mHealth性健康促进应用程序，通过进行研究获得更大的收益 理解和应对这些相互关联且仍在发展中的跨特定新冠肺炎 影响。具体地说，我们的目标是：1)进行快速形成研究，以检查新冠肺炎和 缓解战略，包括通过Focus对变性妇女产生意想不到的负面后果 小组、专家顾问和积极参与的社区顾问委员会；2)发展一个文化定制的社区- 优势与认知行为理论启迪新冠肺炎互动教育活动模块 集成到整个TWC移动应用程序中。技能建设活动旨在支持新冠肺炎缓解 战略，降低新冠肺炎的发病率和死亡率，并从总体上提高医疗保健的利用率，增加 自我照顾和复原力，并促进变性妇女之间的联系，从而导致改善 总体身心健康；以及3)作为更大的 父母补助双臂随机对照试验，共有450名变性妇女参加。此评估将启用 美国将收集新冠肺炎数据以及移动健康模块在12个月内对变性人女性的影响 时间段可能包括放松疏远措施，可能出现第二波和第三波感染 以及更长的禁闭期，以及潜在的疫苗的出现。该项目提供了一种可能性 对新冠肺炎大流行对健康、互联和行为的影响的前所未有的洞察力 这是美国最脆弱和最边缘化的人群之一。

ABSTRACT: Staying Connected: Community-engaged research to address the impacts of the COVID-19 Pandemic among transgender women through an mhealth prevention program The COVID-19 pandemic has reminded the world that viral outbreaks are a reality and can quickly generate high levels of mortality and morbidity, overwhelm health-care systems, and produce massive social and economic upheaval. Epidemiological data suggest that COVID-19 will have its most devastating impact on the most vulnerable members of society, and in the process, exacerbate existing health disparities. In the United States, transgender women, and in particular transgender women of color, are particularly at risk for COVID-19 infection due to high levels of HIV infection, substance abuse, depression, anxiety disorders, and social isolation. Research demonstrates that these health disparities and vulnerabilities are connected to the multiple forms of discrimination that shape transgender women’s lives. In this context, the COVID-19 pandemic and accompanying mitigation strategies affect not only COVID-19 transmission and disease, but also transgender women’s adherence to HIV anti-retroviral therapies, utilization of the HIV prevention continuum, financial and housing stability, and anxiety and depression associated with the disruption of gender-affirming care. This proposed administrative supplement will build on our current project, Trans Women Connected (TWC), an mhealth sexual health promotion app for transgender women, by conducting research to gain greater understanding of and ways to respond to these inter-connected and still evolving trans-specific COVID-19 impacts. Specifically, we aim to: 1) Conduct rapid formative research to examine the impact of COVID-19 and mitigation strategies, including unintended negative consequences, on transgender women through focus groups, expert advisors, and an engaged community advisory board; 2) Develop a culturally tailored, community- strengths and cognitive behavior theory informed module of interactive COVID-19 educational activities for integration into the overall TWC mobile app. The skills-building activities seek to support COVID-19 mitigation strategies, reduce COVID-19 morbidity and mortality, and in general, improve health care utilization, increase self-care and resilience, and promote connectedness among transgender women, thereby leading to improved overall mental and physical health; and 3) Evaluate the impact of the COVID-19 module as part of the larger parent grant 2-arm cluster randomized controlled trial with 450 transgender women. This evaluation will enable us to collect data on COVID-19 and the impact of the mhealth module on transgender women over a 12-month time period likely encompassing relaxation of distancing measures, possible second and third waves of infections and additional periods of lockdown, and potentially, the emergence of a vaccine. The project offers the possibility of unprecedented insights into effects of the COVID-19 pandemic on the health, connectedness, and behaviors of one of the most vulnerable and socially marginalized populations in the US.