Background: Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW. Setting: Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017. Methods: This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention. Results: Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake. Conclusions: Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.

Background: In the United States, transgender women (TW) are disproportionately burdened by HIV infection. Cohort studies are needed to evaluate factors driving HIV acquisition among TW over time. These will require implementation strategies that are acceptable to the TW community and feasible to implement. Objective: This study aims to investigate the rate and correlates of HIV acquisition and other health outcomes among TW in eastern and southern United States. Methods: LITE is a multisite prospective cohort in 6 eastern and southern US cities, which will be followed across 24 months of technology-enhanced biobehavioral follow-up. Adult TW, regardless of HIV status, are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants are enrolled in a baseline study visit, complete a sociobehavioral survey, and test for HIV and sexually transmitted infections. Participants who are not living with HIV at baseline are offered enrollment into the cohort (N=1100); follow-up assessments occur quarterly. Results: Cohort assembly was informed by synchronous Web-based focus group discussions with TW (n=41) and by continuing engagement with community advisory board members from each site. Enrollment launched in March 2018. The study is underway in the Atlanta; Baltimore; Boston; Miami; New York City; and Washington, DC, metro areas. As of March 2019, 795 TW completed a baseline visit (mean age 35 years). The majority of the participants are racial/ethnic minorities, with 45% of the TW identifying as black and 28% of the TW identifying as Hispanic/Latinx. More than one-quarter (28%) of the TW are living with HIV infection (laboratory-confirmed). Online recruitment methods support engagement with TW, although peer referral and referral through trusted health facilities and organizations remain most effective. Conclusions: This study is responsive to increasing research interest in technology-enhanced methods for cohort research, particularly for hard-to-reach populations. Importantly, the diversity of literacy, technology use, and overall socioeconomic situations in this sample of TW highlights the need to leverage technology to permit a flexible, adaptive methodology that enhances engagement of potential participants living in marginalized contexts while still ensuring rigorous and sound study design. International Registered Report Identifier (IRRID): DERR1-10.2196/14704

Latina transgender women (LTW) are disproportionately vulnerable to depression, although the role of immigration/documentation status (legal authority to live/work in the U.S.) in depression has not been explored. LTW in Washington, DC were recruited into a cross-sectional study via convenience sampling. Most were Spanish-speaking Central American immigrants. Participants completed rapid HIV tests, and a Spanish-language survey assessing recent depressive symptoms (PHQ-2), sociodemographics, and factors from the minority stress framework: structural stressors (documentation status, stable housing), social stressors (discrimination, fear of deportation, violence) and coping resources (social support, resilience). Among immigrant LTW (n = 38), 24 were undocumented. Among the undocumented, the average PHQ-2 score was 2.7, and among the documented, the average PHQ-2 score was 1.4 (p < 0.05). Undocumented LTW were significantly more likely to experience employment discrimination, recent unstable housing, and fear of deportation. Bivariate and multiple linear regressions were performed to assess the relationship between documentation status and other correlates of past two week depressive symptoms. In multivariate analysis, PHQ-2 scores were inversely associated with being documented (p < 0.01), having an income above the federal poverty level, higher friends’ social support, and increased resiliency. Documentation status is an important correlate of depressive symptoms among LTW that should be considered within the context of health interventions.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Novel, technology-based methods are rapidly increasing in popularity across multiple facets of quantitative HIV research. Qualitative HIV research, however, has been slower to integrate technology into research methodology. One method, computer-mediated communication (CMC), has been utilized to a limited extent for focus group discussions. Objective: This study aimed to assess feasibility of an online video conferencing system to further adapt CMC to facilitate focus group discussions among transgender women living in six cities in eastern and southern U.S. Methods: Between August 2017 and January 2018, focus group discussions with adult transgender women were conducted in English and Spanish by research teams based in Boston, MA and Baltimore, MD. Participants were sampled from six cities: Baltimore, MD, Boston, MA, New York, NY, Washington, DC, Atlanta, GA, and Miami, FL. This was formative research to inform a technology enhanced cohort study to assess HIV acquisition among transgender women in these cities. This analysis focuses on the methodologic use of CMC focus groups conducted synchronously using online software that enables video or phone discussion. Findings are based on qualitative observations of attendance and study team debriefing on topics of individual, social, technical and logistical challenges encountered. Results: A total of 41 transgender women from all six cities participated in seven online focus group discussions (five English, two Spanish). An equal distribution of attendees were Black/African American and White race (34%), with 29% reporting Hispanic/Latina ethnicity. Overall, 29 of 70 eligible and scheduled transgender women failed to attend the focus group discussions. The most common reason for non-attendance was forgetting or having a scheduling conflict (55%); 14% reported technical challenges associated with accessing the CMC focus group discussion. CMC focus group discussions were found to facilitate geographic diversity; increase perceptions of anonymity and privacy (e.g., use of pseudonyms, option to use video); ease scheduling by eliminating challenges related to travel to a data collection site; offer flexibility to join via telephone (cell or landline), smart phone or tablet (through an application), or computer. Challenges encountered were overlapping conversations; variable audio quality in cases where Internet or cellular connection was poor; distribution of incentives (e.g., cash vs gift card). As with all focus group discussions, establishment of ground rules and employing a skilled facilitator were critical to the success of CMC focus group discussions. Conclusions: Synchronous CMC focus group discussions provide an efficient and secure opportunity to bring together transgender women across geographic space, without losing the standardized approach or reducing the quality that is expected of in-person focus group discussions. Participants with limited technological literacy, inconsistent access to a phone and/or cellular data/service, and circumstances necessitating immediate cash incentives may require additional support and accommodation when connecting to CMC focus group discussions.