Controlled Trial of Game Changers: A Group Intervention to Train HIV Clients to be Change Agents for HIV Prevention in Uganda

游戏规则改变者的对照试验：培训艾滋病患者成为乌干达艾滋病毒预防变革推动者的集体干预

• 批准号: 10319366
• 负责人: Laura M Bogart
• 金额: $ 80.5万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-06 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10319366
• 关键词: AIDS prevention; Address; Advocacy; Advocate; Behavior; Caring; Client; Cognitive; Communicable Diseases; Communities; Cost Effectiveness Analysis; Diffusion; Disclosure; Epidemic; Family; Focus Groups; Friends; Funding; Government; HIV; HIV risk; Health; Health Personnel; High Prevalence; Household; Human immunodeficiency virus test; Incidence; Individual; Information Networks; Institutes; Intervention; Mediating; National Institute of Mental Health; Outcome; Participant; Penetration; Politics; Positioning Attribute; Prevalence; Prevention; Process; Randomized; Randomized Controlled Trials; Research; Risk; Social Network; Surveys; Testing; Time; Touch sensation; Training; Uganda; Unsafe Sex; Viral; Viral Load result; Woman; Work; acceptability and feasibility; aged; antiretroviral therapy; arm; attentional control; behavior change; community living; condoms; fight against; group intervention; improved; innovation; intervention effect; member; men; peer; pre-exposure prophylaxis; primary outcome; public-private partnership; recruit; secondary outcome; sex; social; social stigma; theories; therapy development; tool; uptake; virtual; AIDS prevention; Address; Advocacy; Advocate; Behavior; Caring; Client; Cognitive; Communicable Diseases; Communities; Cost Effectiveness Analysis; Diffusion; Disclosure; Epidemic; Family; Focus Groups; Friends; Funding; Government; HIV; HIV risk; Health; Health Personnel; High Prevalence; Household; Human immunodeficiency virus test; Incidence; Individual; Information Networks; Institutes; Intervention; Mediating; National Institute of Mental Health; Outcome; Participant; Penetration; Politics; Positioning Attribute; Prevalence; Prevention; Process; Randomized; Randomized Controlled Trials; Research; Risk; Social Network; Surveys; Testing; Time; Touch sensation; Training; Uganda; Unsafe Sex; Viral; Viral Load result; Woman; Work; acceptability and feasibility; aged; antiretroviral therapy; arm; attentional control; behavior change; community living; condoms; fight against; group intervention; improved; innovation; intervention effect; member; men; peer; pre-exposure prophylaxis; primary outcome; public-private partnership; recruit; secondary outcome; sex; social; social stigma; theories; therapy development; tool; uptake; virtual

