scholarly journals Implementation and evaluation of the ‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’ provider education pilot

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashley Lacombe-Duncan ◽  
Carmen H. Logie ◽  
Yasmeen Persad ◽  
Gabrielle Leblanc ◽  
Kelendria Nation ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Social Service ◽  
Service Providers ◽  
Scale Up ◽  
Hiv Care ◽  
Provider Education ◽  
Post Intervention ◽  
Link Type ◽  
Trans Women ◽  
Score Range

Abstract Background Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated ‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’. This theoretically-informed community-developed intervention aimed to increase providers’ gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. Methods Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. Results The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12–10.86, p < 0.001, possible score range: 16–96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90–4.90, p < 0.001, possible score range: 9–63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training. Conclusions This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women. Trial registration ClinicalTrials.gov (NCT04096053).

scholarly journals ‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’: protocol of community-based intervention development and a non-randomised multisite pilot study with pre–post test design in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034144
Author(s):  
Ashley Lacombe-Duncan ◽  
Carmen H Logie ◽  
Yasmeen Persad ◽  
Gabrielle Leblanc ◽  
Kelendria Nation ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hiv Prevention ◽  
Healthcare Providers ◽  
Intervention Development ◽  
Hiv Care ◽  
Test Design ◽  
Community Based ◽  
Trans People ◽  
Post Test ◽  
Trans Women

IntroductionEducational workshops are a promising strategy to increase healthcare providers’ ability to provide gender-affirming care for transgender (trans) people. This strategy may also reduce healthcare providers’ stigma towards trans people and people living with HIV. There is less evidence, however, of educational workshops that address HIV prevention and care among trans women. This protocol details development and pilot testing of the Transgender Education for Affirmative and Competent HIV and Healthcare intervention that aims to increase gender-affirming HIV care knowledge and perceived competency, and to reduce negative attitudes/biases, among providers.Methods and analysisThis community-based research (CBR) project involves intervention development and implementation of a non-randomised multisite pilot study with pre–post test design. First, we conducted a qualitative formative phase involving focus groups with 30 trans women and individual interviews with 12 providers to understand HIV care access barriers for trans women and elicit feedback on a proposed workshop. Second, we will pilot test the intervention with 90–150 providers (n=30–50×3 in-person settings). For pilot studies, primary outcomes include feasibility (eg, completion rate) and acceptability (eg, workshop satisfaction). Secondary preintervention and postintervention outcomes, assessed directly preceding and following the workshop, include perceived competency, attitudes/biases towards trans women with HIV, and knowledge needed to provide gender-affirming HIV care. Primary outcomes will be summarised as frequencies and proportions (categorical variables). We will conduct paired-sample t-tests to explore the direction of preintervention and postintervention differences for secondary outcomes.Ethics and disseminationThis study has been approved by the University of Toronto HIV Research Ethics Board (Protocol Number: 00036238). Study findings will be disseminated through community forums with trans women and service providers; manuscripts submitted to peer reviewed journals; and conferences. Findings will inform a larger CBR research agenda to remove barriers to engagement in HIV prevention/care among trans women across Canada.Trial registration numberNCT04096053; Pre-results.

scholarly journals Enhancing domestic violence advocates’ ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention

2022 ◽  
Vol 18 ◽  
pp. 174550652110705
Author(s):  
Tiara C Willie ◽  
Laurel Sharpless ◽  
Mauda Monger ◽  
Trace S Kershaw ◽  
Wendy B Mahoney ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Intimate Partner Violence ◽  
Hiv Prevention ◽  
Partner Violence ◽  
Self Efficacy ◽  
Intimate Partner ◽  
Hiv Care ◽  
Post Intervention ◽  
Prevention Services ◽  
Exposure Prophylaxis

Background: Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. Setting: A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. Methods: Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. Results: Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates’ intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. Conclusion: This group-based intervention enhanced domestic violence advocates’ acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.

