An evaluation of nine culturally tailored interventions designed to enhance engagement in HIV care among transgender women of colour in the United States

Abstract

Introduction Transgender women (TW) worldwide have a high prevalence of HIV, and TW with HIV encounter numerous healthcare barriers. It is critical to develop evidence‐informed interventions to improve their engagement in healthcare to achieve durable viral suppression (VS). We evaluated whether participation in one of nine interventions designed specifically for TW was associated with improved engagement in HIV care among transgender women of colour (TWC). Methods Between 2013 and 2017, nine US organizations implemented nine distinct and innovative HIV care engagement interventions with diverse strategies, including: individual and group sessions, case management and navigation, outreach, drop‐in spaces, peer support and/or incentives to engage TWC with HIV in care. The organizations enrolled 858 TWC, conducted surveys, captured intervention exposure data and extracted medical record data. Our evaluation of the interventions employed a pre‐post design and examined four outcomes—any HIV care visit, antiretroviral therapy (ART) prescription, retention in HIV care and VS (both overall and among those with a clinic visit and viral load test), at baseline and every 6 months for 24 months. We employed logistic generalized estimating equations to assess the relative odds of each outcome at 12 and 24 months compared to baseline. Results Overall, 79% of participants were exposed to at least one intervention activity. Over 24 months of follow‐up, participants received services for a median of over 6 hours (range: 3–69 hours/participant). Compared to baseline, significantly ( p <0.05) greater odds were demonstrated at both 12 and 24 months for three outcomes: prescription of ART (ORs: 1.42 at 12 months, 1.49 at 24 months), VS among all participants (ORs: 1.49, 1.54) and VS among those with a clinic visit and viral load test (ORs: 1.53, 1.98). The outcomes of any HIV care visit and retention in HIV care had significantly greater odds (ORs: 1.38 and 1.58, respectively) only at 12 months compared to baseline. Conclusions These evaluation results illustrate promising approaches to improve engagement in HIV care and VS among TWC with HIV. Continued development, adaptation and scale‐up of culturally tailored HIV care interventions for this key population are necessary to meet the UNAIDS 95‐95‐95 goals.

Structural and Psychosocial Syndemic Conditions and Condomless Anal Intercourse Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020

“…Results indicate that syndemic-focused interventions for Black transgender women should address the intersection between experiencing homelessness and exchange sex; those for Hispanic transgender women should address the intersection between exchange sex and polydrug use; and those for White transgender women should address the intersections between sexual violence and psychological distress, incarceration and experiencing homelessness, and experiencing homelessness and exchange sex. Culturally tailored syndemic-focused interventions that offer comprehensive services addressing social and structural barriers to status-neutral HIV services might be effective ( 64 , 65 ). For example, interventions designed for transgender women of color with HIV infection have increased engagement in HIV care by offering patient navigation or case management, housing and employment assistance, mental health services, and substance use services ( 65 ).…”

“…Culturally tailored syndemic-focused interventions that offer comprehensive services addressing social and structural barriers to status-neutral HIV services might be effective ( 64 , 65 ). For example, interventions designed for transgender women of color with HIV infection have increased engagement in HIV care by offering patient navigation or case management, housing and employment assistance, mental health services, and substance use services ( 65 ). Although HIV behavioral interventions have proven efficacy among transgender women, multilevel interventions are also critical to reduce gender-identity–related and racial- and ethnic–related stigma and discrimination and increase access to pre-exposure prophylaxis, HIV treatment, and gender-affirming medical care ( 32 , 66 ).…”

The Black women first initiative: using implementation science to examine bundled interventions to improve care and treatment coordination for Black women with HIV

“…Emerging strategies include the use of motivational interviewing techniques to support adherence to care and peers as members of the care team to encourage linkage and retention in care [ 16 – 18 ]. Recent studies show Black women with HIV employing resilience-based strategies, such as building supportive communities through children, grandmothers, peers/friends as coping strategies to face the adversities of stigma and discrimination and to promote health behaviors [ 19 – 21 ]. Further research is needed to identify the mechanisms by which these strategies reduce the challenges to care and treatment and improve the health and well-being for Black women with HIV.…”

Improving the HIV response for transgender populations: evidence to inform action

“…Rebchook et al. describe a variety of innovative interventions implemented to increase engagement in HIV care among transgender women of colour in nine sites across the United States, including housing linkages, legal services and peer support [ 14 ]. Heterogeneous, tailored, combination interventions were offered across the sites.…”