JMIR Publications

ABSTRACT

Background:

Transgender women have few interventions to support their HIV prevention and treatment outcomes in South Africa. Further, increased focus should be on intervention development that will reduce HIV transmission within HIV-discordant partnerships, especially for transgender women who navigate gender, sexuality, and relationship stigma as well. The Speaking Out and Allying Relationships (SOAR) intervention has been developed for sexual minority men to address these outcomes in South Africa. It is a behavioral intervention that is delivered in groups on videoconference to develop coping skills to manage HIV-related stress, disclosure to partners, and establish and maintain safer sex practices with partners. Tailoring SOAR may be feasible for transgender women to support their HIV care while reducing transmission within their relationships.

Objective:

To adapt SOAR for transgender women and test its usability (Aim 1), and then assess its feasibility (Aim 2).

Methods:

To achieve Aim 1, we will use a human-centered design approach to tailor the existing SOAR intervention for transgender women. Interviews and a survey will be administered to transgender women (N=15) to assess intervention preferences. Findings will be used to tailor content like role-plays, scenarios, and media to align with transgender women’s lived experiences navigating HIV and relationships. Afterward, we will conduct a usability test with 6 of the 15 participants to determine intervention understanding and satisfaction. Participants will be transgender women living with HIV and in a relationship with a man with unknown HIV status or HIV-negative. All participants will be recruited using community-based approaches. In Aim 2, we will examine SOAR feasibility using a one-arm pilot-test. Transgender women (N=20) will be recruited using Aim 1 methods and eligibility criteria with participants completing feasibility surveys and interviews, and behavioral and biomedical assessments.

Results:

Intervention adaptation began in May 2023 with interviews. Feasibility pilot-testing is due to be completed by March 2024.

Conclusions:

Transgender women need more intervention options that engage their relationships since these can present barriers to HIV treatment outcomes like hindering viral suppression in South Africa. Delivering an existing yet tailored intervention on videoconference expands reach to transgender women and allows them to engage with others and learn new skills in a secure setting like their homes. SOAR has the potential to improve relationship dynamics and reduce violence, that will in turn enhance HIV treatment and prevention engagement.