scholarly journals Engagement and Retention in HIV Care for Transgender Women: Perspectives of Medical and Social Service Providers in New York City

2020 ◽  
Vol 34 (1) ◽  
pp. 16-26 ◽  
Author(s):  
Walter Bockting ◽  
Caitlin MacCrate ◽  
Hayley Israel ◽  
Joanne E. Mantell ◽  
Robert H. Remien
Keyword(s):  
New York ◽  
New York City ◽  
Social Service ◽  
York City ◽  
Service Providers ◽  
Transgender Women ◽  
Hiv Care ◽  
Social Service Providers ◽  
Retention In Hiv Care

scholarly journals PROMISE (Program Refinements to Optimize Model Impact and Scalability based on Evidence): A cluster-randomized, stepped-wedge trial assessing effectiveness of the revised versus original Ryan White Part A HIV Care Coordination Program for patients with barriers to treatment

2019 ◽  
Author(s):  
Mary K. Irvine ◽  
Bruce Levin ◽  
McKaylee Robertson ◽  
Katherine Penrose ◽  
Jennifer Carmona ◽  
...  
Keyword(s):  
New York ◽  
Care Coordination ◽  
Viral Suppression ◽  
Service Providers ◽  
Hiv Care ◽  
List Type ◽  
Matched Pairs ◽  
Stepped Wedge ◽  
Link Type ◽  
Ryan White

AbstractIntroductionGrowing evidence supports combining social, behavioral and biomedical strategies to strengthen the HIV care continuum. However, combination interventions can be resource-intensive and challenging to scale up. Research is needed to identify intervention components and delivery models that maximize uptake, engagement and effectiveness. In New York City (NYC), a multi-component Ryan White-funded medical case management intervention called the Care Coordination Program (CCP) was launched at 28 agencies in 2009 to address barriers to care and treatment. Effectiveness estimates based on >7,000 clients enrolled by April 2013 and their controls indicated modest CCP benefits over ‘usual care’ for short- and long-term viral suppression, with substantial room for improvement.Methods and analysisIntegrating evaluation findings and CCP service-provider and community-stakeholder input on modifications, the NYC Health Department packaged a Care Coordination Redesign (CCR) in a 2017 request for proposals. Following competitive re-solicitation, 17 of the original CCP-implementing agencies secured contracts. These agencies were randomized within matched pairs to immediate or delayed CCR implementation. Data from three nine-month periods (pre-implementation, partial implementation and full implementation) will be examined to compare CCR versus CCP effects on timely viral suppression (TVS, within four months of enrollment) among individuals with unsuppressed HIV viral load newly enrolling in the CCR/CCP. Based on estimated enrollment (n=824) and the pre-implementation outcome probability (TVS=0.45), the detectable effect size with 80% power is an odds ratio of 2.90 (relative risk: 1.56).Ethics and disseminationThis study was approved by the NYC Department of Health and Mental Hygiene Institutional Review Board (IRB, Protocol 18-009) and the City University of New York Integrated IRB (Protocol 018-0057) with a waiver of informed consent. Findings will be disseminated via publications, conferences, stakeholder meetings, and Advisory Board meetings with implementing agency representatives.Trial registrationRegistered with ClinicalTrials.gov under identifier: NCT03628287, Version 2, 25 September 2019; pre-results.ARTICLE SUMMARYStrengths and limitations of this studyThe PROMISE trial, conducted in real-world service settings, leverages secondary analyses of programmatic and surveillance data to assess the effectiveness of a revised (CCR) versus original HIV care coordination program to improve viral suppression.To meet stakeholder expectations for rapid completion of the CCR rollout, the study applies a stepped-wedge design with a nine-month gap between implementation phases, prompting use of a short-term (four-month) outcome and a brief (five-month) lead-in time for enrollment accumulation.Randomization is performed at the agency level to minimize crossover between the intervention conditions, since service providers would otherwise struggle logistically and ethically with simultaneously delivering the two different intervention models to different sets of clients, especially given common challenges related to reaching agreement on clinical equipoise.1–3The use of agency matching, when followed by randomization within matched pairs, offers advantages akin to those of stratified random assignment: increasing statistical power in a situation where the number of units of randomization is small, by maximizing equivalency between the intervention and control groups on key observable variables, thus helping to isolate the effects of the intervention.3In addition, nuisance parameters are removed through the conditional analytic approach, which accounts and allows for the unavoidably imperfect matching of agencies and arbitrary variation of period effects across agency pairs.4

