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Crepaz N, Peters O, Higa DH, Mullins MM, Collins CB. Identifying Effective Strategies for Improving Engagement in HIV Prevention and Care Among Transgender Persons in the United States: A Systematic Review. AIDS Behav 2024:10.1007/s10461-024-04473-1. [PMID: 39230617 DOI: 10.1007/s10461-024-04473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/05/2024]
Abstract
This systematic review synthesized published literature (2000 - 2023) to identify HIV interventions specifically designed for transgender persons in the United States (PROSPERO registration number: CRD42021256460). The review also summarized strategies for improving outcomes related to the four pillars of the Ending the HIV Epidemic (EHE) initiative in the United States: Diagnose, Treat, Prevent, and Respond. A comprehensive search was conducted using the Centers for Disease Control and Prevention's HIV Prevention Research Synthesis Project database, which included over 120,000 citations from routine systematic searches in CINAHL, EMBASE, Global Health, MEDLINE, PsycInfo, and Sociological Abstracts. Of 23 interventions that met inclusion criteria, 94% focused on transgender women of color and 22% focused on young transgender persons aged 15-29 years old. Most interventions focused on Treat or Prevent, few focused on Diagnosis, and none focused on Respond. Twenty interventions (87%) showed improvement in at least one EHE related outcome and a quarter of these effective interventions were tested with randomized controlled trials. Common strategies observed in effective interventions include the following: engaging the community in intervention development; pilot-testing with the focus population to ensure appropriateness and acceptability; addressing social determinants of health (e.g. stigma, discrimination, violence) through empowerment and gender-affirming approaches; increasing access to care, prevention, and services through co-location and one-stop shop models; and utilizing peer-led counseling, education, support, and navigation. Continuous effort is needed in addressing gaps, including more research for transgender men and rural settings and for how best to adopt and adapt best practices for subgroups of transgender population.
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Affiliation(s)
- Nicole Crepaz
- Division of HIV Prevention, The U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd., MS H24-5, Atlanta, GA, 30333, USA.
| | - Olivia Peters
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darrel H Higa
- Division of HIV Prevention, The U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd., MS H24-5, Atlanta, GA, 30333, USA
| | - Mary M Mullins
- Division of HIV Prevention, The U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd., MS H24-5, Atlanta, GA, 30333, USA
| | - Charles B Collins
- Division of HIV Prevention, The U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd., MS H24-5, Atlanta, GA, 30333, USA
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Brown LL, Perkins JM, Shepherd BE, Ramasamy S, Wilkins M, Osman A, Turner M, Link T, Edgerton R, Suiter SV, Pettit AC. Piloting Safety and Stabilization: A Multi-component Trauma Intervention to Improve HIV Viral Suppression, Retention in Care, and Post-traumatic Stress Disorder in a Southern United States HIV Service Organization. AIDS Behav 2024; 28:174-185. [PMID: 37751108 PMCID: PMC10868717 DOI: 10.1007/s10461-023-04174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
In this observational study, we assessed the extent to which a community-created pilot intervention, providing trauma-informed care for persons with HIV (PWH), affected HIV care retention and viral suppression among PWH attending an HIV Services Organization in the Southern US. PWH with trauma exposure and/or trauma symptoms (N = 166) were offered a screening and referral to treatment (SBIRT) session. Per self-selection, 30 opted-out, 29 received SBIRT-Only, 25 received SBIRT-only but reported receiving other behavioral health care elsewhere, and 82 participated in the Safety and Stabilization (S&S) Intervention. Estimates from multivariable logistic regression analyses indicated S&S Intervention participants had increased retention in HIV care (adjusted odds ratio [aOR] 5.46, 95% CI 1.70-17.50) and viral suppression (aOR 17.74, 95% CI 1.83-172), compared to opt-out participants. Some evidence suggested that PTSD symptoms decreased for intervention participants. A randomized controlled trial is needed to confirm findings.
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Affiliation(s)
- Leslie Lauren Brown
- Psychiatry and Behavioral Sciences, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37203, USA.
