Research

Does the Healthy Divas Intervention Work?

To test the efficacy of the Healthy Divas intervention, we conducted a randomized controlled clinical trial (RCT) in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3-, 6-, 9-, and 12-months post-randomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visits, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence 90%, and (4) self-reported antiretroviral therapy adherence 80%.

We enrolled 278 participants into the Healthy Divas RCT; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points.

The Healthy Divas efficacy trial demonstrated the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time.

What's the Best Way to Implement Healthy Divas?

UCSF’s Prevention Research Center (PRC), in partnership with California Prostitutes Education Project (Cal-PEP), is conducting an implementation study of the Healthy Divas intervention in West Oakland, California.

Our partner, Cal-PEP, has been serving communities in Oakland for 33 years, with a focus on communities of color and those affected by HIV. Cal-PEP has recently been expanding their services to include transgender women and has successfully obtained funding to implement Healthy Divas over three years'. We have collaborated with Cal-PEP on several research projects over the years' and they have been represented on our CDC PRC Prevention Forum for five years'.

The implementation study is a Hybrid Type III design with primary emphasis on the implementation process and secondary emphasis on the intervention outcomes. In this study, the RE-AIM framework is utilized to understand the process of implementation of Healthy Divas at Cal-PEP. In RE-AIM, reach refers to the individuals in the target population who participate in an intervention or program; effectiveness is the impact of an intervention on specific outcomes; adoption includes the settings, staff, and institutions that adopt and deliver an intervention or program; implementation involves the integration of the intervention into practice; and maintenance is the extent to which the intervention or program becomes a part of routine practice or policy.

The convergence of expertise at PRC in implementation science and the Healthy Divas intervention, along with Cal-PEP’s expertise in serving communities in Oakland, makes this a unique, timely, and critical opportunity to study a real-world implementation of an urgently needed intervention for a highly vulnerable population and to support adoption of Healthy Divas in other organizations in an expeditious manner.

Publications