Shifting the Paradigm in HIV Prevention and Treatment Service Delivery Toward Differentiated Care for Youth

2019 ◽  
Author(s):  
Vincent Guilamo-Ramos ◽  
Marco Thimm-Kaiser ◽  
Adam Benzekri ◽  
Donna Futterman
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Service Delivery ◽  
The United States ◽  
Hiv Care ◽  
Health Concern ◽  
Service Needs ◽  
Minority Adolescents ◽  
Prevention And Treatment ◽  
Differentiated Care

Despite significant progress in the fight against HIV/AIDS in the United States, HIV prevention and treatment disparities among key populations remain a national public health concern. While new HIV diagnoses are increasing among people under age 30—in particular among racial, ethnic, and sexual minority adolescents and young adults (AYA)—dominant prevention and treatment paradigms too often inadequately consider the unique HIV service needs of AYA. To address this gap, we characterize persistent and largely overlooked AYA disparities across the HIV prevention and treatment continuum, identify AYA-specific limitations in extant resources for improving HIV service delivery in the United States, and propose a novel AYA-centered differentiated care framework adapted to the unique ecological and developmental factors shaping engagement, adherence, and retention in HIV services among AYA. Shifting the paradigm for AYA to differentiated HIV care is a promising approach that warrants implementation and evaluation as part of reinforced national efforts to end the HIV epidemic in the United States by 2030.

scholarly journals Allogeneic human neural stem cells for improved therapeutic delivery to peritoneal ovarian cancer

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Rachael Mooney ◽  
Wafa Abidi ◽  
Jennifer Batalla-Covello ◽  
Hoi Wa Ngai ◽  
Caitlyn Hyde ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cell Tracking ◽  
Scale Up ◽  
Cancer Therapeutics ◽  
Cost Effective ◽  
Tumor Stroma ◽  
Clinical Safety ◽  
Peritoneal Cancer ◽  
Human Neural Stem Cells ◽  
Link Type

Abstract Background Immortalized, clonal HB1.F3.CD21 human neural stem/progenitor cells (NSCs), loaded with therapeutic cargo prior to intraperitoneal (IP) injection, have been shown to improve the delivery and efficacy of therapeutic agents in pre-clinical models of stage III ovarian cancer. In previous studies, the distribution and efficacy of the NSC-delivered cargo has been examined; however, the fate of the NSCs has not yet been explored. Methods To monitor NSC tropism, we used an unconventional method of quantifying endocytosed gold nanorods to overcome the weaknesses of existing cell-tracking technologies. Results Here, we report efficient tumor tropism of HB1.F3.CD21 NSCs, showing that they primarily distribute to the tumor stroma surrounding individual tumor foci within 3 h after injection, reaching up to 95% of IP metastases without localizing to healthy tissue. Furthermore, we demonstrate that these NSCs are non-tumorigenic and non-immunogenic within the peritoneal setting. Conclusions Their efficient tropism, combined with their promising clinical safety features and potential for cost-effective scale-up, positions this NSC line as a practical, off-the-shelf platform to improve the delivery of a myriad of peritoneal cancer therapeutics.

scholarly journals Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
W. Chris Buck ◽  
Hanh Nguyen ◽  
Mariana Siapka ◽  
Lopa Basu ◽  
Jessica Greenberg Cowan ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Scale Up ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Pediatric Care ◽  
P Value ◽  
Missed Opportunities ◽  
Art Initiation

Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

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