Adapting the Finding Respect and Ending Stigma around HIV (FRESH) Intervention for the Dominican Republic

为多米尼加共和国调整“寻求尊重并消除艾滋病毒耻辱”(FRESH) 干预措施

基本信息

批准号：
10220168
负责人：
Henna Budhwani
金额：
$ 14.94万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2022-08-08
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10220168
关键词：
Address Affect Africa Age Attitude Behavior Caribbean region Caring Characteristics Client Clinic Clinical Communities Consequences of HIV Continuity of Patient Care Country Data Data Collection Deep South Development Dominican Republic Educational workshop Epidemic Feedback Focus Groups Funding Future Goals HIV HIV Infections Health Personnel Healthcare Systems Home Intervention Interview Minority Groups Modeling Outcome Patients Perception Phase Pilot Projects Process Provider Randomized Randomized Controlled Trials Reporting Research Research Personnel Resources Services Sexual and Gender Minorities Site Societies Source Stigmatization Surveys System Testing Time United States Viral Load result Vision base care outcomes combat design empowered experience health care settings men who have sex with men post intervention primary outcome provider intervention satisfaction secondary outcome social cognitive theory social stigma theories therapy design transgender women

项目摘要

PROJECT SUMMARY The proposed study addresses the high level of stigma against people living with HIV (PLWH), particularly gender and sexual minorities, that is embedded in the Dominican Republic’s HIV treatment system through the adaptation and testing of a patient-provider intervention -- Finding Respect and Ending Stigma around HIV (FRESH). The Dominican Republic is a high priority setting with an increasing need for HIV stigma reduction studies. The Caribbean holds the second highest regional burden of HIV in the world, yet receives insufficient HIV-related stigma research funding. The Dominican Republic is 1 of 5 countries that accounts for over 95% of all Caribbean HIV infections; it also has a significant concentrated HIV epidemic, a deeply conservative society in which PLWH are stigmatized, and an exceptionally low national viral load suppression rate. To accomplish this pilot study, three Specific Aims are proposed. Aim 1 is to explore sources, characteristics, and consequences of HIV-related and intersectional stigmas experienced in healthcare settings by MSM and transgender women to inform the adaptation of FRESH. To accomplish Aim 1, we will conduct qualitative in-depth interviews with healthcare workers who provide HIV care, focus groups with MSM, and in-depth interviews with transgender women. Aim 2 is to adapt FRESH to address stigmas experienced by MSM and transgender women in the Dominican Republic. We will apply the Aim 1 findings using the ADAPT-ITT framework to systematically adapt FRESH, an intervention that has been employed to reduce stigma in healthcare settings in Africa and the United States. Through an iterative process, each revision of FRESH will be shared with both PLWH and healthcare workers to solicit and incorporate their feedback about each version of the adapted intervention. Aim 3 will pilot- test the adapted intervention to obtain estimates of its ability to reduce stigmatizing attitudes and behaviors from HWs and experiences of stigma reported by sexual and gender minorities (SGM) and non-SGM clients living with HIV (primary); while exploring if FRESH has the potential to influence clinic-level HIV cascade outcomes. By adapting and testing the FRESH intervention for the Spanish-speaking Caribbean, FRESH could become a validated, multi-region HIV and intersectional stigma reduction intervention designed specifically for healthcare settings in high-stigma, culturally conservative, resource-constrained communities; such a scientific development would be a significant contribution to HIV stigma reduction efforts in the Caribbean and globally.

项目概要拟议的研究解决了对艾滋病毒感染者（PLWH）的高度耻辱，特别是性别和性少数群体，通过以下方式纳入多米尼加共和国的艾滋病毒治疗系统：患者-提供者干预措施的调整和测试——寻找尊重并结束艾滋病毒耻辱 (FRESH) 多米尼加共和国是一个高度优先的国家，减少艾滋病毒耻辱感的需求日益增加。加勒比地区的艾滋病毒负担位居世界第二，但其接受的艾滋病毒治疗不足。多米尼加共和国是占 95% 以上的 5 个国家之一。所有加勒比地区的艾滋病毒感染者；该国的艾滋病毒流行情况也非常集中，是一个非常保守的社会 PLWH 受到污名化，全国病毒载量抑制率极低。这项试点研究提出了三个具体目标 1 是探索来源、特征和后果。 MSM 和跨性别女性在医疗机构中经历的与艾滋病毒相关和交叉的耻辱为了实现目标 1，我们将与 FRESH 进行定性深入访谈。提供艾滋病毒护理的医护人员、MSM 焦点小组以及跨性别者的深度访谈目标 2 是采用 FRESH 来解决 MSM 和跨性别女性所经历的耻辱。多米尼加共和国。我们将使用 ADAPT-ITT 框架应用目标 1 的研究结果来系统地进行调整。 FRESH，一种干预措施，已被用于减少非洲和美国医疗机构中的耻辱感通过迭代过程，FRESH 的每次修订都将与 PLWH 和医疗保健部门共享。工作人员征求并纳入他们对目标 3 将试点的每个版本的反馈。测试调整后的干预措施，以评估其减少污名化态度和行为的能力性少数群体 (SGM) 和非 SGM 客户报告的 HW 和耻辱经历 HIV（主要）；同时探索 FRESH 是否有可能影响临床层面的 HIV 级联结果。通过对加勒比西班牙语地区的 FRESH 干预进行调整和测试，FRESH 可能会成为专为医疗保健而设计的经过验证的多区域艾滋病毒和交叉耻辱减少干预措施耻辱感高、文化保守、资源有限的社区的环境；发展将为加勒比地区和全球减少艾滋病毒耻辱的努力做出重大贡献。