Multi-Level Intervention Addressing Intersectional Stigma to Improve HIV Testing in MSM

多层次干预解决交叉耻辱，改善男男性行为者的艾滋病毒检测

• 批准号: 10431888
• 负责人: LaRon Earnest Nelson
• 金额: $ 53.9万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10431888
• 关键词: AIDS prevention; Address; Behavior; Budgets; Car Phone; Caring; Cities; Clinic; Counseling; Discrimination; Education; Empathy; Exposure to; Face; Feedback; Focus Groups; Frequencies; Gender; General Population; Ghana; HIV; HIV Infections; HIV diagnosis; Health; Health Policy; Health Status; Health care facility; Human immunodeficiency virus test; Individual; Intervention; Interview; Life; Location; Maintenance; Manuals; Methods; Modeling; Motivation; Outcome; Peer Group; Persons; Phase; Prevalence; Protocols documentation; Randomized; Randomized Controlled Trials; Reporting; Research; Same-sex; Sampling; Science; Social Network; Social support; Source; Stigmatization; Symptoms; Testing; Time; Voice; Work; acceptability and feasibility; arm; base; behavior test; civil society; community clinic; efficacy trial; empowerment; evidence base; gender nonconforming; improved; intervention effect; marginalized population; member; men; men who have sex with men; novel; peer; predictive modeling; prevention service; recruit; rehearsal; same sex behavior; scale up; self testing; sex; social norm; social stigma; standard of care; starfish sampling; testing services; theories; treatment as usual; trial design

PROJECT SUMMARY HIV prevalence among men with have sex with men (MSM) in Ghana is at least eight times higher than that of the general population (2%). MSM in Ghana face high levels of stigma due to HIV status (actual or perceived), same-sex behavior, and gender non-conformity. These stigmas are documented barriers to HIV prevention and treatment. In our preliminary work in Ghana (N=137), one-third of MSM had never been tested for HIV. We propose a randomized controlled trial to evaluate the feasibility, acceptability and estimate effect size of a multi-component, multi-level (organizational, interpersonal, and intrapersonal-level) intersectional stigma-reduction intervention to increase HIV testing frequency among MSM in Ghana where HIV, same-sex behavior and gender non-conformity are highly stigmatized. To date, stigma-reduction interventions in Ghana have focused on uni-level targets (e.g., health care facilities (HCFs)) and addressed one type of stigma (e.g., HIV), without engaging the intersectional character of the multiple stigmas that MSM encounter. Our specific aims are: (1) to evaluate the feasibility and acceptability of a novel multi-component, multi-level intervention to address intersectional stigma and (2) to estimate effect size of the intervention for scale up to a definitive efficacy trial. We will combine three theory-based interventions that were previously implemented separately in Ghana for reducing stigma at HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. We will use the Convergence Framework for combining interventions. The ADAPT-ITT framework guides our approach to enhancing the interventions’ content on intersectional stigma. To achieve these aims we will undergo a systematic adaptation that will refine the individually developed HCF, peer- and individual-level interventions to produce a comprehensive multi-level intersectional stigma reduction intervention. This will consist of focus groups and in-depth interviews with HCF staff and MSM to sharpen content on drivers and manifestations of HIV, same-sex and gender non-conforming stigmas within HCFs and peer groups and how these intersecting stigmas undermine HIV testing. This information will be used to refine the content of the interventions which will then be reviewed by a workgroup of HCF and Ghanaian MSM. The trial involves 8 HCFs, matched on HCF staff size. Matched pairs will each be randomized to have an intervention and a control arm. Before assignment to HCFs, 216 MSM, recruited through Starfish Sampling (combined time-location and peer-referral sampling), will be randomized to receive the intervention or usual care. Each arm of MSM will have members randomized to one of the four clinics per city and asked to stay in the assigned community-clinic pipeline. Using the RCT design, we will formally test the following outcomes: HIV testing at 3 and 6 months, acceptability and feasibility. We will fit multi-level regression models for the predictor variables at the HCF, peer and individual-levels. Based on the study’s findings, we will finalize a protocol to test our intervention in a definitive efficacy trial.

项目摘要 加纳与男性发生性关系（MSM）男性的艾滋病毒患病率至少是一般的八倍 人口（2％）。由于艾滋病毒状况（实际或感知），同性行为和 性别不符。这些污名是预防HIV和治疗的障碍。在我们的初步工作中 在加纳（n = 137）中，三分之一的MSM从未接受过HIV的测试。我们提出了一项随机对照试验来评估 多组分，多层次（组织，人际关系和 人际级别的污名减少干预措施，以增加加纳MSM中MSM中的HIV测试频率 在艾滋病毒，同性行为和性别不符合性的情况下，高度污名化。迄今为止，减少污名干预措施 在加纳，专注于统一目标（例如，医疗保健设施（HCFS）），并解决了一种类型的污名（例如，艾滋病毒）， 不参与MSM遇到的多个污名的交叉特征。我们的具体目的是：（1） 评估新型多组分，多层干预的可行性和可接受性，以解决交叉 污名和（2）以估计干预措施的效果大小，以扩展到确定性有效性试验。我们将结合三个 以前在加纳分别实施的基于理论的干预措施，以减少HCF级的污名， 增加在同伴组级别的艾滋病毒测试，并增加个人级别的同伴社会支持。我们将使用 合并干预措施的收敛框架。改编-ITT框架指导我们增强的方法 干预措施对交叉污名的内容。为了实现这些目标，我们将进行系统的适应 完善单独开发的HCF，同伴和个体级别的干预措施，以产生全面的多层次 交叉柱头还原干预措施。这将包括焦点小组和与HCF员工的深入访谈以及 MSM在HCFS内培养驱动因素和艾滋病毒，同性和性别不合格的污名的驱动因素和表现 以及同伴组以及这些相交的污名如何破坏HIV测试。此信息将用于完善 干预措施的内容将由HCF和加纳MSM的工作组进行审查。试验涉及8 HCF，与HCF员工大小相匹配。匹配的对将随机分配以进行干预和对照组。前 通过海星采样（合并时位置和同行推荐采样）招募到216 MSM的HCFS，216 MSM， 将被随机接受干预或通常的护理。 MSM的每个臂都将使成员随机分配到其中一个 每个城市的四个诊所，并要求留在指定的社区临床管道中。使用RCT设计，我们将 正式测试以下结果：3和6个月的HIV测试，可接受性和可行性。我们将适合多层次 HCF，同伴和个体级别的预测变量的回归模型。根据研究的发现，我们将 最终确定一项协议，以测试我们在确定效率试验中的干预措施。