# Addressing violence and HIV cascade of care outcomes among transgender women

> **NIH NIH R21** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2021 · $213,106

## Abstract

PROJECT SUMMARY
Transgender (`trans') women of color experience violence in a variety of contexts, including from partners,
strangers, law enforcement, healthcare providers, and in public accommodations. Violence is consistently
linked with avoiding care, suboptimal ART adherence, and lower odds of viral suppression via pathways
including chronic stress, immune inflammatory response, posttraumatic stress disorder (PTSD) symptoms, and
substance use. These epidemics are concurrent and mutually reinforcing, constituting a “syndemic” or
synergistic interaction that contributes to documented inequities in HIV continuum of care outcomes. In Detroit,
Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in
engagement in HIV care. In this R21 exploratory/developmental research application, we propose to adapt and
pilot test a culturally-responsive, evidence-based, and trauma-informed intervention to improve engagement in
HIV care (primary outcome), reduce PTSD symptoms (secondary outcome), and increase sustained viral
suppression (tertiary outcome) among trans women of color living with HIV. Guided by the ADAPT-ITT model,
our first aim seeks to conduct a systematic adaptation of the intervention, with a focus on the unique aspects of
violence, gender affirmation needs, and engagement in HIV care by conducting interviews with trans women of
color and key stakeholders to inform the adaptation. Our community advisory board consisting of trans women
of color will review all adapted materials. The second aim seeks to examine the feasibility, acceptability, and
preliminary efficacy of the adapted intervention in a one-arm pilot with follow-ups immediate and 3-month post-
intervention. The third aim seeks to gather qualitative data from one-arm pilot participants to identify strategies
to overcome barriers to implementing rigorous randomized controlled trial research designs with trans women
of color within limited-resources settings. Study findings will provide the necessary groundwork for a
subsequent community-engaged large-scale randomized controlled trial. Findings also have the potential to
provide a blueprint to guide future research efforts with trans women of color who are often embedded in close-
knit communities with few existing culturally-responsive services.

## Key facts

- **NIH application ID:** 10077889
- **Project number:** 5R21MH121974-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Kristi E Gamarel
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $213,106
- **Award type:** 5
- **Project period:** 2020-01-01 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10077889

## Citation

> US National Institutes of Health, RePORTER application 10077889, Addressing violence and HIV cascade of care outcomes among transgender women (5R21MH121974-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10077889. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*