ABSTRACT: Staying Connected: Community-engaged research to address the impacts of the COVID-19
Pandemic among transgender women through an mhealth prevention program
The COVID-19 pandemic has reminded the world that viral outbreaks are a reality and can quickly generate high
levels of mortality and morbidity, overwhelm health-care systems, and produce massive social and economic
upheaval. Epidemiological data suggest that COVID-19 will have its most devastating impact on the most
vulnerable members of society, and in the process, exacerbate existing health disparities. In the United States,
transgender women, and in particular transgender women of color, are particularly at risk for COVID-19 infection
due to high levels of HIV infection, substance abuse, depression, anxiety disorders, and social isolation.
Research demonstrates that these health disparities and vulnerabilities are connected to the multiple forms of
discrimination that shape transgender women’s lives. In this context, the COVID-19 pandemic and
accompanying mitigation strategies affect not only COVID-19 transmission and disease, but also transgender
women’s adherence to HIV anti-retroviral therapies, utilization of the HIV prevention continuum, financial and
housing stability, and anxiety and depression associated with the disruption of gender-affirming care. This
proposed administrative supplement will build on our current project, Trans Women Connected (TWC), an
mhealth sexual health promotion app for transgender women, by conducting research to gain greater
understanding of and ways to respond to these inter-connected and still evolving trans-specific COVID-19
impacts. Specifically, we aim to: 1) Conduct rapid formative research to examine the impact of COVID-19 and
mitigation strategies, including unintended negative consequences, on transgender women through focus
groups, expert advisors, and an engaged community advisory board; 2) Develop a culturally tailored, community-
strengths and cognitive behavior theory informed module of interactive COVID-19 educational activities for
integration into the overall TWC mobile app. The skills-building activities seek to support COVID-19 mitigation
strategies, reduce COVID-19 morbidity and mortality, and in general, improve health care utilization, increase
self-care and resilience, and promote connectedness among transgender women, thereby leading to improved
overall mental and physical health; and 3) Evaluate the impact of the COVID-19 module as part of the larger
parent grant 2-arm cluster randomized controlled trial with 450 transgender women. This evaluation will enable
us to collect data on COVID-19 and the impact of the mhealth module on transgender women over a 12-month
time period likely encompassing relaxation of distancing measures, possible second and third waves of infections
and additional periods of lockdown, and potentially, the emergence of a vaccine. The project offers the possibility
of unprecedented insights into effects of the COVID-19 pandemic on the health, connectedness, and behaviors
of one of the most vulnerable and socially marginalized populations in the US.