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Jessica M Perkins
- Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bryan E Shepherd
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shobana Ramasamy
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Megan Wilkins
- Infectious Disease Clinic, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Megan Turner
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Ryan Edgerton
- Department of Family & Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - Sarah V Suiter
- Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - April C Pettit
- Infectious Disease Division, Vanderbilt University School of Medicine, Nashville, TN, USA
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Rhodes SD, Alonzo J, Mann-Jackson L, Aviles LR, Tanner AE, Galindo CA, Bessler PA, Courtenay-Quirk C, Garcia M, Sucaldito AD, Smart BD, Goldenberg T, Reboussin BA. Preexposure Prophylaxis Uptake Among Spanish-Speaking Transgender Women: A Randomized Controlled Trial in North and South Carolina, 2019-2022. Am J Public Health 2024; 114:68-78. [PMID: 38091558 PMCID: PMC10726943 DOI: 10.2105/ajph.2023.307444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 12/18/2023]
Abstract
Objectives. To evaluate Chicas Creando Acceso a la Salud (Girls Creating Access to Health; ChiCAS), a Spanish-language, small-group intervention designed to increase preexposure prophylaxis (PrEP) use, consistent condom use, and medically supervised gender-affirming hormone therapy use among Spanish-speaking transgender Latinas who have sex with men. Methods. Participants were 144 HIV-negative Spanish-speaking transgender Latinas, aged 18 to 59 years, living in North and South Carolina. From July 2019 to July 2021, we screened, recruited, and randomized them to the 2-session ChiCAS intervention or the delayed-intervention waitlist control. Participants completed assessments at baseline and 6-month follow-up. Follow-up retention was 94.4%. Results. At follow-up, relative to control participants, ChiCAS participants reported increased PrEP use (adjusted odds ratio [AOR] = 4.64; 95% confidence interval [CI] = 1.57, 13.7; P < .006). However, ChiCAS participants did not report increased use of condoms or medically supervised gender-affirming hormone therapy. ChiCAS participants reported increases in knowledge of HIV (P < .001), sexually transmitted infections (P < .001), and gender-affirming hormone therapy (P = .01); PrEP awareness (P < .001), knowledge (P < .001), and readiness (P < .001); condom use skills (P < .001); and community attachment (P < .001). Conclusions. The ChiCAS intervention was efficacious in increasing PrEP use among Spanish-speaking, transgender Latinas in this trial. (Am J Public Health. 2024;114(1):68-78. https://doi.org/10.2105/AJPH.2023.307444).
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Affiliation(s)
- Scott D Rhodes
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Jorge Alonzo
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Lilli Mann-Jackson
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Lucero Refugio Aviles
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Amanda E Tanner
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Carla A Galindo
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Patricia A Bessler
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Cari Courtenay-Quirk
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Manuel Garcia
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Ana D Sucaldito
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Benjamin D Smart
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Tamar Goldenberg
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Beth A Reboussin
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Aviles LR, Galindo CA, Bessler PA, Courtenay-Quirk C, Smart BD, Garcia M, Goldenberg T, Sucaldito AD, Reboussin BA. Adapting a Group-Level PrEP Promotion Intervention Trial for Transgender Latinas During the COVID-19 Pandemic. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:481-495. [PMID: 36454131 PMCID: PMC10552717 DOI: 10.1521/aeap.2022.34.6.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has profoundly affected the conduct of community-based and community-engaged research. Prior to the pandemic, our community-based participatory research partnership was testing ChiCAS, an in-person, group-level behavioral intervention designed to promote uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised gender-affirming hormone therapy among Spanish-speaking transgender Latinas. However, the pandemic required adaptations to ensure the safe conduct of the ChiCAS intervention trial. In this article, we describe adaptations to the trial within five domains. Transgender women are disproportionately affected by HIV, and it is essential to find ways to continue research designed to support their health within the context of the COVID-19 pandemic and future infectious disease outbreaks, epidemics, and pandemics. These adaptations offer guidance for ongoing and future community-based and community-engaged research during the COVID-19 pandemic and/or potential subsequent outbreaks (e.g., monkeypox), epidemics, and pandemics, particularly within under-served marginalized and minoritized communities.
