Background: Several recent studies have documented persistent multi-level discrimination and social exclusion, and health needs of transgender and non-binary (TNB) communities in Baltimore, Maryland, including disproportionate HIV risk and prevalence. Launched to address gaps in the local evidence base to inform TNB health needs and priorities for the Baltimore metropolitan area, the Behavioral Surveillance Research Study (BESURE)’s Transgender Health Project, is a community-engaged research and practice initiative that aims to: identify the strengths and assets, and understand health, social, and service needs of TNB individuals living in and around Baltimore. Formative research was critical for informing development of a community-academic partnership for improving the health and wellbeing of TNB people in Baltimore. Methods: A comprehensive review of existing local data and insights from prior research among TNB communities in the region provided a foundation for primary data collection. Key informant (KIIs) interviews (n=15) were conducted with community leaders, allies, and health and social service providers well known to the local TNB community. Subsequently, six small group discussions (SGDs) were conducted with TNB individuals (n=21), recruited using a purposive sampling approach. Field guides addressed: (1) best practices for conducting research, (2) community challenges and needs, (3) opportunities for collaboration and mechanisms for data dissemination. KIIs and SGDs were audio-recorded and transcribed verbatim. Analysis included identification of key themes, debriefing with community advisory board members and co-investigators, and ongoing theoretical sampling to explore relationships among themes and inform next steps in research and program development. Results: Participants described frustration with: researchers’ focus on HIV among transgender women; lack of attention to transgender men and non-binary individuals; and persistent focus on health problems instead of strengths and resiliency. Participants suggested broad inclusion of TNB communities, intentionality in development of research, and attention to TNB individuals’ immediate needs through direct linkage to resources, partnerships with trusted local organizations and community leaders, and, recognizing that TNB communities are supporting themselves when services are unavailable, filling gaps where useful. A need for continuous and strategic research dissemination was emphasized, including transparency, ongoing collaboration, and data sharing and training to maximize data utilization by community members and stakeholders to inform policy and practice. Participants felt strongly about the importance of TNB inclusion among project staff and decision makers for project success and sustainability, and particularly for engaging previously excluded TNB communities. Conclusions: These findings highlight key recommendations for TNB health research and program development that centers community voices and goals. These recommendations have been integrated into the operational plan for the BeSuRe Transgender Health Project, which now includes a multidimensional research component, a direct service linkage and support component, and a mutual knowledge transfer component focused on community and systems level capacity building, dissemination, and communication.

 
Background:
HIV continues to have a disparate impact on youth assigned male at birth who have male sexual partners – young men who have sex with men (YMSM), young trans women (YTW), and gender nonconforming (GNC) youth. Outcomes are generally worse for these youth when they are also people of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence these young people’s proximity to HIV risk, by limiting their access to health care and potentially moving them toward sex work as a means of income. Work2Prevent is an intervention that intends to target economic stability (i.e., employment) as a structural-level intervention for preventing adolescent HIV. The Work2Prevent curriculum is an adaptation of an effective theoretically-driven, employment program for HIV-positive adults (iFOUR), tailored to the needs of at-risk Black and Latinx YMSM and YTW/GNC, ages 16-24.
 
Methods:
In the preparatory phase of the Work2Prevent study, 21 interviews and 7 focus groups were conducted in Chicago with a total of 67 Black and Latinx YMSM, YTW, and GNC individuals who were assigned male at birth (ages 16-32). Interviews and focus groups were used to gather information about participants’ experiences navigating employment and elements they considered desirable in a tailored employment intervention. After initial analysis of the qualitative data, the research team engaged in a process of multiple phases of curriculum revision, review with a community advisory board (CAB), and subsequent revision. In this process, modules were developed, revised, and removed as necessary in order to tailor the intervention for the needs of the target population.
 
