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 变性妇女在应对艾滋病毒方面的服务严重不足，特别是在南方腹地。南部各州是 不成比例地受到艾滋病毒的影响。在面临绝大多数新增艾滋病毒感染的南部各州中， 路易斯安那州的艾滋病毒诊断率仅次于佐治亚州。在新奥尔良，我们的团队进行了第一次人口普查- 对变性妇女进行了基本的艾滋病毒监测研究，46%的人艾滋病毒检测呈阳性。这些发现与大多数 最近路易斯安那州卫生部(LDH)2018年STD/HIV年度报告确认了黑人同性恋/双性恋男性和 变性人妇女是路易斯安那州所有人口中携带艾滋病毒最多的人。尽管艾滋病毒对 在新奥尔良的变性妇女中，没有基于证据的PrEP干预措施或努力满足社区需求。在……里面 响应RFA-MH-21-151加强对美国南部妇女的艾滋病毒预防工作，我们的团队建议 为了测试T‘Cher，采取负责干预措施，以提高变性妇女对PrEP的认识、接受和依从性 新奥尔良。T‘Cher建立在为告知和实施第一个以人口为基础的TRANS研究而进行的工作的基础上 2019年的妇女，最近完成了对变性妇女的两项循证干预措施 调查人员。这项干预将包括一项社交媒体活动，以提高跨性女性对PrEP的认识。它 还将包括同行导航，以在跨性别者之间建立信任，并提供PrEP导航。我们将为同行量身定做 来自Stay研究的导航模型将以数字方式实施，并使用Health Enav方法进行增强。也就是说，我们 还将使用激励性访谈和EMA来增强医疗保健能力并解决社会决定因素 关于PrEP吸收和坚持的健康障碍。我们将招募200名跨性女性参与我们的研究 方法在我们之前对变性妇女的HIV研究中被证明是成功的。跨性别女性将参与干预 12个月，提供足够的时间来解决PrEP的障碍并支持遵守。这项提议的目标是 T‘Cher，主管干预措施是：(1)制定、实施和衡量T’Cher的影响，负责 在路易斯安那州新奥尔良的变性妇女中开展的关于PrEP意识的社交媒体活动，使用了基于人口的样本 跨性别女性；(2)为了测试T‘Cher的影响，掌管数字mHealth的同行导航模式正在增加 路易斯安那州新奥尔良跨性妇女接受和依从性的随机楔形交叉研究 设计；以及，(3)评估卫生保健赋权和对健康的社会决定因素的支持方面的变化，作为中介 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来适应有希望的跨特异性艾滋病毒 满足路易斯安那州新奥尔良变性妇女艾滋病毒预防需求的干预措施。有证据表明 有效性，我们准备在路易斯安那州大规模测试干预措施，以加强PrEP的获取和 在路易斯安那州和整个南方腹地的变性妇女中使用。

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.