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Affiliation(s)
| | | | | | - Jorge Alonzo
- Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | | | | | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
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Rebchook GM, Chakravarty D, Xavier JM, Keatley JG, Maiorana A, Sevelius J, Shade SB. An evaluation of nine culturally tailored interventions designed to enhance engagement in HIV care among transgender women of colour in the United States. J Int AIDS Soc 2022; 25 Suppl 5:e25991. [PMID: 36225153 PMCID: PMC9557010 DOI: 10.1002/jia2.25991] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Transgender women (TW) worldwide have a high prevalence of HIV, and TW with HIV encounter numerous healthcare barriers. It is critical to develop evidence-informed interventions to improve their engagement in healthcare to achieve durable viral suppression (VS). We evaluated whether participation in one of nine interventions designed specifically for TW was associated with improved engagement in HIV care among transgender women of colour (TWC). METHODS Between 2013 and 2017, nine US organizations implemented nine distinct and innovative HIV care engagement interventions with diverse strategies, including: individual and group sessions, case management and navigation, outreach, drop-in spaces, peer support and/or incentives to engage TWC with HIV in care. The organizations enrolled 858 TWC, conducted surveys, captured intervention exposure data and extracted medical record data. Our evaluation of the interventions employed a pre-post design and examined four outcomes-any HIV care visit, antiretroviral therapy (ART) prescription, retention in HIV care and VS (both overall and among those with a clinic visit and viral load test), at baseline and every 6 months for 24 months. We employed logistic generalized estimating equations to assess the relative odds of each outcome at 12 and 24 months compared to baseline. RESULTS Overall, 79% of participants were exposed to at least one intervention activity. Over 24 months of follow-up, participants received services for a median of over 6 hours (range: 3-69 hours/participant). Compared to baseline, significantly (p<0.05) greater odds were demonstrated at both 12 and 24 months for three outcomes: prescription of ART (ORs: 1.42 at 12 months, 1.49 at 24 months), VS among all participants (ORs: 1.49, 1.54) and VS among those with a clinic visit and viral load test (ORs: 1.53, 1.98). The outcomes of any HIV care visit and retention in HIV care had significantly greater odds (ORs: 1.38 and 1.58, respectively) only at 12 months compared to baseline. CONCLUSIONS These evaluation results illustrate promising approaches to improve engagement in HIV care and VS among TWC with HIV. Continued development, adaptation and scale-up of culturally tailored HIV care interventions for this key population are necessary to meet the UNAIDS 95-95-95 goals.
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Affiliation(s)
- Gregory M. Rebchook
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Deepalika Chakravarty
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - JoAnne G. Keatley
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA,Innovative Response Globally for Transgender Women and HIV (IRGT)San FranciscoCaliforniaUSA
| | - Andres Maiorana
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jae Sevelius
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Starley B. Shade
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Nortrup E, Dawson Rose C, Meyers J, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for addressing trauma among people with HIV: a narrative review. AIDS Care 2021; 34:505-514. [PMID: 34612097 DOI: 10.1080/09540121.2021.1984382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Traumatic experiences are disproportionately prevalent among people with HIV and adversely affect HIV-related health outcomes. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature for interventions designed to address trauma among people with HIV in the U.S. Our search yielded 22 articles on 14 studies that fell into five intervention categories: expressive writing, prolonged exposure therapy, coping skills, cognitive-behavioral approaches integrated with other methods, and trauma-informed care. Thematic elements among the interventions included adaptating existing interventions for subpopulations with a high burden of trauma and HIV, such as transgender women and racial/ethnic minorities; addressing comorbid substance use disorders; and implementing organization-wide trauma-informed care approaches. Few studies measured the effect of the interventions on HIV-related health outcomes. To address the intersecting epidemics of HIV and trauma, it is critical to continue developing, piloting, and evaluating trauma interventions for people with HIV, with the goal of wide-scale replication of effective interventions in HIV settings.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Carol Dawson Rose
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Janet Meyers
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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8
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Maiorana A, Sevelius J, Keatley J, Rebchook G. "She is Like a Sister to Me." Gender-Affirming Services and Relationships are Key to the Implementation of HIV Care Engagement Interventions with Transgender Women of Color. AIDS Behav 2021; 25:72-83. [PMID: 31912274 PMCID: PMC7223907 DOI: 10.1007/s10461-020-02777-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present findings from qualitative interviews (N = 67) with 36 staff and 31 participants of nine distinct individual and/or group level interventions to engage transgender women of color (TWOC) in HIV care in the U.S. We examine the commonalities amongst the intervention services (addressing unmet basic needs, facilitating engagement in HIV care, health system navigation, improving health literacy, emotional support), and the relationships formed during implementation of the interventions (between interventionists and participants, among participants in intervention groups, between participants and peers in the community). Interventionists, often TWOC themselves, who provided these services developed caring relationships, promoted personal empowerment, and became role models for participants and the community. Intervention groups engaged participants to reinforce the importance of health and HIV care and provided mutual support. Gender affirming services and caring relationships may be two key characteristics of interventions that address individual and structural-level barriers to engage TWOC in HIV care.
