# Strengthening the HIV care continuum for transgender women living with HIV in Malaysia

> **NIH NIH R21** · YALE UNIVERSITY · 2023 · $218,127

## Abstract

Project Abstract
HIV antiretroviral therapy (ART) is effective at lowering HIV-related mortality among people with HIV (PWH) and
reducing onward transmission of the virus. The HIV care continuum has emerged as an internationally recognized
framework for measuring and evaluating HIV treatment outcomes. For patients, however, navigating the complex system
of HIV care services can be complex and challenging, particularly patients who face multiple layers of social stigma.
Transgender women (TGW), for example, experience several unique vulnerabilities to HIV, including structural factors
such as discrimination in employment and economic opportunities, steering TGW toward more high-risk occupations,
such as sex work. Other structural factors, including civil and religious laws that ban TGW from changing their name or
sex on government-issued identification, further limits TGW’s autonomy and ability to safely and effectively navigate social
and health care services. In the context of health care, being both HIV-positive and transgender presents a dual-layer of
stigma for patients that may lead to suboptimal encounters with health care professionals. Peer navigator programs (PNP),
however, have been shown to improve engagement in medical care for people with chronic diseases, including patients
with cancer, diabetes, and HIV. Currently, however, no published research has examined the impact of PNP among HIV+
TGW in Malaysia. Thus, in response to PA-20-145, “Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize
HIV Prevention and Care Continuum Outcomes”, we propose to develop and evaluate a peer navigation intervention
(“MyLink+”) to engage (or re-engage) HIV+ TGW in the HIV care continuum. The specific aims of this application are:
(1) Using the ADAPT-ITT intervention adaptation framework,20 create an adapted peer navigation program (“MyLink+”)
to engage or reengage HIV+ Malaysian TGW in HIV treatment services; (2) To conduct a pilot RCT of the adapted PNP
intervention (MyLink+) vs. enhanced treatment-as-usual (TAU+) among HIV+ TGW to measure feasibility, acceptability
and preliminary efficacy; and (3) Using data from Aim 2, to conduct dyadic analyses of peers and clients to better
understand shared decision-making and linkage to care outcomes. Dyadic effects between peer navigators and patients will
be explored using data from baseline (T0) and weeks 12 (T12) and 24 (T24), including trust, compatibility, and perceived
quality of peer-client interactions on (re-)engaging in ART. Findings from this research will yield important information
about the use of PNP interventions for improving HIV care outcomes in the Malaysian context. Our results will also
inform the optimal strategy for deploying PNP among a highly stigmatized and vulnerable population (HIV+ TGW) and
illustrate the impact of shared decision-making processes between peer navigators and patients. Furthermore, our results
will guide the development of a research protocol...

## Key facts

- **NIH application ID:** 10650426
- **Project number:** 5R21MH128114-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Jeffrey Allen Wickersham
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $218,127
- **Award type:** 5
- **Project period:** 2022-07-01 → 2025-10-10

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10650426

## Citation

> US National Institutes of Health, RePORTER application 10650426, Strengthening the HIV care continuum for transgender women living with HIV in Malaysia (5R21MH128114-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10650426. Licensed CC0.

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