PROJECT SUMMARY/ABSTRACT Dr. Glenda Baguso’s long-term goal is to be a high-impact, NIH-funded, independent investigator with expertise working with marginalized communities at risk for HIV. Transgender (trans) women are disproportionately burdened by HIV, yet have lower engagement in HIV prevention and HIV care compared to other affected populations. To end the HIV epidemic, interventions are needed that address psychosocial and structural factors that impact engagement in HIV care, such as trauma. The goal of the K23 is to address trauma to improve HIV prevention and care engagement in community clinics that provide care to trans women. This proposal uses three aims to achieve this goal. The first aim is to explore the relationship between trauma, mental health, HIV prevention and care engagement, and the multi-level intersectional factors among trans women using in-depth interviews with 20 trans women. The second aim is to examine barriers and facilitators to implementing T-SBIRT, a trauma screener, brief intervention, and referral to treatment in community clinics using in-depth interviews with 20 clinic stakeholders (e.g., leadership, health care providers, staff). The third aim is to pilot test T-SBIRT with 50 trans women in a community clinic to assess implementation outcomes. The implementation of T-SBIRT in a community clinic that provides care to trans women will be guided by a modified intersectionality-enhanced Consolidated Framework for Implementation Research. These specific aims will be achieved by the following training aims: 1) develop content expertise on trauma stressors, T-SBIRT and mental health, 2) gain intersectional methodological expertise and advanced skills in clinical trials and intervention development, and 3) develop knowledge and skills for implementation science. The training aims are supported by Dr. Baguso’s mentoring team of experts in trauma, mental health, intersectionality, and implementation science. With support from her mentors, UCSF, and the department chair of the Department of Community Health Systems in the School of Nursing, Dr. Baguso will successfully meet the training aims, complete the specific aims, and be fully equipped to launch her NIH independent investigator career.

PROJECT NARRATIVE Given that transgender women face high levels of trauma (e.g., events that result in harmful effects), clarifying the mechanisms by which traumatic events and the mental health sequelae impact HIV prevention and HIV care engagement is needed. This proposed study will explore trauma, mental health, and trans women’s engagement in HIV prevention and HIV care, implement an evidence-based trauma intervention, and explore implementation outcomes. Findings from this study will inform a larger scale study that will implement the trauma-informed intervention across multiple clinics to improve HIV prevention and HIV care for transgender women. .