JMIR Publications

ABSTRACT

Background:

In the U.S., 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:

The American Cohort to Study HIV Acquisition among Transgender Women in High Risk Areas (also known as the LITE study) aims to investigate the rate and correlates of HIV acquisition and other health outcomes among TW in eastern and southern US.

Methods:

LITE is a multi-site prospective cohort in six eastern and southern U.S. cities, which will be followed across 24-months of technology-enhanced biobehavioral follow-up. Adult transgender women, regardless of HIV status, are recruited via convenience sampling (e.g., peer referrals, social media, dating apps). Participants are enrolled in a baseline study visit and complete a socio-behavioral survey and HIV/ STI testing. Participants who are not living with HIV at baseline are offered enrollment into the cohort (N=1,100); follow-up assessments occur quarterly.

Results:

Cohort assembly was informed by synchronous online focus group discussions with TW (n=41) and continuing engagement with community advisory board members from each site. Enrollment launched in March 2018 and 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 are racial/ethnic minorities with 45% identifying as Black and 28% as Hispanic/Latinx. More than one-quarter (28%) are living with HIV infection (laboratory-confirmed). Online recruitment methods support engagement with TW, though 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 socio-economic situations in this sample of TW highlights the need to leverage technology to permit flexible, adaptive methodology that enhances engagement of potential participants living in marginalized contexts while still ensuring rigorous and sound study design.