PrEP Engagement Trajectories Among Transgender Women in the United States

项目摘要/摘要 背景：与其他关键人群相比，变性人女性(TW)的艾滋病毒感染率最高 艾滋病流行人群中有14%的美国TW患者携带艾滋病毒。HIV暴露前 预防措施(PrEP)自2012年开始在美国推出，但普及速度缓慢，面临着相关挑战 对坚持的态度已经出现。对社会经济、行为和制度的全面理解 有助于在TW中吸收、坚持和坚持PrEP的因素将照亮潜力 优化PrEP参与和减少艾滋病毒发病率的机制。 研究目标和目的：这项研究将确定将优化PrEP摄取、依从性和 在美国，有感染艾滋病毒风险的变性人妇女的持久性。具体目标是：1) 识别具有不同纵向PrEP参与轨迹的TW组；2)检查关联 在每个PrEP参与组的成员身份与人口统计、社会经济、行为和 系统指标；以及3)开发一种模型，说明社会经济、行为和 系统因素影响TW的PrEP参与轨迹。 方法：这项解释性的顺序混合方法研究将利用 现有的父母研究，已经建立了1215 TW的纵向队列，有感染艾滋病毒的风险 美国。目标1和目标2将对家长收集的纵向调查数据进行二次分析 学习。目标1将利用基于组的轨迹建模，这是潜在类分析的扩展，适用于 纵向数据，以确定遵循相似模式的PrEP摄取、依从性和 坚持24个月以上的随访。目标2将使用多项Logistic回归来确定因素 与目标1中确定的每个PrEP轨迹组的成员相关联。以目标1的调查结果为基础 和2，目标3将定性地探索社会经济、行为和制度 通过对TW和利益相关方的深入访谈，影响TW的PrEP参与轨迹的因素。 将对调查结果进行三角划分，以便对这一重要主题有更细微的理解。 奖学金信息：建议的研究是博士生Erin Cooney女士的博士论文 在约翰霍普金斯大学布隆伯格公共卫生学院。该培训由艾滋病预防专家指导。 包括一名赞助者、两名共同赞助者和两名科学顾问，方法和方法互补 专业的专业知识。培训计划概述了正式的课程工作、持续的指导、研究实施、 和其他高级培训机会，为库尼女士成为领先的独立研究人员做好准备 在艾滋病毒预防方面。拟议的研究与NIMH的艾滋病研究优先事项司直接一致 扩大将行为科学与有效的艾滋病毒预防生物医学战略相结合的方法。

PROJECT SUMMARY/ABSTRACT Background: Transgender women (TW) shoulder the highest prevalence of HIV compared to other key populations in the epidemic with 14% of all TW in the United States (US) living with HIV. HIV pre-exposure prophylaxis (PrEP) has been available in the US since 2012 yet uptake has been slow and challenges related to adherence have emerged. A comprehensive understanding of the socioeconomic, behavioral and systems factors that contribute to PrEP uptake, adherence and persistence among TW will illuminate potential mechanisms for optimizing PrEP engagement and reducing HIV incidence. Study Goal and Aims: This study will identify factors that will optimize PrEP uptake, adherence and persistence among transgender women at risk for HIV acquisition in the United States. Specific aims are to: 1) Identify groups of TW with distinct longitudinal PrEP engagement trajectories; 2) Examine associations between membership in each PrEP engagement group with demographic, socioeconomic, behavioral and systems indicators; and 3) Develop a model for the mechanisms by which socioeconomic, behavioral and systems factors impact TW's PrEP engagement trajectories. Approach: This explanatory, sequential mixed-methods study will leverage the data and infrastructure of an existing parent study, which has established a longitudinal cohort of 1,215 TW at risk of HIV acquisition in the United States. Aims 1 and 2 will be secondary analyses of longitudinal survey data collected by the parent study. Aim 1 will utilize group-based trajectory modeling, an extension of latent class analysis appropriate for longitudinal data, to identify groups of TW who follow similar patterns of PrEP uptake, adherence and persistence over 24-months of follow-up. Aim 2 will use multinomial logistic regression to identify factors associated with membership in each PrEP trajectory group identified in Aim 1. Building on findings from Aims 1 and 2, Aim 3 will qualitatively explore the mechanisms by which socioeconomic, behavioral and systems factors impact TW's PrEP engagement trajectories through in-depth interviews with TW and stakeholders. Findings will be triangulated to develop a more nuanced understanding of this important topic. Fellowship Information: The proposed research is the doctoral dissertation of Ms. Erin Cooney, PhD student at Johns Hopkins Bloomberg School of Public Health. The training is mentored by experts in HIV prevention including one Sponsor, two Co-sponsors, and two Scientific Advisors with complementary methodological and topical expertise. The training plan outlines formal coursework, ongoing mentorship, research implementation, and other advanced training opportunities to prepare Ms. Cooney to become a leading independent researcher in HIV prevention. The proposed study directly aligns with the NIMH's Division of AIDS Research priorities of expanding approaches to integrate behavioral science with effective biomedical strategies for HIV prevention.