Risk and Protective Factors for Adherence to Pre-Exposure Prophylaxis (PrEP) in Transwomen of Color

项目摘要 跨性别妇女（TW）目前是美国艾滋病毒感染风险最高的SGM人群。 国家，特别是那些种族/族裔少数群体。TW还报告了最严重的歧视， 受害，创伤性生活事件和其他压力经历，是最高风险群体， 药物滥用和精神健康问题。艾滋病研究人员表示，弹性可能在很大程度上是 在行为干预方面尚未开发的资源，它可能与心理健康的减少有关。 边缘化人群中的问题、药物滥用和艾滋病毒相关风险。每日预暴露 预防性治疗（PrEP）在预防HIV阴性者感染HIV方面非常有效。而 这是TW少数民族艾滋病预防的一个令人兴奋的发展，艾滋病预防工作现在必须转变 专注于研究在面临多次复发的高风险人群中优化PrEP依从性 压力生活事件和许多结构性障碍。在拟议的研究中，我们将利用正在进行的研究 在南加州PrEP示范中招募的种族和民族多样的TW（N =300） 项目，为了进行混合方法的研究，首先使用结构方程模型（SEM）， 评估与TW之间PrEP依从性最相关的风险和弹性因素。然后使用 SEM调查结果为后续深入的定性访谈提供信息，其中包含高依从性至低依从性的子样本 少数TW进一步探索那些风险和弹性因素和经验最突出的准备 高风险少数TW之间的依从性。本研究将提供初步数据以支持提交 一项干预发展赠款（NIDA R34），用于制定一项基于依从性的干预措施，重点是 改善TW的PrEP依从性。

Project Abstract Transgender women (TW) are currently the SGM population at highest risk for HIV infection in the United States, especially those who are racial/ethnic minorities. TW also report the highest levels of discrimination, victimization, traumatic life events, and other stressful experiences and are of the highest risk groups for substance abuse and mental health problems. HIV researchers have suggested resiliency may be a largely untapped resource in behavioral interventions and that it may be associated with reductions in mental health problems, substance abuse, and HIV related risk among marginalized populations. Daily pre-exposure prophylaxis (PrEP) is extremely effective in preventing HIV infection among those who are HIV-negative. While this is an exciting development for HIV prevention among minority TW, HIV prevention efforts must now shift focus to research on optimizing PrEP adherence among this high-risk population facing multiple recurring stressful life events and numerous structural barriers. In the proposed study, we will leverage an ongoing study of (N =300) racially and ethnically diverse TW enrolled in the Southern California based PrEP demonstration project, in order to conduct mixed-methods research, first using structural equation modeling (SEM) to assessing the risk and resiliency factors most associated with PrEP adherence among TW. Then using the SEM findings to inform follow-on, in-depth qualitative interviews with a sub-sample of high- to low-adherence minority TW to further explore those risk and resiliency factors and experiences most salient to PrEP adherence among high-risk minority TW. This study will provide the preliminary data to support the submission of an intervention development grant (NIDA R34) to develop a resilience-based intervention focused on improving PrEP adherence for TW.