TRANSCEND

Transgender (TG) persons, especially transgender women (TGW), have a high lifetime risk of acquiring HIV. Black/African American (Black) and Hispanic/Latino (Hispanic) TGW have the highest prevalence of HIV among TG persons. Many TG persons experience poverty, homelessness, stigma, discrimination, and abuse; have mental health and substance use disorders; and need essential support services. In this demonstration project, transgender health care organizations (TG clinics) are funded to work in collaboration with transgender-serving community-based organizations (TG CBOs) to develop models for community-to-clinic, status-neutral HIV prevention and care services. Recipients provide comprehensive, co-located health services including HIV testing, preexposure prophylaxis (PrEP), gender-affirming hormone therapy, primary health care, and navigation. Navigation is used to link TG persons as needed to service for mental health and substance use disorders and essential support services. Recipients work with TG CBOs to engage TG persons in HIV testing and education and navigate them to TG clinics. Key outcomes in the project include an increased number of TG persons who initiate, adhere to, and persist with PrEP; increased rates of viral suppression among TG persons with diagnosed HIV; and an increased number of TG persons with unmet needs who receive services for mental health and substance use disorders and other essential support services.

• St. John’s Community Health – Los Angeles, CA
• Care Resource Community Health Center – Miami, FL
• Callen-Lorde Community Health Center – New York, NY
• Whitman-Walker Health – Washington, DC

Total funding for the 4-year project period is estimated to be up to $8,000,000. CDC awarded $2,000,000 for the first year of the project, which started on June 30, 2022. The approximate average award is $500,000 per budget period to each of the four TRANSCEND funded recipients.

CDC is working in partnership with the recipients to develop and evaluate community-to-clinic integrated and holistic models to provide co-located status-neutral HIV prevention and care services for TG persons. Co-located health services have been associated with persons remaining engaged in health care and better health outcomes. These services have been developed with cultural and linguistic responsiveness for TG persons.

This project has four strategies: (1) To provide integrated HIV testing, status-neutral HIV prevention and care services, and comprehensive TG health services to TG persons through TG CBO and clinic collaboratives; (2) To support use of mental health and substance use disorder services and other essential support services by TG persons with needs for these services; (3) To provide services that are culturally sensitive for TG persons, especially for Black and Hispanic persons; and (4) To support development of and participation in a national learning collaborative to share lessons learned and best practices for TG clinic and TG CBO partnerships to provide community-to-clinic, status-neutral, comprehensive services for TG persons.

Note that all activities are implemented according to CDC-approved protocols and procedures.

CDC is requesting de-identified person-level longitudinal data, collected, and stored through electronic health records (EHRs), at baseline and every 6 months from recipients to calculate outcome measures for the intended outcomes:

Short Term Outcomes

• Increased capacity of TG clinics to provide or link to HIV prevention and care services as well as provide comprehensive TG health services
• Increased PrEP initiation by PrEP-eligible TG persons
• Increased nPEP initiation by nPEP-eligible TG persons
• Increased rapid ART initiation by TG persons with diagnosed HIV
• Increased linkage to HIV care among TG persons with diagnosed HIV
• Increased linkage to mental health, substance use disorder, and other essential support services among TG persons with need for services

Intermediate Outcomes

• Increased adherence to PrEP by TG persons
• Increased persistence with PrEP by TG persons
• Increased retention in HIV care among TG persons with diagnosed HIV
• Increased viral suppression among TG persons with diagnosed HIV

Long Term Outcomes

• Increased capacity of TG clinics to provide or link to HIV prevention services well as provide comprehensive TG health services
• Increased PrEP initiation by PrEP-eligible TG persons
• Increased adherence to PrEP by TG persons
• Increased persistence with PrEP by TG persons
• Increased nPEP initiation by nPEP-eligible TG persons
• Increased rapid ART initiation by TG persons with diagnosed HIV
• Increased linkage to HIV care among TG persons with diagnosed HIV
• Increased retention in HIV care among TG persons with diagnosed HIV
• Increased viral suppression among TG persons with diagnosed HIV
• Increased linkage to mental health services by TG persons with needs for services
• Increased linkage to substance use disorder services by TG persons with needs for services
• Increased linkage to other essential support services by TG persons with needs for services

Purpose: to share lessons learned and best practices for TG clinic and TG CBO partnerships to provide community-to-clinic, status-neutral, comprehensive services for TG persons.

CDC’s Division of HIV Prevention is proud to announce the launch of the Transgender Status-Neutral Community to Clinic Models to End the HIV Epidemic (TRANSCEND) Learning Collaborative (LC). The TRANSCEND Learning Collaborative welcomes all healthcare and other service providers who work with or are interested in expanding services to TG persons in clinics and CBOs (including those who are not funded for this project), to participate in the Learning Collaborative.

The TRANSCEND Learning Collaborative, hosted by the National Prevention Information Network (NPIN), will provide an NPIN Community forum and quarterly meetings to dialog with other TRANSCEND Learning Collaborative members to share best practices, lessons learned, and program-related materials and resources with one another.

How to join the TRANSCEND Learning Collaborative:

1. Visit NPIN at https://npin.cdc.gov.
2. Join the NPIN Community and use the Group Invitation Code: TRANSCEND.
3. Look for an email indicating that you have been approved to join NPIN and the TRANSCEND Learning Collaborative Community Page.

Once a member of the Learning Collaborative, members can engage the Community and register for TRANSCEND Learning Collaborative quarterly meetings and other special events using the links provided in the Community page.