Juntas Adelante: A Peer-coaching Intervention to Promote Chemoprophylaxis for HIV Prevention among Latina Transgender Women in the Washington DC Metropolitan Area

项目总结/摘要 跨性别妇女（TW）承担着不成比例的艾滋病毒负担，其中一个最大的艾滋病毒相关疾病是 在拉丁美洲TW之间发现的差异，其艾滋病毒感染率（26%）几乎是他们之间的四倍。 非西班牙裔白色人（7%）。根据我们Adelante研究的结果， 纵向试点项目，评估哥伦比亚特区移民LTW对PrEP和PEP的认识和接受情况 大都市地区，这个原始的流行病学干预项目旨在开发和试点测试一个同行， 辅导干预，以促进文化上的艾滋病毒预防的化学预防（即PrEP和PEP） 符合LTW社区的特点。为了实现这一目标，我们建立了一个强大的 社区-学术界-政府伙伴关系，由为提供服务的组织工作的LTW组成 艾滋病毒/艾滋病、肝炎、性病和结核病的官员向华盛顿大都市区的LTW社区介绍了他们的情况。 华盛顿特区卫生部和华盛顿特区艾滋病中心的研究人员 研究（DC CFAR）。使用基于社区的参与性研究（CBPR）方法，我们的所有成员 伙伴关系将协同工作，以制定干预措施，其中将包括：1）同行辅导会议， 改善艾滋病毒风险评估，提供有关PrEP/PEP的信息，并支持PrEP/PEP的吸收， 坚持，2）导航到现有的PrEP/PEP服务和3）认为适合文化的其他组成部分 CBPR团队的相关信息。我们将使用随机延迟干预对照试验来检查可行性， 可接受性和初步疗效，将HIV阴性LTW随机分配至干预组（n=25）或6个月 候补对照组（n=25）。将在基线和第3、6和12天评估PrEP/PEP摄取和依从性- 月随访，使用自我报告，医疗记录审查和临床分析。干预的可行性和 可接受性将通过与参与者进行定性深入访谈进行评估， 干预完成。我们的社区-学术界-政府伙伴关系非常适合开展 拟议的研究已证明有能力招募、留住和吸引华盛顿特区LTW社区参与之前的艾滋病毒感染 research.在“Adelante”研究中，我们招募了62名移民LTW，总体留存率为82%。 纵行部分（n=41/50）。我们与为LTW服务的组织建立了牢固的关系 社区，谁将在这个项目上合作，确保社区的需求和优先事项推动有效的艾滋病毒 反应该提案补充并扩展了HAHSTA的艾滋病毒预防工作， 到2030年，DC的流行病（EHE）。根据EHE计划的主要战略，通过使用 经过验证的干预措施，这项研究将支持发展第一个循证艾滋病毒预防 针对LTW的干预。这项研究的结果将用于准备NIH R系列奖，以进行更多的研究。 严格检验干预措施的有效性。这一建议与MARI的总体目标非常一致 该计划旨在支持受艾滋病毒严重影响的少数民族社区的创新实施科学研究。

PROJECT SUMMARY/ABSTRACT Transgender women (TW) bear a disproportionate burden of HIV, with one of the single largest HIV-related disparities found among Latina TW, whose HIV prevalence (26%) is almost four times greater than among their non-Hispanic White counterparts (7%). Based on findings from our Adelante study, a mixed-methods longitudinal pilot project assessing awareness and uptake of PrEP and PEP among immigrant LTW in the DC metropolitan area, this original epidemiological-interventional project seeks to develop and pilot test a peer- coaching intervention to promote chemoprophylaxis (i.e. PrEP and PEP) for HIV prevention that is culturally responsive to the characteristics of the LTW community. To achieve this aim we have established a strong community-academia-government partnership, composed of LTW working for organizations providing services to the LTW community in the DC metropolitan area, officials from the HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) of the DC Department of Health and researchers from the DC Center for AIDS Research (DC CFAR). Using a community-based participatory research (CBPR) approach, all members of our partnership will work collaboratively to develop the intervention, which will include: 1) peer-coaching sessions for improving HIV-risk assessments, providing information about PrEP/PEP, and supporting PrEP/PEP uptake and adherence, 2) navigation to existing PrEP/PEP services and 3) other culturally appropriate components deemed relevant by the CBPR team. We will use a randomized delayed-intervention control trial to examine feasibility, acceptability and preliminary efficacy, randomizing HIV negative LTW to the intervention (n=25) or a 6-month waitlist control group (n=25). PrEP/PEP uptake and adherence will be assessed at baseline and 3, 6 and 12- month follow ups, using self-report, medical records reviews and clinical assays. Intervention feasibility and acceptability will be assessed using qualitative in-depth individual interviews with participants one month after intervention completion. Our community-academia-government partnership is ideally suited to carry out the proposed research with a demonstrated ability to recruit, retain and engage the LTW community in DC in prior HIV research. For the “Adelante” study we recruited 62 immigrant LTW, with an overall retention rate of 82% for the longitudinal portion (n=41/50). We have established strong relationships with organizations serving the LTW community, who will collaborate on this project, ensuring that community needs and priorities drive an effective HIV response. This proposal complements and extends HAHSTA's HIV prevention efforts towards Ending the HIV Epidemic (EHE) in DC by 2030. In line with the EHE plan's key strategy to prevent new HIV transmissions by using proven interventions, this research will support the development of the first evidence-informed HIV prevention intervention targeting LTW. Results from this study will be used to prepare a NIH R–series award to conduct a more stringent test of effectiveness of the intervention. This proposal aligns well with the overarching goal of the MARI program to support innovative implementation science research in a minority community heavily impacted by HIV.