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Affiliation(s)
- Andres Maiorana
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd floor, Box 0886, San Francisco, CA, 94143, USA.
| | - Jae Sevelius
- Center for AIDS Prevention Studies and Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd floor, Box 0886, San Francisco, CA, 94143, USA
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9
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Abstract
An Introduction to the SPNS Transgender Women of Color Special Supplemental Issue.
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Affiliation(s)
- Jessica Xavier
- Center for AIDS Prevention Studies, UCSF: University of California San Francisco, San Francisco, USA.
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10
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Farvid P, Vance TA, Klein SL, Nikiforova Y, Rubin LR, Lopez FG. The health and wellbeing of transgender and gender
non‐conforming
people of colour in the United States: A systematic literature search and review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Panteá Farvid
- Psychology, Schools of Public Engagement The New School New York New York USA
| | - Thomas A. Vance
- Psychology, Schools of Public Engagement The New School New York New York USA
- Boys and Girls Clubs of America Atlanta Georgia USA
| | - Samantha L. Klein
- Psychology, School for Social Research The New School New York New York USA
| | | | - Lisa R. Rubin
- Psychology, School for Social Research The New School New York New York USA
| | - Felix G. Lopez
- Psychology, School for Social Research The New School New York New York USA
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11
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A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women. J Acquir Immune Defic Syndr 2020; 82:131-140. [PMID: 31180995 DOI: 10.1097/qai.0000000000002112] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW. SETTING Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017. METHODS This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention. RESULTS Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake. CONCLUSIONS Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.
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12
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Logie CH, Lacombe-Duncan A, Persad Y, Ferguson TB, Yehdego DM, Ryan S, Forrester M, Moses C, Guta A. The TRANScending Love Arts-Based Workshop to Address Self-Acceptance and Intersectional Stigma Among Transgender Women of Color in Toronto, Canada: Findings from a Qualitative Implementation Science Study. Transgend Health 2019; 4:35-45. [PMID: 30783630 PMCID: PMC6376455 DOI: 10.1089/trgh.2018.0040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender (trans) women of color's HIV vulnerabilities are shaped by social exclusion and intersectional stigma. There is a dearth of tailored HIV prevention interventions with trans women of color in Canada. The objective of the study was to explore trans women of color's HIV prevention priorities and to pilot test an intervention developed from these priorities. Methods: We conducted a qualitative implementation science study to develop HIV intervention strategies with trans women of color in Toronto, Canada. First, we conducted a focus group with trans women of color (n=8) to explore HIV prevention priorities. Second, we held a consultation with trans women of color community leaders (n=2). Findings informed the development of the TRANScending Love (T-Love) arts-based workshop that we pilot tested with three groups of trans women of color (n=18). Workshops were directly followed by focus groups to examine T-Love products and processes. Results: Focus group participants called for researchers to shift the focus away from trans women's bodies and HIV risks to address low self-acceptance produced by intersecting forms of stigma. The community leader consultation articulated the potential for strengths-focused arts-based approaches to address self-worth. T-Love participants described how workshops fostered self-acceptance and built connections between trans women of color. Conclusions: Findings demonstrate the feasibility and acceptability of an arts-based strategy with trans women of color to elicit group-based sharing of journeys to self-acceptance, fostering feelings of solidarity and connection. Providing opportunities for dialogue and reflection about individual and collective strengths may reduce internalized stigma among trans women of color.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | | | | | - Shannon Ryan
- Black Coalition for AIDS Prevention (Black CAP), Toronto, Canada
| | | | - Catherine Moses
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
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13
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Poteat T, Malik M, Scheim A, Elliott A. HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action. Curr HIV/AIDS Rep 2018; 14:141-152. [PMID: 28752285 DOI: 10.1007/s11904-017-0360-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the available evidence-based HIV prevention interventions tailored for transgender people. RECENT FINDINGS A limited number of evidence-based HIV prevention interventions have been tested with transgender populations. Most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Studies addressing biomedical interventions for transgender women are ongoing. Few interventions address social and structural barriers to HIV prevention, such as stigma, discrimination, and poverty. Evidence-based multi-level interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence. Future research should address not only pre-exposure prophylaxis uptake and condom use but also structural barriers that limit access to these prevention strategies.
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Affiliation(s)
- Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E7138, Baltimore, MD, 21205, USA.
| | - Mannat Malik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E7138, Baltimore, MD, 21205, USA
| | - Ayden Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, K201 Kresge Building, London, ON, N6B 3J6, Canada
| | - Ayana Elliott
- Director of Clinical Operations, City of Hope South Pasadena, 209 Fair Oaks Avenue, South Pasadena, CA, 91030, USA
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