Culturally relevant intervention development for incarcerated transgender women

描述(由申请人提供)：这项研究的目的是开发和试点测试循证干预项目START的文化相关性、理论驱动的改编，以改善变性人妇女入狱后的卫生保健参与。调整后的干预措施(Trans Start)将侧重于改善与四个医疗保健领域(艾滋病毒、药物使用、心理健康和变性人相关医疗保健)的联系和参与，以响应每个参与者的自我确定的需求。监禁是一个重大的公共健康问题，对变性妇女的影响不成比例，监禁周期与高水平的药物使用、精神疾病和艾滋病毒相互作用，在变性妇女中产生更高的疾病负担。被逮捕的跨性女性更有可能报告精神疾病，使用药物，从事危险的性行为，并在获释后需要跨性敏感服务。在健康、出院后服务需求和参与医疗保健的预测因素方面的性别差异需要针对性别的战略。《削减战略武器条约》项目的这一改编将纳入一种创新的、针对变性人的理论模式--性别肯定模式。未满足的性别肯定需求预示着艾滋病毒变性妇女中的艾滋病毒风险和艾滋病毒携带者中的治疗失败，而获得性别肯定与更好的精神健康有关。此外，获得性别肯定有助于艾滋病毒携带者的跨性别妇女之间的联系、参与和留住护理。使用Adapt-ITT战略来指导适应过程，我们将对15-20名被关押在旧金山县监狱(SFCJ)的跨性女性进行定性访谈，在释放之前和之后。我们还将对SFCJ和社区中与这些人群合作的5-10个关键利益相关者进行定性访谈。一旦适应材料最终确定，我们将进行试点随机对照试验，以测试适应干预的可行性和可接受性，以及方案和程序，以告知未来全面的随机对照试验适应干预的有效性。为了实现这一目标，我们将把50名被监禁至少一周的跨性女性随机分为Trans Start(调整后的Project Start课程加照常治疗)或单独照常治疗(TAU)。我们预计，在干预暴露后，与对照组相比，Trans Start参与者将报告更高的艾滋病毒检测率(基线为艾滋病毒妇女)和更高的艾滋病毒就诊就诊率(艾滋病毒阳性变性妇女)。此外，干预参与者将报告：a)与药物滥用治疗、精神卫生保健和变性人相关医疗护理的联系和参与程度更高(在认为这些是需求的参与者中)。利用可行性和可接受性试点的数据，我们将利用资金进行更大规模的疗效研究 调整后的课程的目标是为被监禁的准备释放到社区的变性妇女制定可复制的、与文化相关的、以证据为基础的健康促进干预措施。

DESCRIPTION (provided by applicant): The purpose of this study is to develop and pilot test a culturally relevant, theory-driven adaptation of the evidence-based intervention Project START to improve post-incarceration health care engagement among transgender ('trans') women. The adapted intervention (Trans START) will focus on improving linkage to and engagement in four health care domains (HIV, substance use, mental health, and transgender-related medical care), responsive to each participant's self-identified needs. Incarceration is a significant publi health issue that disproportionately impacts trans women, and the cycle of incarceration interacts with high levels of substance use, mental illness, and HIV to produce an elevated burden of disease among trans women. Trans women who have been arrested are more likely to report mental illness, using substances, engaging in risky sex, and needing trans-sensitive services upon release. Gender differences in health, post-release service needs, and predictors of engagement in healthcare call for gender-specific strategies. This adaptation of Project START will incorporate an innovative, transgender-specific theoretical model, the Model of Gender Affirmation. Unmet need for gender affirmation predicts HIV risk among HIV- trans women and treatment failure among those who are living with HIV, and access to gender affirmation is related to better mental health. Furthermore, access to gender affirmation supports linkage, engagement, and retention in care among trans women who are living with HIV. Using the ADAPT-ITT strategy to guide the adaptation process, we will conduct qualitative interviews with 15-20 trans women who are incarcerated in the San Francisco County Jail (SFCJ), prior to and after release. We will also conduct qualitative interviews with 5-10 key stakeholders who work with this population in SFCJ and in the community. Once the adapted materials are finalized, we will conduct a pilot randomized controlled trial to test the feasibility and acceptability of the adapted intervention, as well as the protocols and procedures, to inform a future full-scale randomized controlled trial for efficacy of the adapted intervention. To accomplish this aim, we will randomize 50 trans women who have been incarcerated for a minimum of one week to either Trans START (adapted Project START curriculum plus treatment as usual) or treatment as usual alone (TAU). We expect that following intervention exposure, relative to control group, Trans START participants will report higher rates of HIV testing (among HIV- women at baseline) and higher HIV medical appointment attendance (for HIV-positive trans women). Moreover, intervention participants will report: a) higher levels of linkage to and engagement in substance abuse treatment, mental health care, and transgender-related medical care (among participants who identify these as needs). With the data from the feasibility and acceptability pilot, we will leverage funding to conduct a larger efficacy study of the adapted curriculum with the goal of producing a replicable, culturally relevant, evidence-based health promotion intervention for incarcerated trans women who are preparing for release into the community.