Addressing violence and HIV cascade of care outcomes among transgender women

项目总结 有色人种的变性人妇女在各种情况下经历暴力，包括来自伴侣的暴力， 陌生人，执法人员，医疗保健提供者，以及公共住宿。暴力始终如一 与避免护理、次佳的抗逆转录病毒治疗依从性以及通过途径抑制病毒的几率较低有关 包括慢性应激、免疫炎症反应、创伤后应激障碍(PTSD)症状，以及 物质使用。这些流行病是同时发生和相辅相成的，构成了一种“合并症”或 协同作用，有助于记录艾滋病毒连续护理结果中的不平等现象。在底特律， 在密歇根州，有色人种的跨性女性是艾滋病毒感染风险最高的群体之一，在 参与艾滋病毒护理。在R21探索性/发展研究应用中，我们建议适应和 试点测试文化响应性、基于证据和创伤信息的干预措施，以提高参与度 艾滋病毒护理(主要结果)，减少创伤后应激障碍症状(次要结果)，并增加持续病毒感染 艾滋病毒携带者中的有色人种妇女的压抑(第三种结果)。在Adapt-ITT模式的指导下， 我们的第一个目标是寻求对干预措施进行系统的调整，重点放在 暴力、性别肯定需求和参与艾滋病毒护理，通过与#年的变性妇女进行访谈 颜色和关键利益相关者通知改编。我们由变性妇女组成的社区顾问委员会 将审查所有改编的材料。第二个目标旨在检查可行性、可接受性和 适应性干预对单臂飞行员即刻和术后3个月随访的初步疗效 干预。第三个目标是收集单臂试验参与者的定性数据，以确定策略 克服障碍，在变性女性中实施严格的随机对照试验研究设计 在有限的资源设置下的颜色。研究结果将提供必要的基础工作 随后进行了社区参与的大规模随机对照试验。这些发现也有可能 提供一张蓝图来指导未来对跨性别女性的研究努力，她们经常被嵌入到 编织社区，现有的响应文化的服务很少。

PROJECT SUMMARY Transgender (`trans') women of color experience violence in a variety of contexts, including from partners, strangers, law enforcement, healthcare providers, and in public accommodations. Violence is consistently linked with avoiding care, suboptimal ART adherence, and lower odds of viral suppression via pathways including chronic stress, immune inflammatory response, posttraumatic stress disorder (PTSD) symptoms, and substance use. These epidemics are concurrent and mutually reinforcing, constituting a “syndemic” or synergistic interaction that contributes to documented inequities in HIV continuum of care outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in engagement in HIV care. In this R21 exploratory/developmental research application, we propose to adapt and pilot test a culturally-responsive, evidence-based, and trauma-informed intervention to improve engagement in HIV care (primary outcome), reduce PTSD symptoms (secondary outcome), and increase sustained viral suppression (tertiary outcome) among trans women of color living with HIV. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of the intervention, with a focus on the unique aspects of violence, gender affirmation needs, and engagement in HIV care by conducting interviews with trans women of color and key stakeholders to inform the adaptation. Our community advisory board consisting of trans women of color will review all adapted materials. The second aim seeks to examine the feasibility, acceptability, and preliminary efficacy of the adapted intervention in a one-arm pilot with follow-ups immediate and 3-month post- intervention. The third aim seeks to gather qualitative data from one-arm pilot participants to identify strategies to overcome barriers to implementing rigorous randomized controlled trial research designs with trans women of color within limited-resources settings. Study findings will provide the necessary groundwork for a subsequent community-engaged large-scale randomized controlled trial. Findings also have the potential to provide a blueprint to guide future research efforts with trans women of color who are often embedded in close- knit communities with few existing culturally-responsive services.