Tcher, Take Charge: Increasing PrEP Awareness, Uptake, and Adherence Through Health Care Empowerment and Addressing Social Determinants of Health Among Racially Diverse Trans Women in the Deep South

摘要 跨性别妇女在应对艾滋病毒方面得不到充分的服务，特别是在南方腹地。南方各州是 受艾滋病毒的严重影响。在面临绝大多数新艾滋病毒感染的南方腹地各州， 路易斯安那州的艾滋病毒诊断率仅次于格鲁吉亚州。在新奥尔良，我们的团队进行了第一次人口调查- 根据艾滋病毒监测研究，46%的变性妇女艾滋病毒检测呈阳性。这些发现与大多数 路易斯安那州卫生部（LDH）2018年的性病/艾滋病年度报告确定了黑人同性恋/双性恋男子， 在路易斯安那州，变性妇女是艾滋病毒感染者中最多的。尽管艾滋病毒对 新奥尔良的跨性别妇女，没有基于证据的PrEP干预措施或努力正在进行中，以满足社区需求。在 对RFA-MH-21-151加强美国南部妇女艾滋病毒预防工作的回应，我们的团队建议 测试T 'Cher，负责干预，以提高跨性别女性的PrEP意识，吸收和坚持， 新奥尔良T 'Cher建立了为通知和实施第一个基于人群的跨性别研究而进行的工作。 2019年的女性，最近完成了两项针对跨性别女性的循证干预措施， investigators.干预措施将包括社交媒体活动，以提高跨性别妇女的PrEP意识。它 还将包括同行导航，以建立跨人群之间的信任，并提供PrEP导航。我们将为同行量身定制 Stay Study中的导航模型将以数字方式实现，并使用Health eNav方法进行增强。即，我们 还将使用动机性访谈和EMA来增加医疗保健授权并解决社会决定因素 PrEP吸收和坚持的健康障碍。我们将招募200名跨性别女性参与我们的研究， 在我们之前对跨性别女性进行的艾滋病研究中，这些方法被证明是成功的。跨性别女性将参与干预 为期12个月，提供足够的时间来解决PrEP的障碍并支持依从性。提出的目标 T 'Cher，Take Charge干预措施包括：（1）制定、实施和衡量T' Cher，Take Charge的影响 社交媒体活动对新奥尔良跨性别女性的PrEP意识，LA使用基于人口的样本， （2）为了测试T 'Cher的影响，负责数字mHealth同行导航模型对增加 使用随机阶梯式楔形交叉研究，在新奥尔良，LA的跨性别女性中进行PrEP摄取和依从性 设计;以及（3）评估卫生保健授权和支持健康社会决定因素的变化， PrEP摄取和依从性的因素。我们的目标是利用学到的经验教训， 在路易斯安那州新奥尔良市，为满足跨性别妇女的艾滋病毒预防需求而采取的干预措施。的证据 有效性，我们准备在整个路易斯安那州大规模测试干预措施，以加强PrEP的获取， 在路易斯安那州和整个南方腹地的跨性别女性中使用。

Abstract Trans women are highly underserved in the response to HIV, especially in the deep south. Southern states are disproportionately impacted by HIV. Among states in the deep south, which face the vast majority of new HIV infections, HIV diagnosis rates in Louisiana were second only to Georgia. In New Orleans, our team conducted the first population- base HIV surveillance study of trans women and 46% tested positive for HIV. These findings are consistent with the most recent Louisiana Department of Health (LDH) STD/HIV annual report in 2018 that identified Black gay/bisexual men and transgender women as bearing the largest burden of HIV of any population in Louisiana. Despite the impact of HIV on trans women in New Orleans, no evidence-based PrEP interventions or efforts are underway to meet community needs. In response to RFA-MH-21-151 Strengthening HIV Prevention Efforts for Women in the Southern U.S., our team proposes to test the T'Cher, Take Charge intervention to increase PrEP awareness, uptake, and adherence among trans women in New Orleans. T'Cher builds off the work conducted to inform and implement the first population-based study of trans women in 2019 with the adaptation of two evidence-based interventions for trans women recently completed by investigators. The intervention will include a social media campaign to increase PrEP awareness among trans women. It will also include peer navigation to build trust among trans people and provide PrEP navigation. We will tailor the peer navigation model from the Stay Study to be implemented digitally and enhanced using Health eNav methods. Namely, we will also use motivational interviewing and EMAs to increase health care empowerment and address social determinants of health barriers to PrEP uptake and adherence. We will recruit 200 trans women to participate in our study using methods proven successful in our prior HIV research with trans women. Trans women will be engaged in the intervention for 12 months, providing enough time to address barriers to PrEP and support adherence. The goals of this proposed T'Cher, Take Charge intervention are: (1) To develop, implement and measure the impact of a T'Cher, Take Charge social media campaign on PrEP awareness among trans women in New Orleans, LA using a population-based sample of trans women; (2) To test the impact of the T'Cher, Take Charge digital mHealth peer navigation model on increasing PrEP uptake and adherence among trans women in New Orleans, LA, using a randomized stepped wedge cross-over study design; and, (3) To assess changes in health care empowerment and support for social determinants of health as mediating factors in PrEP uptake and adherence. Our goal is to used lessons learned to adapt promising trans-specific HIV interventions to meet the HIV prevention needs of trans women in New Orleans, Louisiana. With evidence of effectiveness, we are prepared to test the intervention at scale throughout Louisiana to strengthen PrEP access and utilization among trans women Louisiana and throughout the deep south.