Piloting a multi-level intervention to promote viral suppression among transgender women living with HIV

Ended Project Grant Awarded Last action

Award ID
R34MH129218
Recipient
Awarding agency
Obligated
$1,158,387

Award facts

Assistance listing
93.242 Mental Health Research Grants
Completion date
Place of performance
North Carolina, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Transgender (TRANS) women across the globe experience a disproportionate burden of HIV with an estimated global HIV prevalence of 19%. TRANS women living with HIV also have worse HIV care and treatment outcomes than cisgender adults, including lower rates of viral suppression. Multilevel responses are needed to improve HIV outcomes among TRANS women by simultaneously and synergistically addressing individual, provider, and community dynamics. TRANS women experience intersectional stigma due to the frequent association between TRANS identity, HIV, and SEX work. These intersecting forms of stigma include internalized stigma in the form of applying negative beliefs and enacted stigma in the form of exclusion and discrimination. Developing social cohesion can be a critical first step in community processes to address stigma. We adapted a multilevel intervention, abriendo puertas (opening doors), including individual counseling, peer navigation, and community mobilization for TRANS women living with HIV in the dominican republic using an iterative consultation process. We assessed feasibility and initial effects on HIV care and treatment behaviors with 30 TRANS women living with HIV (no control group) and documented positive trends in art use (70% to 85%, P=0.03), missed care appointments (35% to 20%, P=0.39) and art adherence (86% to 96%, P=0.50). Participants emphasized that trusting intervention staff and being treated with respect in individual sessions allowed them to improve self-esteem. Limited trust and cohesion among TRANS women, however, inhibited more extensive engagement with peer navigation and community activities. In response, we identified two key modifications to strengthen and further tailor the intervention for TRANS women living with HIV: 1) integrate more gender affirming content, including with providers and 2) focus on building trust among TRANS women through sequential implementation of individual and then community components. The purpose of the proposed study is to conduct a pilot randomized trial of the GAP model, or gender-affirming abriendo puertas. In aim 1, we will assess preliminary efficacy of the GAP intervention on viral suppression among TRANS women randomized to the intervention compared to those randomized to control. We will randomly assign TRANS women living with HIV to the GAP intervention (N=60) (individual counseling, peer navigation, provider training, and community support building) or control group (N=60). We will conduct baseline, 6, and 12-month surveys and viral load assessments to assess differences across study arms. In aim 2, we will examine pathways of influence (e.g. decreased stigma, increased cohesion) and experiences with the intervention to identify specific areas for improvement and scale up. We will conduct longitudinal qualitative interviews at baseline, 6, and 12 months with 20 intervention participants and, together with surveys, assess how GAP participation affects pathways between stigma, cohesion, and HIV outcomes. We will also elicit experiences and recommendations from providers and intervention staff in focus groups at 6 (N=2) and 12 months (N=2).

Transactions

Action Obligated Date
Amendment -$58,253
Amendment $0
Amendment $78,491
Amendment $78,491
Amendment $259,282
Amendment $259,282
Amendment $270,547
Original award $270,547

Subawards

Subrecipient Amount Awarded
George Washington University (The) The George Washington University (GW) researcher will contribute to the project by providing expert guidance to the conceptualization, assessment tools and… $59,868
Instituto Dermatologico Y Cirugia De Piel "Dr. Huberto Bogaert Diaz" The HIV Vaccine Research Unit at the Dermatology and Skin Surgery Institute-Instituto Dermatologico y Cirugia de Pie (IDCP) will work with UNC-CH in all… $276,032

Quick answers

Who received award R34MH129218?

R34MH129218 was awarded to University Of North Carolina At Chapel Hill by National Institute of Mental Health (National Institutes of Health) on August 5, 2022.

How much is award R34MH129218 worth?

$1,158,387 has been obligated on R34MH129218.

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