The Fenway Institute, Fenway Health, Boston, MA, USA.
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Public Health Rep. 2023 Jan-Feb;138(1):19-30. doi: 10.1177/00333549211065517. Epub 2022 Jan 21.
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
跨性别女性感染艾滋病毒的比例过高，并且在获得治疗、保持治疗、药物依从性和病毒抑制方面存在障碍。作为美国卫生资源与服务管理局艾滋病毒/艾滋病局资助的国家合作协议的一部分，我们从 2010 年 1 月 1 日至 2020 年 6 月 1 日，检索了关于旨在改善至少 1 项艾滋病毒护理连续体结果或解决跨性别女性艾滋病毒感染者获得艾滋病毒护理连续体结果障碍的干预措施的英文文献。纳入的文章需要将跨性别女性确定为干预的优先人群。我们发现了 22 项干预措施，其中 15 项报告了定量或定性结果，7 项报告了研究方案。最近的干预措施采用了一系列策略，有望解决普遍存在的结构性和个人障碍，这些障碍源于社会和文化对跨性别者的污名化和歧视。干预措施中发现的交叉主题包括有意义的社区参与设计和实施干预措施；以性别肯定为基础的项目，作为艾滋病毒护理的切入点，将性别肯定护理和社会服务与艾滋病毒护理相结合；改善行为健康结果的干预措施；同行领导的咨询、教育和指导；以及基于技术的干预措施，以增加获得护理管理和在线社会支持的机会。正在进行的研究将进一步阐明这些干预措施的效果和有效性，目标是减少艾滋病毒护理连续体中的差异，并使我们更接近在美国结束跨性别女性中的艾滋病毒流行。
