1 - (SYM 2) A Community-engaged Pilot Implementation Trial of a Behavior Activation/exposure Group Therapy Intervention to Address Syndemic Mental Health and HIV Risk Among Transgender Women

Depression, anxiety, and HIV risk are mutually reinforcing syndemic factors driving behavioral health disparities among transgender women. Transgender women are at 66 times higher odds of being infected with HIV than the populace, concomitant with disparities in anxiety and depression. Given evidence that neither biomedical interventions nor psychosocial approaches delivered in clinical settings have appeared to meaningfully reduce these disparities, interrupting this syndemic may require interventions targeting transdiagnostic risk mechanisms that cut across social, individual, and biological contexts. Further, transgender women are subjected to high levels of discrimination, both within and outside healthcare settings that contribute to the development of depression and anxiety, and may reinforce avoidance of HIV-preventative behaviors (e.g., screening, testing, medication adherence). Behavioral activation (BA) and exposure therapy (EXT), long recognized as gold standard treatments for depression and anxiety, work by targeting behavioral avoidance. However, BA/EXT interventions were not designed to address the unique psychosocial pathways by which experiences of stigma, discrimination, and vigilance coping impact mental health and the HIV care continuum for transgender women.

The current study entails a pilot implementation trial of a transdiagnostic group BA/EXT intervention to increase uptake of HIV preventative health behaviors and decrease depression and anxiety among transgender women adapted for delivery in a community-based organization specializing in addressing the impact of social stigma and oppression on transgender women of color (i.e., The Brooklyn GHOST [Guiding and Helping Others Survive Tranisition] Project). We will present preliminary findings from the pilot implementation trial delivered by community facilitators to a group of ten transgender women presenting with  anxiety and/or depressive disorders. We will present data on the  feasibility of the implementation of the group-based BA/EXT program in a community-setting along with patient retention and satisfaction data. Preliminary impacts of the intervention on depressive/anxiety symptoms, HIV cascade of care outcomes, and their associations will also be presented.  Findings will be discussed in terms of their contributions to the growing body of implementation science research needed to inform expansion of the reach of cognitive-behavioral interventions to populations subjected to intransigent behavioral health inequities.