SeCuRE Pilot Trial: A Community-Engaged HIV Status-Neutral Microeconomic Intervention in the United States

Transgender women of color in the United States experience inequities across the HIV prevention and care continua shaped by intersectional oppression and economic marginalization. We evaluated the "Strengthening Community Responses to Economic Vulnerability" (SeCuRE) intervention, an HIV status-neutral, multicomponent program comprising financial assistance, peer-facilitated group sessions focused on economic empowerment, gender affirmation, community support, individualized mentorship, and microgrants, in a two-arm pilot mixed-methods randomized waitlist-controlled trial with transgender women of color in Detroit, Michigan. The intervention included 12 peer-led group sessions adapted from a prior microenterprise program and individualized mentoring with a microgrant. Primary outcomes were feasibility, acceptability, and fidelity. Enrollment was 97.5% (39/40), retention ranged from 84.6 to 87.2%, and group attendance averaged 90.3%. Acceptability was high and fidelity benchmarks were achieved. Exploratory analyses showed significant improvements in financial self-efficacy at 3 months (B = 0.67, 95% CI 0.16-1.17, z = 2.60, p = 0.009) and reductions in condomless sex at 6 months (OR = 0.05, 95% CI 0.002-0.86, z = - 2.06, p = 0.040). Qualitative exit interviews indicated high acceptability and highlighted themes of financial empowerment, community connection, and affirming environments. SeCuRE was feasible, acceptable, delivered with fidelity, and showed preliminary efficacy. Findings underscore the urgent need for larger trials of community-driven, status-neutral interventions embedded within community partnerships that provide housing, food, and financial supports.