Key points
In this demonstration project, CDC is funding health care organizations that provide services to transgender people to partner with transgender-serving community-based organizations (CBOs) in developing and evaluating community-to-clinic models for integrated status-neutral HIV prevention and care services, gender-affirming services, and primary health care. These models will increase use of HIV prevention and treatment by transgender people, decrease HIV transmission, and improve overall health and wellbeing.
About
Transgender people, especially transgender women, have increased chances of getting HIV due to social determinants of health. Black/African American and Hispanic/Latino transgender women have the highest prevalence of HIV among transgender people. Many transgender people experience poverty, homelessness, stigma, discrimination, and abuse; have mental health and substance use disorders; and need essential support services.
In this demonstration project, recipients provide comprehensive, co-located health services including HIV testing, pre-exposure prophylaxis (PrEP), gender-affirming hormone therapy, primary health care, and navigation. Navigation is used to link transgender people as needed to service for mental health and substance use disorders and essential support services.
Recipients work with transgender-serving CBOs to engage transgender people in HIV testing and education and navigate them to health care organizations that provide services to transgender people. Key outcomes in the project include an increased number of transgender people who initiate, adhere to, and persist with PrEP; increased rates of viral suppression among transgender people with diagnosed HIV; and an increased number of transgender people with unmet needs who receive services for mental health and substance use disorders and other essential support services.
Recipients
- 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)
Funding
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 recipients.
Strategies and activities
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 transgender people. Co-located health services have been associated with people remaining engaged in health care and better health outcomes. These services have been developed with cultural and linguistic responsiveness for transgender people.
This project has four strategies:
1. To provide integrated HIV testing, status-neutral HIV prevention and care services, and comprehensive health services to transgender people through transgender-serving CBO and clinic collaboratives.
2. To support use of mental health and substance use disorder services and other essential support services by transgender people with needs for these services.
3. To provide services that are culturally sensitive for transgender people, especially for Black/African American and Hispanic/Latino people.
4. To support development of and participation in a national learning collaborative to share lessons learned and best practices for health care organizations that provide services to transgender people and transgender-serving CBO partnerships to provide community-to-clinic, status-neutral, comprehensive services for transgender people.
Note that all activities are implemented according to CDC-approved protocols and procedures.
Evaluation and performance measurement
CDC is requesting de-identified person-level longitudinal data, collected, and stored through electronic health records, at baseline and every 6 months from recipients to calculate outcome measures for the intended outcomes:
Short-term outcomes
- Increased capacity of health care organizations that provide services to transgender people to provide or link to HIV prevention and care services as well as provide comprehensive health services
- Increased PrEP initiation by PrEP-eligible transgender people
- Increased nPEP initiation by nPEP-eligible transgender people
- Increased rapid ART initiation by transgender people with diagnosed HIV
- Increased linkage to HIV care among transgender people with diagnosed HIV
- Increased linkage to mental health, substance use disorder, and other essential support services among transgender people with need for services
Intermediate outcomes
- Increased adherence to PrEP by transgender people
- Increased persistence with PrEP by transgender people
- Increased retention in HIV care among transgender people with diagnosed HIV
- Increased viral suppression among transgender people with diagnosed HIV
Long-term outcomes
- Increased capacity of health care organizations that provide services to transgender people to provide or link to HIV prevention services well as provide comprehensive health services
- Increased PrEP initiation by PrEP-eligible transgender people
- Increased adherence to PrEP by transgender people
- Increased persistence with PrEP by transgender people
- Increased nPEP initiation by nPEP-eligible transgender people
- Increased rapid ART initiation by transgender people with diagnosed HIV
- Increased linkage to HIV care among transgender people with diagnosed HIV
- Increased retention in HIV care among transgender people with diagnosed HIV
- Increased viral suppression among transgender people with diagnosed HIV
- Increased linkage to mental health services by transgender people with needs for services
- Increased linkage to substance use disorder services by transgender people with needs for services
- Increased linkage to other essential support services by transgender people with needs for services
Learning collaborative
Purpose: to share lessons learned and best practices for health care organizations that provide services to transgender people and transgender-serving CBO partnerships to provide community-to-clinic, status-neutral, comprehensive services for transgender people.
CDC's Division of HIV Prevention launched the TRANSCEND Learning Collaborative in 2023 as part of a CDC-funded project, PS22-2209. The TRANSCEND Learning Collaborative welcomes all health care and other service providers who work with or are interested in expanding services to transgender people in clinics and CBOs (including those who are not funded for this project), to participate in the Learning Collaborative.
The TRANSCEND Learning Collaborative provides a community forum through LinkedIn Groups and quarterly meetings to dialog with other TRANSCEND Learning Collaborative members to share best practices, lessons learned, and program-related materials and resources.
How to join the TRANSCEND Learning Collaborative:
- Access LinkedIn (if new to the site, create a profile to join).
- Request to join CDC's TRANSCEND Learning Collaborative LinkedIn Group Site by clicking on the following link: CDC's TRANSCEND Learning Collaborative (LC) | Groups | LinkedIn
- Once a Group Administrator approves your request to join, you will be able to access and participate as member of the Learning Collaborative. Your LinkedIn Notifications will alert you to when this approval has occurred. CDC's TRANSCEND Learning Collaborative should now appear under your "Groups."
Once a member of the Learning Collaborative, members can engage the Group and register for TRANSCEND Learning Collaborative quarterly meetings and other special events using the links provided in the Group page.