Adaptation and Implementation of an Evidence-Based Approach to Advance HIV Prevention and Care - ABSTRACT Transgender women (TW) in Vietnam face cultural and societal pressure, stigma, isolation, and violence, contributing to substance use, risky sexual behaviors, and suboptimal engagement in HIV prevention and care. Despite these health disparities and adversities experienced by TW in Vietnam, there are no TW-specific interventions designed to address their needs. TransAction is an evidence- and theory-based intervention, developed by Dr. Cathy Reback (Co-Investigator) and TW in Los Angeles County, comprised of four core elements: outreach, individual risk-reduction counseling sessions, skill-building and support groups, and social events. TransAction participation is associated with increased self-efficacy and social support as well as decreased HIV risks including engagement in exchange sex and substance use. TransAction is designed to be delivered in resource-limited settings, so it is well-positioned to serve as an evidence-based HIV health promotion intervention model for adaptation in Vietnam. Following the implementation science ADAPT-ITT framework, researchers from the University of California, Los Angeles, Friends Research Institute, and the University of Medicine and Pharmacy in Ho Chi Minh City (HCMC) have completed the first five steps (Assessment, Decision, Adaptation, Production, Topical expert) of adapting TransAction for TW in Vietnam. The four core elements of TransAction were deemed urgently needed while TW community members provided valuable feedback on the adaptation and implementation of TransAction for Vietnamese cultural competency. This R34 will build upon our strong existing U.S.-Vietnam and academic-community collaborative relationships to complete the last three steps (Integration, Training, Testing) of the ADAPT-ITT process. In Phase 1, the team will take a community participatory approach to work with TW community-based organizations (CBOs) to develop TransAction protocols, materials, and health/social service navigation plans in the context of Vietnam. TW peer facilitators will be identified and trained to deliver the intervention activities. In Phase 2, the adapted TransAction will be pilot-tested with 80 HIV status-neutral TW aged 16 and above from HCMC and adjacent provinces with a two-arm, randomized design. TW in the intervention condition will participate in individual risk- reduction counseling sessions and skill-building and support groups using an online/offline hybrid modality. Both intervention and control groups will be invited to social events. Intervention outcomes, including placement along the HIV prevention/care continua, multilevel/multifaceted stigma and coping, self-efficacy, service utilization, HIV risks, and general health will be assessed at baseline, 3-, and 6-month. Implementation outcomes, including feasibility, fidelity, and acceptability, will be evaluated based on data collected from multiple sources. This study will lay the foundation for a subsequent full-scale trial to evaluate the scalability, efficacy, and sustainability of the culturally responsive HIV prevention and care intervention for TW in Vietnam and other settings with limited trans-inclusive services.
