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 HIV transmission risk and avoiding HIV prevention services via pathways including chronic stress, 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 Prevention Continuum outcomes. In Detroit, Michigan, trans women of color are one of the `most-at-risk' groups for HIV, with significant disparities in sustained engagement in HIV prevention services. In this R21 exploratory/developmental research application, we propose to adapt, integrate, and pilot test a culturally-relevant evidence-based trauma-informed violence prevention intervention to improve HIV Prevention Continuum outcomes. Guided by the ADAPT-ITT model, our first aim seeks to conduct a systematic adaptation of three interventions and integrate these components into a trauma-informed combination prevention intervention for TWOC, with a focus on HIV Prevention Continuum outcomes 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 and acceptability of the trauma-informed combination prevention intervention in a one-arm pilot with follow-ups immediate and 3-month post-intervention. The primary outcome is improvements in HIV Prevention Continuum outcomes and the secondary outcomes are mental health and substance use. The project also 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. Study findings will provide the necessary groundwork for a community-engaged efficacy trial in a subsequent, large-scale clinical trial.
Transgender women of color experience trauma and violence, which contributes to HIV risk and inequities across the HIV Prevention Continuum. The proposed exploratory/developmental R21 application seeks to evaluate the feasibility and acceptability of a trauma-informed combination prevention intervention for transgender women of color to improve HIV Prevention Continuum outcomes and reduce mental health symptoms and substance use. The proposed approach will provide the necessary groundwork for an efficacy trial in a future, large-scale randomized controlled trial.
