Combination interventions to reduce disparities in HIV infection for transgender women (TW) who have sex with men are sorely needed, as this population is one of the highest risk and most underserved groups in the United States. The goal of this proposed research project is to evaluate a locally developed and potentially effective intervention, the TransLife Center (TLC), which provides combination (i.e., biomedical, behavioral, social/structural) HIV prevention services to adult TW at high risk for HIV infection, in a culturally specific and highly accessible affirming environment. The TLC intervention directly addresses the structural barriers to health promotion among TW through a coordinated screening and service model, including direct access to services most needed and requested by TW: employment, housing, legal, and health services, following a social determinants of health conceptual model. To date there are no evidence-based HIV prevention interventions (EBIs) for TW listed in the CDC compendium of EBIs. The proposed study will address this gap through collaboration between Chicago House and Social Service Agency (Chicago House), a long-standing HIV/AIDS service provider and HIV prevention researchers who have been actively engaged in the development of HIV prevention interventions for TW. Our experience suggests that Chicago House's TLC intervention is feasible and acceptable to the target population, with over 200 HIV-uninfected TW participating in services over the past three years and evidence suggesting potential efficacy of the intervention for both sexual risk reduction and health promotion. We propose to test the TLC intervention in a single arm trial among 100 HIV-uninfected and sexually active TW, ages 18 and older, and evaluate intervention effectiveness over a 12-month period with visits at 6-month intervals (baseline, 6-months, 12-months). All participants will receive standard-of-care HIV/STI prevention and testing services, assessment and linkage to pre-exposure prophylaxis (PrEP), as indicated. We will evaluate the TLC intervention via the following aims:
AIM 1) To determine the pre-post efficacy of the TLC intervention on the primary outcome: number of condomless anal sex acts without protection by PrEP. 1a) To assess the dose response relationship between intervention exposure as well as exposure to specific components (i.e., employment, housing, legal, and health) on reductions in the primary outcome. 1b) To assess mediation of intervention effects on protective processes (gender affirmation, collective self-esteem, social support) theorized to increase with intervention exposure;
AIM 2) To examine intervention implementation experiences through semi-structured interviews with 20 TLC participants and 10 Chicago House staff members.
AIM 3) Exploratory Aims: 3a) To describe the trajectory of PrEP indication, uptake, retention and adherence in the community-based sample over a 12-month follow-up period and evaluate the impact of the TLC intervention on the PrEP continuum of care. 3b) To explore whether reductions in HIV risk are associated with epidemiologically-linked moderators including age and race/ethnicity.
Extremely high rates of HIV infection among transgender women (TW) and evidence that socioeconomic marginalization (e.g., unemployment, incarceration, homelessness) drives HIV-related risk indicate a need for comprehensive HIV prevention programs targeted to their unique circumstances. The goal of this proposed research project is to evaluate a locally developed and potentially effective intervention, Chicago House's TransLife Center (TLC), which provides combination (i.e., biomedical, behavioral, social/structural) HIV prevention and care services to adult transgender women at high risk for HIV infection, in a culturally specific and highly accessible affirming environment. Effective interventions to prevent HIV infection in TW may decrease the population burden of disease.
