Peer Navigation to Support Transgender Women’s Engagement in HIV Care: Findings from the Trans Amigas Pilot Trial in São Paulo, Brazil

Abstract

Trans women living with HIV (TWH) have suboptimal HIV care engagement. We pilot tested Trans Amigas, a theory-based, trans-specific peer navigation (PN) intervention to address barriers to care in São Paulo, Brazil. TWH were randomized to the PN intervention (n = 75) or control (n = 38) condition. Control participants were referred to trans-friendly HIV care. Intervention participants were assigned a navigator who conducted nine in-person one-on-one sessions and bi-weekly phone or text check-ins to help participants overcome barriers to care and work towards gender affirmation and healthcare goals. We followed participants for 9 months to determine intervention feasibility, acceptability, and preliminary efficacy in improving retention in care. Analyses were intention to treat (ITT). Intervention acceptability was high: at end line, 85.2% of PN participants said they would continue receiving services and 94.4% would recommend peer navigation to a friend. A priori feasibility criteria were met: 92% of eligible participants enrolled and 70% were retained at 9 months; however, only 47% achieved moderate or better adherence to both in-person and phone/text program components. Though the pilot was not powered for efficacy, ITT findings trended toward significance, with intervention participants 40% more likely to be retained in care at the end of the study. Population-specific peer programming to support care engagement is acceptable, feasible, and can improve HIV outcomes for Trans women living with HIV.

Fatores associados à retenção de travestis e mulheres trans vivendo com HIV em uma intervenção com navegação de pares em São Paulo, Brasil

“…The project Improving Health Outcomes for HIV-positive Trans Women in Brazil (TransAmigas project) was conducted as a pilot to test the feasibility and acceptability of a peer navigation intervention aimed at improving adherence to ART among TrTGW 32 . This cohort study was performed in the city of São Paulo in a SUS health service called STD/AIDS Reference and Training Center (CRT-DST/Aids SP).…”

Community engagement tools in HIV/STI prevention research

“…Peers possess an inherent understanding of their community's needs and dynamics, making their involvement both relevant and impactful. The integration of peers into community engagement initiatives is often reported with high feasibility and acceptability [21][22][23]. The second type is patient-led interventions, which occurred in the form of patient navigation and patient notification in clinical settings [5,24].…”

Sexual violence is associated with poor treatment outcomes among transgender women living with HIV in Brazil

“…We conducted a secondary analysis of data from Trans Amigas, a pilot study of a peer navigation intervention to improve engagement in HIV care among TWH in São Paulo, Brazil [21]. Trans Amigas participants were 18 years or older, assigned 'male' at birth but currently identi ed as female or transgender, residents of São Paulo, and were in care or agreed to begin HIV care at the study health facility.…”

“…Intervention participants were paired with a peer navigator (PN), who was a TWH engaged in HIV care with extensive empowerment-based training. The Trans Amigas intervention has been described in detail elsewhere [21].…”

“…The primary outcome was retention in HIV care at follow-up, de ned as having a con rmed HIV clinical visit or antiretroviral therapy (ART) medication pick-up around nine months from enrollment (using the window of 7 ½ to 10 ½ months given the three-month treatment interval) [21]. The secondary outcome was viral suppression (viral load <1,000 copies/mL) at follow-up.…”