The BeT intervention to reduce HIV prevention and care disparities among young transwomen in Rio De Janeiro

NIH RePORTER · NIH · UH3 · $258,580 · view on reporter.nih.gov ↗

Abstract

ABSTRACT Our recent research discovered that almost 25% of a population-based sample of young transwomen in Brazil tested positive for HIV. This finding is consistent with research demonstrating that transwomen are the population most severely affected by HIV worldwide and face important barriers to accessing effective prevention and care programs. There is no HIV prevention intervention for young transwomen with evidence of efficacy outside the US. We propose a two-phase combination prevention intervention to address the main barriers to HIV prevention and care found in our research in this resource constrained setting. Stigma prevents young transwomen from accessing HIV prevention and care services, despite the fact that such services are freely available to all Brazilians in the public health system care system (i.e., SUS). Young people's HIV testing levels and care access is uneven. Data from our study show that almost no young transwomen regularly got tested for HIV, and given low testing levels, it is unlikely youth are accessing HIV care. In response to NICHD RFA-HD-18-032, we propose the Brilho e Transcender (BeT, or Shine and Transcend) intervention for young transwomen ages 18-24 years old in Brazil. Our proposed intervention uses expertise gleaned from a US based cohort study of young transwomen and knowledge from our cross-sectional transwomen HIV risk study in Brazil. Our study is comprised of two phases to address stigma in the public health system, intervene to overcome youth challenges with health care systems navigation and to scale the intervention widely if proven efficacious. During the 2-year UG3 phase, we propose to develop, implement and measure a highly visible, community-informed social marketing campaign to reduce anti-trans stigma in four SUS clinics currently implementing national PrEP access efforts that are also part of ImPrEP, which is a 3-country PrEP implementation project focused on transgender individuals and MSM. During the UG3 phase, we will also collect formative data to adapt our ARTAS-based system navigation intervention to the cultural context and HIV prevention and care needs of young transwomen in Brazil. After adaptation, we will conduct a small pilot intervention with 20 youth participants to determine preliminary efficacy and demonstrate our ability to recruit youth in this population. Preliminary data gathered from the RCT in the UG3 phase will be used to refine the intervention and justify movement to the UH3 phase and larger RCT to test efficacy of the intervention. During the UH3 phase, we will conduct a RCT with 150 young transwomen randomized to the BeT intervention or control. The intervention will be a digital systems navigation intervention utilizing peers to address youth-specific barriers to HIV prevention and care- namely, risk perception, system navigation skills and health literacy. The intervention will be intensively implemented over three months with follow-up to twelve months. The co...

Key facts

NIH application ID
10468192
Project number
5UH3HD096914-05
Recipient
PUBLIC HEALTH FOUNDATION ENTERPRISES
Principal Investigator
Erin Catherine Meek
Activity code
UH3
Funding institute
NIH
Fiscal year
2022
Award amount
$258,580
Award type
5
Project period
2018-09-06 → 2024-08-31