4 - (SYM 130) A Delphi Method Study to Adapt Behavior Activation/exposure Group Therapy to Address Syndemic Mental Health and HIV Risk Among Transgender Women

Depression, anxiety, and HIV risk are mutually reinforcing syndemic factors driving health disparities among transgender women. 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 risk mechanisms that cut across social, individual, and biological contexts. Behavioral avoidance has been identified as a key mechanism underlying anxiety and depressive disorders; anxiety and depression have also been shown to increase the morbidity of HIV by poor adherence to treatment. 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 constitutes a first step in addressing this gap by using a modified Delphi Method approach to adapt a transdiagnostic group BA/EXT intervention to increase uptake of HIV preventative health behaviors and decrease depression and anxiety among transgender women 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 Delphi process comprising data from an expert panel (N = 10) including 5 BA/EXT experts and 5 experts in transgender mental health whose collective expertise with be systematically culled in a consensus-building process to identify modifications necessary to implement existing BA/EXT protocols for: 1) transgender women at highest risk for HIV, 2) delivery by peer/community facilitators, and 3) the community-based setting. The preliminary treatment manual will be presented along with a discussion of next steps in this research agenda (i.e., the conduct of a pilot trial).