Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV

Abstract

Background: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%.Results: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.Conclusions: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.Trial Registration:Clinicaltrials.gov identifier: NCT03081559.

Diversity, Equity, and Inclusion in Clinical Research: A Path Toward Precision Health for Everyone

“…Mechanisms that rely on community advisors can be particularly valuable, [29][30][31] as are approaches that find trusted community partners for their ground operations. The strategy of activating community members as "peers" to foster engagement in self-care has provided some initial success in lesbian, gay, bisexual, transgender, queer (LGBTQ) groups 32 and could translate into outreach for research purposes.…”

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern

“…For example, while a large majority of studies on COVID-19 addressed the general population, HIV studies frequently focused on interventions targeting specific groups identified as vulnerable [e.g. 37 , 40 ]. They were also more likely to consider outreach approaches to CICICE in the contexts in which people live and work [ 36 ].…”

“…The few studies that considered the role of community-based surveillance (which often depends on the work of CHWs at the local level) noted increases in case reporting by comparison with passive surveillance systems (e.g. [ 37 , 50 ]). However, these studies were mostly small-scale observational or pilot studies [ 33 ].…”

Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations

“…Gender-affirmative PrEP systems necessitate for trans people to receive the necessary PrEP care continuum services [36] while also highly valuing and ensuring that trans people's gender identity and treatment goals are medically, socially, and structurally recognized and supported-to maximize the benefits of PrEP within trans communities directly [15,37]. In the context of HIV care, this includes the critical and comprehensive integration of HIV care with gender-affirming health services, which has been shown to improve engagement and retention for achieving viral suppression [38][39][40]. There have been some efforts to implement and evaluate genderaffirmative PrEP programs in existing healthcare settings [29,41]; however, additional efforts are warranted to address PrEP barriers across the personal/biological, social, structural socio-ecological levels.…”