Table 2.
Study protocols of HIV care continuum interventions for transgender women with HIV in the United States
| Description of intervention | Study design, sample, and setting | Key strategies | HIV care continuum goal(s) and key outcomes |
|---|---|---|---|
| Dale, 37 2020 | |||
| Writing to Alleviate Violence Exposure for Transgender Women (WAVE–TW) is designed for transgender women with a detectable viral load and history of trauma/abuse. This intervention provides 1 individual session of cognitive–behavioral therapy to promote ART adherence (LifeSteps) and 4 individual sessions of trauma-focused writing to address PTSD and depressive symptoms. | ● Open pilot trial ● 20 participants ● 100% Transgender women ● Age, ≥18 y ● Miami, FL |
● Cognitive–behavioral therapy for medication adherence ● Expressive writing to confront trauma experiences |
● Adherence, viral suppression ● Feasibility and acceptability; change in depressive symptoms, PTSD symptoms, adherence, viral load |
| Muessig and Hightow-Weidman, 38 2019 | |||
| ● AllyQuest (AQ) is a smartphone app designed to improve adherence by including medication and appointment reminders, social support via daily chat, gaming features, skills-building challenges, education, small financial rewards dependent on app use, and a personalized profile and avatar. ● AQ+ Next Step Counseling is a higher-intensity intervention that includes AQ plus in-app texting with an adherence counselor. |
● Sequential multiple assignment randomization pilot trial ● 60 participants ● 100% MSM and transgender women ● Age range, 15-24 y ● Chapel Hill, NC |
● Smartphone gaming app to support ART adherence by motivating behavior change and providing social support ● Enhanced version includes adherence counseling via texting |
● Adherence, viral suppression ● Feasibility and acceptability; difference in adherence, viral suppression |
| Reback et al, 39 2019 | |||
| Text Me, Girl! provides 3 tailored text messages per day for 90 days to engage young transgender women in care and promote medication adherence. The text scripts are theory-based and promote action. | ● Randomized controlled trial ● Intervention group: 61 participants ● Control group: 69 participants (delayed treatment) ● 100% Transgender women ● Age range, 18-34 y ● Los Angeles, CA |
● Automated text messages tailored and personalized to encourage young transgender women with HIV to change behaviors | ● Linkage, adherence, retention, viral suppression ● Differences in linkage, adherence, retention, viral suppression |
| Reisner, 40 2018 | |||
| The provision of gender-affirming care (ie, hormone therapy and/or surgical interventions) for transgender and nonbinary people in a primary care setting to reduce disparities in HIV-related outcomes | ● Observational, longitudinal prospective cohort study (12 months) ● 4500 clients ● 45% Transgender women ● Age, ≥18 y ● 2 health centers in Boston, MA, and New York, NY |
● Medical gender affirmation delivered in primary care to improve HIV outcomes | ● Viral suppression ● Change in viral suppression |
| Arnold et al, 41 2019 | |||
| Optimizing the HIV Treatment Continuum with a Stepped Care Model for Youth Living with HIV is a stepped care intervention for treatment-experienced young people with HIV. Participants may progress from least to most intensive care as warranted. The steps are: (1) reminder texts and telephone monitoring called Automated Messaging and Monitoring Intervention (AMMI); (2) AMMI plus peer support via social media; and (3) AMMI, peer support, plus electronically delivered coaching by trained community peers. | ● Randomized controlled trial ● Intervention group: 110 participants ● Control group: 110 participants (AMMI only) ● 100% Gay, bisexual, transgender, and/or homeless young people ● Ages, 12-24 y ● 13 clinics, community organizations, and shelters in Los Angeles, CA, and New Orleans, LA |
● Stepped approach to intensity of intervention ● Automated reminder texts ● Peer support through social media ● Peer coaching |
● Adherence, retention, viral suppression ● Differences in adherence, retention, viral suppression, substance use, mental health, sexual behavior |
| Sevelius, 42 2017 | |||
| Healthy Divas involves 6 peer-led, manualized, individual counseling sessions, and 1 group workshop, during a 3-month period. In Healthy Divas, transgender women identify and receive tools, information, and support to accomplish personal goals related to gender affirmation and HIV, and to address complex barriers to care engagement. | ● Randomized controlled trial ● 278 participants ● Control group: treatment as usual ● 100% Transgender women ● Community and health organizations in Los Angeles and San Francisco, CA |
● Peer counseling and education ● Integration of gender affirmation goals with HIV care goals ● Based on frameworks of gender affirmation and health care empowerment |
● Linkage, adherence, retention, viral suppression ● Difference in viral suppression, composite engagement in care measure (adherence, linkage, retention) |
| Schneider, 43 2020 | |||
| In the Navigating Insurance Coverage Expansion (NICE) intervention, organizations provide in-person assistance to enroll clients in health insurance coverage at the time of HIV testing, and to link clients to HIV care. | ● Randomized controlled trial ● 800 participants ● Control group: standard clinic procedures ● Black and Hispanic MSM and transgender people ● 3 sites in Chicago, IL |
● Structural change in organization to assist with health insurance coverage and immediate linkage to care | ● Linkage, retention ● Differences in linkage, retention, viral suppression, health insurance enrollment |
Abbreviations: app, application; MSM, men who have sex with men; PTSD, posttraumatic stress disorder.