PROJECT SUMMARY In Uganda, HIV prevalence is estimated to be 6.2% among those aged 15-64, and is higher (6.9%) in Kampala, the proposed study setting. Political and cultural barriers, including limited government funding and HIV stigma, impede HIV prevention and have led to projections of rapid increases in HIV incidence. The proposed research will be a randomized controlled trial (RCT) of Game Changers, a 6-session peer-led group intervention that aims to empower and mobilize people living with HIV (PLWH) to be agents for HIV prevention in their social networks. By decreasing stigma among PLWH and their social network members, and training PLWH on strategies to engage social network members in discussions around HIV, Game Changers provides PLWH with the tools to do prevention advocacy. Game Changers was developed through an NIMH R34 that found high feasibility and acceptability, and preliminary intervention effects on increased HIV prevention advocacy between PLWH and their social network members, reduced internalized stigma, and increased HIV-serostatus disclosure to social network members among PLWH, and medium to large effects on increased condom use and HIV testing among a subsample of network members. The Specific Aims are: (1) To conduct an RCT of Game Changers, a peer- led group intervention for PLWH in Uganda, to test intervention effects on the primary outcomes of reduced condomless sex, increased HIV testing, and decreased enacted HIV stigma among social network members; (2) To test intervention effects on the secondary outcomes of reduced internalized HIV stigma, increased HIV serostatus disclosure, and increased viral load suppression among PLWH, and PrEP uptake among social network members; (3) To examine whether increased HIV prevention advocacy by PLWH mediates intervention effects on social network members’ increased condom use and HIV testing, and whether increased HIV disclosure by PLWH mediates intervention effects on social network members’ reduced enacted HIV stigma; and (4) To conduct a cost-effectiveness analysis of the intervention. We will recruit 210 PLWH, randomizing 105 to the intervention and 105 to an attention control. Each PLWH will be asked to recruit social network members to complete assessments (736 total, 368/arm), to test intervention effects on social networks. All participants will complete surveys at baseline and 6-, 12-, and 18-months post-baseline; PLWH will also complete social network assessments. The cost-effectiveness analysis will inform policymakers about whether Game Changers is a feasible intervention in which to invest. Our approach is particularly timely in the era of biomedical interventions, which require widespread penetration of effective HIV prevention messaging into communities. Positioning PLWH as central to the solution for controlling (vs. causing) the HIV epidemic has the potential to reduce HIV stigma and improve prevention outcomes at the individual, household, and network levels.

项目摘要 在乌干达，艾滋病毒的患病率估计为15-64岁的艾滋病毒率是6.2％，坎帕拉（Kampala）较高（6.9％） 拟议的研究环境。政治和文化障碍，包括有限的政府资金和艾滋病毒污名， 阻碍了艾滋病毒预防，并导致了艾滋病毒事件快速增加的预测。拟议的研究 将是一个随机对照试验（RCT），改变游戏规则，这是一个6节的同行团体干预措施 赋予和动员艾滋病毒（PLWH）的人们成为社交网络中预防艾滋病毒的代理人。 通过减少PLWH及其社交网络成员之间的污名，并培训PLWH的策略 让社交网络成员参与围绕艾滋病毒的讨论，游戏规则改变者为PLWH提供工具 做预防倡导。改变游戏规则是通过NIMH R34开发的，该R34发现高可行性和 可接受性和初步干预对PLWH和PLWH之间的HIV预防倡导的影响影响 他们的社交网络成员减少了内在的污名，并增加了HIV-Serostatus向社会披露 PLWH中的网络成员，以及对避孕套使用和艾滋病毒测试增加的中等至重要影响 网络成员的子样本。具体目的是：（1）进行改变游戏规则的RCT，同行 LED在乌干达对PLWH的小组干预，以测试干预对减少的主要结果的影响 社交网络成员中无避孕套的性别，增加艾滋病毒测试以及增加了艾滋病毒的污名； （2） 测试干预对降低内部HIV污名的次要结果的影响，HIV增加 血统的披露，增加了PLWH之间的病毒载荷抑制，并在社交中吸收了准备 网络成员； （3）检查是否增加了PLWH媒体干预的预防艾滋病毒预防倡导 对社交网络成员增加的安全套使用和艾滋病毒测试的影响，以及艾滋病毒是否增加 PLWH披露介导了干预对社交网络成员减少的艾滋病毒污名的影响； （4）对干预措施进行成本效益分析。我们将招募210 PLWH，随机化105 进行干预和105进行注意力控制。每个PLWH将被要求招募社交网络成员 要完成评估（总计736个/ARM），以测试对社交网络的干预影响。所有参与者都会 在基线以及6个月和18个月后的基线和18个月后完成调查； PLWH还将完成社交网络 评估。成本效益分析将告知决策者游戏改变者是否是 可行的干预措施。在生物医学干预时代，我们的方法尤其及时， 需要将有效的艾滋病毒预防消息传递到社区中的宽度渗透。定位 PLWH是控制解决方案（与导致）hiv流行的核心 污名并改善了个人，家庭和网络水平的预防结果。