PROJECT SUMMARY/ABSTRACT Transgender women (TW) bear a disproportionate burden of HIV, with one of the single largest HIV-related disparities found among Latina TW, whose HIV prevalence (26%) is almost four times greater than among their non-Hispanic White counterparts (7%). Based on findings from our Adelante study, a mixed-methods longitudinal pilot project assessing awareness and uptake of PrEP and PEP among immigrant LTW in the DC metropolitan area, this original epidemiological-interventional project seeks to develop and pilot test a peer- coaching intervention to promote chemoprophylaxis (i.e. PrEP and PEP) for HIV prevention that is culturally responsive to the characteristics of the LTW community. To achieve this aim we have established a strong community-academia-government partnership, composed of LTW working for organizations providing services to the LTW community in the DC metropolitan area, officials from the HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) of the DC Department of Health and researchers from the DC Center for AIDS Research (DC CFAR). Using a community-based participatory research (CBPR) approach, all members of our partnership will work collaboratively to develop the intervention, which will include: 1) peer-coaching sessions for improving HIV-risk assessments, providing information about PrEP/PEP, and supporting PrEP/PEP uptake and adherence, 2) navigation to existing PrEP/PEP services and 3) other culturally appropriate components deemed relevant by the CBPR team. We will use a randomized delayed-intervention control trial to examine feasibility, acceptability and preliminary efficacy, randomizing HIV negative LTW to the intervention (n=25) or a 6-month waitlist control group (n=25). PrEP/PEP uptake and adherence will be assessed at baseline and 3, 6 and 12- month follow ups, using self-report, medical records reviews and clinical assays. Intervention feasibility and acceptability will be assessed using qualitative in-depth individual interviews with participants one month after intervention completion. Our community-academia-government partnership is ideally suited to carry out the proposed research with a demonstrated ability to recruit, retain and engage the LTW community in DC in prior HIV research. For the “Adelante” study we recruited 62 immigrant LTW, with an overall retention rate of 82% for the longitudinal portion (n=41/50). We have established strong relationships with organizations serving the LTW community, who will collaborate on this project, ensuring that community needs and priorities drive an effective HIV response. This proposal complements and extends HAHSTA's HIV prevention efforts towards Ending the HIV Epidemic (EHE) in DC by 2030. In line with the EHE plan's key strategy to prevent new HIV transmissions by using proven interventions, this research will support the development of the first evidence-informed HIV prevention intervention targeting LTW. Results from this study will be used to prepare a NIH R–series award to conduct a more stringent test of effectiveness of the intervention. This proposal aligns well with the overarching goal of the MARI program to support innovative implementation science research in a minority community heavily impacted by HIV.

PROJECT NARRATIVE The proposed original epidemiological pilot project to develop and evaluate a peer-coaching intervention to promote PrEP and PEP for HIV prevention among Latina transgender women (LTW) is relevant to public health because, in alignment with the Ending the HIV Epidemic (EHE) plan and CDC's MARI initiative, it seeks to address the HIV-related health inequities experienced by LTW in Washington DC, a priority city for the EHE plan. The project advances new horizons in HIV prevention with its specific focus on LTW, its attention to both PrEP and PEP, and the active involvement of the health department, non-governmental organizations and LTW community members, elements that will ensure the cultural relevance and potential for sustainability of the peer-coaching intervention. A significant benefit of the proposed research is that it will lead to the development of the first Evidence-Informed intervention for HIV prevention targeting LTW, which can be scalable to reduce the disproportionate burden experienced by LTW in other areas in the US and abroad.