Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA.
J Acquir Immune Defic Syndr. 2022 Aug 15;90(5):508-516. doi: 10.1097/QAI.0000000000003014. Epub 2022 Mar 5.
Transgender women are disproportionately affected by HIV and are less likely to be optimally engaged in care than other groups because of psychosocial challenges. With community collaboration, we developed Healthy Divas, an individual-level intervention to increase healthcare empowerment and gender affirmation to improve engagement in HIV care. Healthy Divas comprises 6 peer-led individual sessions and one group workshop facilitated by a healthcare provider with expertise in HIV care and transgender health.
SETTING/METHODS: To test the intervention's efficacy, we conducted a randomized controlled clinical trial in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3, 6, 9, and 12 months postrandomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visit, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence ≥90%, and (4) self-reported antiretroviral therapy adherence ≥80%.
We enrolled 278 participants; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points.
This trial demonstrates the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time.
Clinicaltrials.gov identifier: NCT03081559.
跨性别女性受 HIV 的影响不成比例，并且由于心理社会挑战，他们参与护理的可能性低于其他群体。通过社区合作，我们开发了 Healthy Divas，这是一种个体层面的干预措施，旨在增强医疗保健能力和性别认同，以改善 HIV 护理的参与度。Healthy Divas 包括 6 个由同伴领导的个体会议和一个由在 HIV 护理和跨性别健康方面具有专业知识的医疗保健提供者主持的小组研讨会。
方法/设置：为了测试干预措施的效果，我们在旧金山和洛杉矶的 HIV 阳性跨性别女性中进行了一项随机对照临床试验；对照组没有干预措施。跨性别领域工作人员进行了招募。评估在随机分组后 3、6、9 和 12 个月进行。主要结果是 HIV 护理的参与度，定义为以下四项的总和：（1）自我报告的 HIV 护理提供者就诊，过去 6 个月；（2）最近 CD4 计数的知识；（3）自我报告的抗逆转录病毒治疗依从率≥90%；（4）自我报告的抗逆转录病毒治疗依从率≥80%。
我们招募了 278 名参与者；近一半（46%）是非洲裔/非裔美国人，三分之一（33%）是西班牙裔/拉丁裔。在 6 个月时，干预组参与者处于更高的 HIV 护理参与类别的可能性是对照组的两倍多（调整后的优势比=2.17；95%置信区间：1.06 至 4.45；P=0.04）；在其他时间点，研究组之间没有显著的结果差异。
这项试验表明，急需一种行为干预措施来提高 HIV 阳性跨性别女性参与 HIV 护理的短期效果；可能需要持续干预以保持随着时间的推移产生积极影响。
Clinicaltrials.gov 标识符：NCT03081559。
