Participants (transgender women, transgender men, and non-binary persons engaging in chemsex or substance use) will receive a comprehensive, transgender-tailored harm reduction service over a 12-month follow-up period. The intervention includes substance use harm reduction, sexual health services including HIV pre-exposure prophylaxis (PrEP), mental health screening and support, and socio-legal assistance. Participants will attend study visits at baseline and months 3, 6, 9, and 12, with assessments of behavioral risks, substance use, mental health, HIV/STI testing, and social outcomes.

A comprehensive, multi-component harm reduction service tailored for transgender individuals engaging in chemsex, substance use, implemented at Tangerine Clinic.

The intervention includes:

1. Substance Use Harm Reduction

   • Drug-specific literacy, safer use education
   • Counseling on overdose prevention and safer consumption
   • Provision of harm reduction kits

2. Sexual Health Services

   • HIV testing
   • STI screening and treatment (CT/NG, syphilis, HBV, HCV)
   • Provision of PrEP including:
   • Daily oral PrEP
   • Event-driven PrEP

3. Mental Health Services

   • Screening using:
   • Electronic Mental Wellness Tool
   • Community Mental Wellness Tool
   • Referral to psychiatric care when indicated

4. Socio-legal Support

   • Counseling on stigma, discrimination, and legal issues
   • Support for gender-affirming care access

Proportion of participants who initiate any form of HIV pre-exposure prophylaxis (daily oral PrEP or event-driven PrEP) during the 12-month follow-up period among those not on PrEP at baseline.

Metric: Percentage (%)

Proportion of participants reporting consistent use of PrEP according to the prescribed regimen (daily or event-driven), assessed using self-report during follow-up visits.

Metric:Percentage (%) A. PrEP adherence (self-report)

• Metric: % B. PrEP adherence (visit-based adherence score)
• Metric: score (scale range 0-100)