RESUMEN
BACKGROUND: The HIV epidemic continues to disproportionately burden marginalized populations despite the availability of effective preventive and therapeutic interventions. Transgender women are severely affected by HIV worldwide including in Brazil and other low- and middle-income countries, with evidence of increasing new infections among young people. There is an urgent need for youth-specific HIV prevention and care interventions for young transgender women in Brazil. OBJECTIVE: This study aims to (1) address stigma in the Brazilian public health system and (2) reduce barriers to HIV care and prevention with systems navigation among young transgender women aged 18-24 years in Rio de Janeiro, Brazil. METHODS: The Brilhar e Transcender (BeT) study is a status-neutral, peer-led, single-arm digital intervention study enrolling 150 young transgender women in Rio de Janeiro, Brazil. The intervention was pilot tested and refined using data from a formative phase. The BeT intervention takes place over 3 months, is delivered remotely via mobile phone and in person by peers, and comprises three components: (1) BeT sessions, (2) digital interactions, and (3) automated messages. Eligibility criteria include identifying as transgender women, being aged 18-24 years, speaking in Portuguese, and living in the Rio de Janeiro metropolitan area in Brazil. The primary outcomes are HIV incidence, pre-exposure prophylaxis uptake, linkage to HIV care, and viral suppression. Primary outcomes were assessed at baseline and quarterly for 12 months. Participants respond to interviewer-based surveys and receive tests for HIV and sexually transmitted infections. RESULTS: The study has been approved by the Brazilian and the US local institutional review boards in accordance with all applicable regulations. Study recruitment began in February 2022 and was completed in early July 2022. Plans are to complete the follow-up assessment of study participants on July 2023, analyze the study data, and disseminate intervention results by December 2023. CONCLUSIONS: Interventions to engage a new generation of transgender women in HIV prevention and care are needed to curb the epidemic. The BeT study will evaluate a digital peer-led intervention for young transgender women in Brazil, which builds on ways young people engage in systems and uses peer-led support to empower transgender youth in self-care and health promotion. A promising evaluation of the BeT intervention may lead to the availability of this rapidly scalable status-neutral HIV intervention that can be translated throughout Brazil and other low- and middle-income countries for young transgender women at high risk of or living with HIV. TRIAL REGISTRATION: ClinicalTrials.gov NCT05299645; https://clinicaltrials.gov/ct2/show/NCT05299645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44157.
RESUMEN
ABSTRACT: This research seeks to present Community Lay Advisor interventions as a health promoting strategy that have appeared in the international literature, in order to highlight these enabling elements in the intervention's implementation and establish a comparison among the aspects addressed in the analyzed experiences and the "Schoolbased Oral Health Promoters Program" at the Universidad de La Frontera in Temuco, Chile. A comprehensive scoping review was held between February and March 2018, with searches performed in both the academic and grey literature. Peer-reviewed scientific papers were found using the interdisciplinary database Scopus (including MEDLINE) and EBSCOhost, while grey literature and media sources were extracted from the Google and Google Scholar search engines, supplemented with a visit to the EPES foundation in Chile and an analysis of the reference lists for the selected articles. 369 articles were identified, of which 23 met eligibility criteria for this review. Based on the analysis of the experiences, some facilitators were found more pertinent when achieving the goals concerning the intervention's design, implementation and assessment. This paper makes recommendations for the design and execution of peer-led health promotion interventions in order to increase its effectiveness and success rate.
RESUMEN: Esta investigación busca presentar las intervenciones del Community Lay Advisor como una estrategia de promoción de la salud que ha aparecido en la literatura internacional, para resaltar estos elementos habilitadores en la implementación de la intervención y establecer una comparación entre los aspectos abordados en las experiencias analizadas y el "Programa de Promotores de Salud Bucal en las Escuelas" de la Universidad de La Frontera, en Temuco, Chile. Entre febrero y marzo de 2018 se llevó a cabo una revisión exhaustiva del alcance, con búsquedas realizadas tanto en la literatura académica como en la gris. Se encontraron artículos científicos revisados por pares utilizando la base de datos interdisciplinaria Scopus (incluyendo MEDLINE) y EBSCOhost, mientras que la literatura gris y las fuentes de medios se extrajeron de los motores de búsqueda Google y Google Scholar, complementados con una visita a la fundación EPES en Chile y un análisis de las listas de referencias de los artículos seleccionados. Se identificaron 369 artículos, de los cuales 23 cumplieron con los criterios de elegibilidad para esta revisión. Sobre la base del análisis de las experiencias, algunos facilitadores resultaron más pertinentes al alcanzar los objetivos relacionados con el diseño, la implementación y la evaluación de la intervención. Este documento hace recomendaciones para el diseño y la ejecución de intervenciones de promoción de la salud dirigidas por pares para aumentar su eficacia y su tasa de éxito.