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Principal Investigator: John ChisolmGray Imrie
Organization: DUKE UNIVERSITY
Fiscal Year: 2024
Award: $474,719
Funding agency: National Institute of Mental Health
Transgender-specific Differentiated HIV Care Models:
An Implementation Science Study
Project Summary/Abstract
Despite a disproportionate burden of HIV, transgender people are less likely to achieve viral suppression than
the general population and have low engagement in PrEP services. Intervenable barriers to their engagement
in HIV services include facility-based stigma and lack of access to gender affirming care, including hormone
therapy. Transgender-specific differentiated service delivery models have recently been implemented as
demonstration projects in South Africa, providing a unique opportunity to assess feasible and acceptable
implementation strategies as well as analyze the effectiveness and cost of integrating gender affirming
hormone therapy and stigma-reduction strategies into HIV care for transgender people. This observational,
multi-site, mixed methods prospective implementation study will be guided by the Gender Affirmation
Framework and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation
science evaluation framework to meet the following aims: (1) assess barriers, facilitators, acceptability, and
feasibility of transgender-specific differentiated service delivery using site observation checklists, key informant
interviews with facility staff, and longitudinal in-depth interviews with transgender clients; (2) evaluate the effect
of transgender-specific differentiated service delivery on viral suppression and PrEP adherence - testing
stigma and gender affirmation as mediators, using a longitudinal cohort of TGP clients that compares
transgender people enrolled at transgender-specific differentiated service delivery sites with transgender
people enrolled in standard service delivery sites (200/arm on ART and 100/arm on PrEP for a total N = 600);
and (3) estimate the cost associated with transgender-specific differentiated service delivery versus standard
service delivery sites using a micro-costing approach to estimate the cost per service user served and per
service user successfully treated at transgender-specific differentiated service delivery sites relative to
standard service delivery sites, as well as the budget needed for successful South Africa-wide implementation.
Terms: <21+ years old><AIDS Virus><AIDS prevention><AIDS test><AIDS/HIV test><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Adherence><Adult><Adult Human><Africa South of the Sahara><Assess implementation><Budgets><Caring><Cities><Client><Communities><Counseling><Data><Effectiveness><Endocrine Therapy><Enrollment><Epidemic><Evaluation><Gender Identity><General Population><General Public><Goals><HIV><HIV Infections><HIV Prevention><HIV Seronegativities><HIV Seronegativity><HIV negative><HIV test><HIV-1 test><HIV-2 test><HIV/AIDS prevention><HTLV-III Infections><HTLV-III Seronegativities><HTLV-III Seronegativity><HTLV-III-LAV Infections><Health Policy><High-Risk Sex><Hormonal Therapy><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><Human immunodeficiency virus test><Implementation assessment><Incidence><Inequity><Interview><LAV-HTLV-III><Long-term cohort><Longitudinal cohort><Longterm cohort><Lubricants><Lymphadenopathy-Associated Virus><MSM><Measures><Mediating><Mediator><Methods><Modeling><Non-Polyadenylated RNA><Outcome><Persons><Population><PrEP><Prevalence><Preventative strategy><Prevention strategy><Preventive strategy><Primary Care><Psychiatric Social Service><Psychiatric Social Work><Public Health><RE-AIM><RNA><RNA Gene Products><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Recommendation><Reproductive Health><Ribonucleic Acid><Science><Service delivery model><Service model><Services><Site><South Africa><Sub-Saharan Africa><Subsaharan Africa><Survey Instrument><Surveys><Testing><Unprotected Sex><Unsafe Sex><Viral><Virus-HIV><Wit><World Health Organization><acceptability and feasibility><adulthood><arm><biobehavior><biobehavioral><care delivery model><condomless intercourse><condomless sex><condoms><cost><cost effectiveness><cost estimate><cost estimation><design><designing><enroll><evaluate implementation><evaluation of implementation><experience><gender affirmation><gender affirmation hormone therapy><gender affirmation hormone treatment><gender affirmative care><gender affirming><gender affirming care><gender affirming healthcare><gender affirming hormone therapy><gender affirming hormone treatment><gender affirming service><gender identity affirmation><gender identity affirming><health care delivery model><health care policy><healthcare delivery model><healthcare policy><hormone therapy><implementation evaluation><implementation science><implementation strategy><implementation study><improved><informant><innovate><innovation><innovative><men having sex with men><men who have sex with men><men who have sex with other men><microcosting><pre-exposure prophylaxis><prevention service><programs><prospective><psychosocial service><reach, efficacy, adoption, implementation, and maintenance><recruit><response><screening><screenings><service delivery><service engagement><services engagement><social stigma><stigma><strategies for implementation><surveillance study><trans*><trans-men><trans-women><transgender><transgender men><transgender women><transman><transmen><transwoman><transwomen><treatment services><unprotected intercourse>