November 18, 2021

Wayne State researcher’s zest for technology-based health interventions fuels Thai project for transgender women

A behavioral health researcher at the Wayne State University School of Medicine is co-leading a five-year collaboration with researchers in Massachusetts, California and Thailand on a pilot program supported by a $1.3 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to test a mobile technology-based intervention program designed for transgender women in Thailand.

“Our goal is to develop a program to improve use of PrEP to prevent new cases of HIV,” said Associate Professor of Family Medicine and Public Health Sciences Karen MacDonell, Ph.D. 

Karen MacDonell, Ph.D.
Karen MacDonell, Ph.D.

“Transgender women are a group that are at increased risk of HIV, yet few research studies have focused on them specifically. We want to work with local community partners in Bangkok, including young transgender women, to learn more about their specific needs and challenges, and develop a successful program,” she said.

PrEP, or Pre-Exposure Prophylaxis, is a medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. The U.S. Centers for Disease Control and Prevention reports that when taken as prescribed, PrEP is highly effective for preventing HIV.

Dr. MacDonell is one of the three principal investigators leading “Optimizing an mHealth intervention to improve uptake and adherence of the HIV pre-exposure prophylaxis (PrEP) among Thai young transgender women,” along with Bo Wang, Ph.D., at the University of Massachusetts Medical School and Dr. Nittaya Phanuphak Pungpapong at the Institute of HIV Research and Innovation in Bangkok, Thailand.

“PrEP is highly effective when taken as prescribed, but PrEP uptake and adherence have been low, with high discontinuation rates among transgender women. To address these challenges, we propose to develop and pilot a multi-component, technology-based intervention to promote PrEP usage,” Dr. MacDonnell said. “We will adapt an existing two-session, technology-delivered, motivational interviewing intervention to focus on PrEP use in young Thai transgender women, resulting in the Motivational Enhancement System for PrEP Uptake and Adherence. We will also refine and enhance YaCool, a mobile app with integrated text messaging developed and used clinically by our Thai team.”

According to the trio’s proposal, transgender women, particularly ages 18 to 29 years old, are among the fastest growing HIV+ populations worldwide, with HIV prevalence rates of 15% to28%. Thailand has the highest adult HIV seroprevalence in Asia, with HIV infection among 18% of transgender women.

Few interventions have targeted young transgender women. As a researcher in the Department of Family Medicine and Public Health Sciences Division of Behavioral Health, Dr. MacDonell develops health-focused interventions for minorities, particularly those from underserved communities. She is especially interested in using mobile technology to deliver interventions.

“PrEP is a new area of focus for me, as my research in HIV has largely focused on promoting HIV self-management in adolescents and young adults living with HIV,” she said.

In 2016, Dr. Phanuphak Pungpapong and project co-investigator Rena Janamnuaysook co-established the Tangerine Community Health Clinic in Bangkok. As the first transgender health clinic in the region, it has served as a research and service platform to advance transgender-competent health care.

The five- year project started Aug. 1 and is divided into two phases.

The first phase includes interviews with key stakeholders to explore barriers and facilitators of PrEP usage to inform intervention adaptation, and later, adapting and beta testing the Motivational Enhancement System for PrEP, or MES-PrEP Uptake and Adherence and enhanced YaCool for functionality and feasibility using a community advisory board of HIV-negative Thai transgender women.

 In phase two, they will conduct a trial with 160 young transgender women to evaluate the feasibility, acceptability and preliminary efficacy of MES-PrEP and YaCool.

At the conclusion of the pilot work in 2026, the researchers plan to pursue additional NIH funding for a full clinical trial of the resulting intervention.

The grant number for this National Institutes of Health award is 1R21/R33 HD107988.

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