Results:
Participants indicated a number of areas for growth which could be addressed in Work2Prevent, including applying a queer lens to appropriate interview apparel, navigating homo/transphobia in the workspace, and understanding the affordances and limitations of working in the cash economy as compared to the formal economy. CAB members identified opportunities for including culturally appropriate images and vignettes/examples in the workbook. Further, CAB members assisted in the co-development of 4 games to be included in Work2Prevent and modules exploring the reciprocal relationship between employment and health. After revising the iFOUR workshop manual in accordance with qualitative findings and CAB feedback, research staff were able to reduce the intervention from a 50-hour workshop (20 weeks, 20 sessions) to a 16-hour workshop (2 weeks, 4 sessions).
 
Discussion: 
The feedback provided through interviews, focus groups, and CAB meetings was critical for adapting the iFOUR curriculum material for the Black and Latinx YMSM and YTW/GNC, ages 16-24, to be involved in Work2Prevent. This feedback allowed the research team to clarify the needs of the target population in order to increase the cultural and developmental appropriateness of the intervention. This work facilitated the development of activities that were respectful of the particularities of these populations’ experiences, prioritized areas for growth identified by community members, and ensured there were multiple opportunities for interactivity/play during the workshops.
This work was supported by a sub-award from the NIH Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) [U24 HD089880].

Background: Young men who have sex with men (YMSM) bear a disproportionate burden of the HIV epidemic, and most new infections in this population occur in the context of serious romantic relationships. Relationships also provide myriad benefits that promote mental and physical health. Thus, our team developed 2GETHER, an innovative relationship education and HIV prevention program for young male couples that indicated preliminary efficacy in a pilot non-randomized trial. This presentation will describe the adaptation of 2GETHER for remote administration via videoconferencing as part of a national randomized controlled trial. Methods: We conducted the online adaptation of 2GETHER in two phases: an initial content adaptation, followed by a pilot feasibility and acceptability trial. Phase 1 included researching videoconferencing platforms, refining intervention content for online delivery based on literature review and expert consultation, and internal testing. In Phase 2, we conducted a pilot trial of the adapted intervention with 10 dyads (N=20). Participants were diverse in terms of race/ethnicity, HIV status, and geographic location. Participants completed a baseline assessment, consisting of three components: 1) online self-report questionnaire; 2) at-home testing for urethral and rectal Chlamydia and Gonorrhea; and 3) video-recording a couple communication task. Participants then completed group skill building sessions, followed by individualized couple sessions for skill implementation. Upon completion of the intervention, participants completed a 2-week posttest and exit interview. Results: During Phase 1, we made several alterations to address participant fatigue. First, we split the 2 group sessions into 3 sessions to minimize loss of attention. Second, we pre-recorded videos of narrated PowerPoint slides of intervention content and sent them to participants 1 week prior to group sessions (i.e., 3 twenty-minute self-paced modules presenting relationship education and sexual health information and skills). This facilitated briefer, more focused group sessions. These sessions occurred via BlueJeans videoconference with up to 6 couples and 2 facilitators, emphasizing discussion questions and activities that reinforced content presented in video modules. With regard to pilot feasibility and acceptability, recruitment was rapid and couples were diverse in terms of sexual health and risk behaviors. We identified few issues with the adapted intervention. All participants completed all study components and reported few concerns with the format or content. Some participants experienced delays in completing at-home STI testing and recording their communication task. Through participant and staff feedback, we simplified instructions for these tasks and allowed couples to schedule appointments with staff to record the communication task remotely. We experienced occasional connectivity issues during videoconference sessions and difficulty scheduling across time zones. We modified protocols to minimize these barriers (e.g., clarifying and simplifying instructions given to participants, recruiting participants into cohorts by time zone). Discussion: Results supported the feasibility and acceptability of delivering 2GETHER online via videoconferencing; we were able to reach couples throughout the country with diverse relationship and sexual health experiences. Together with evidence of preliminary efficacy from the original pilot trial, 2GETHER shows strong promise of efficacy in both online and in-person formats.