In California, transgender female clients of publicly-funded counseling and testing sites have higher rates of HIV diagnosis (6%) than all other risk categories, including MSM (4%) and partners of people living with HIV (5%); African American transgender women have a substantially higher rate of HIV diagnosis (29%) than all other racial or ethnic groups in California. Despite alarmingly high rates of HIV infection, public health intervention research has produced no theory-driven, evidence-based interventions that are culturally relevant to transgender women. Community-based organizations (CBOs) providing HIV prevention services to transgender women must adapt interventions that were created for other populations. However, adaptations are resource-intensive processes, and it is unclear whether the adaptation retains the effectiveness of the original intervention. CBOs typically have little support during the adaptation process and lack the resources to conduct rigorous evaluations of their adapted interventions. TRANS: THRIVE, a community-based program of API Wellness that serves transgender clients in San Francisco, has identified the need for a structured intervention program for transgender women of color, and upon review of their clients’ needs and preferences they have identified the SISTA intervention as a good fit for adaptation and implementation in their setting. The Transitions Project at UCSF has created an adaptation guide (T-SISTA) to support CBOs who wish to approach the adaptation of SISTA for transgender women of color in a systematic way.
This project aims to utilize a systematic adaptation process to produce a culturally relevant HIV prevention intervention curriculum for transgender women of color adapted from the evidence-based intervention SISTA. We will assess the feasibility and acceptability of the adapted intervention and conduct an evaluation to gather preliminary evidence for the effectiveness of the intervention with transgender women of color.
To determine whether the adaptation process and resultant intervention are feasible from both an organizational and operational perspective, detailed process records will be kept regarding issues such as the exact cost of adaptation and intervention activities, the number and demographic characteristics of individuals who participate in each session, and the amount of staff time devoted to adaptation, and planning and coordinating each session. As materials and activities are adapted, they will be pilot tested with members of the target population to ensure acceptability. To examine the effectiveness of distinct intervention components as well as the overall intervention, we will utilize both qualitative and quantitative methods. At the end of each session, we will assess participant satisfaction and self-efficacy for skills relevant to HIV prevention and intentions to engage in health relevant behaviors, such as safer sex and HIV testing. Following completion of all sessions, semi-structured interviews will be conducted with participants to gather more detailed information on their perceptions and experiences with the intervention, and their recommendations for improvements. Participants will complete assessments at baseline, post-intervention and 3 month follow-up interviews to assess HIV-related sexual risk behavior as well as utilization of HIV testing and counseling services and psychosocial well-being. We will also track which sessions clients attend and examine whether different patterns of session attendance predict improved outcomes. TRANS: THRIVE staff that are directly involved with adaptation and implementation will also be interviewed to assess their impressions of the acceptability of the adapted intervention.
This project aims to optimize HIV prevention efforts with a highly marginalized group that is disproportionately affected by the HIV epidemic in California. With the preliminary evaluation data, we will leverage funding for a larger efficacy study of the adapted curriculum with the ultimate goal of producing a replicable, culturally relevant, evidence-based HIV prevention intervention for transgender women of color.