Improving HIV and Depression Outcomes by Reducing HIV-Mental Illness Stigma in Malawi: a pilot effectiveness-implementation trial

在马拉维通过减少艾滋病毒精神疾病耻辱来改善艾滋病毒和抑郁症的结果：试点有效性实施试验

• 批准号: 10484751
• 负责人: Melissa Ann Stockton
• 金额: $ 17.99万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10484751
• 关键词: Address; Adult; Affect; Africa South of the Sahara; Antidepressive Agents; Caring; Clinical; Communities; Country; Data; Depressed mood; Educational workshop; Epidemic; Epidemiology; Evidence based intervention; Focus Groups; Foundations; Goals; Government; Group Interviews; HIV; Health; Health Sciences; Health Services Accessibility; Hybrids; Individual; Intervention; Interview; Investments; Knowledge; Level of Evidence; Malawi; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentored Research Scientist Development Award; Mentorship; Methodology; Methods; Modeling; Morbidity - disease rate; Nature; Outcome; Patient-Focused Outcomes; Patients; Personal Satisfaction; Persons; Phase; Policies; Provider; Psychotherapy; Reading; Reporting; Research; Research Personnel; Research Training; Resource-limited setting; Site; Stereotyping; Stigmatization; Strategic Planning; Testing; Time; Training; Work; base; career; community based participatory research; comorbid depression; coping mechanism; depressed patient; design; effectiveness implementation study; effectiveness implementation trial; evidence base; experience; implementation barriers; implementation evaluation; implementation facilitators; implementation intervention; implementation outcomes; implementation science; improved; innovation; insight; intersectionality; mortality; pilot trial; programs; psychoeducation; scale up; skills; social stigma; symposium; treatment program; treatment services

ABSTRACT Among people living with HIV (PLHIV), stigma and mental illness (MI), such as depression, bar access to care and worsen health outcomes, particularly in countries like Malawi where 10% of adults are living with HIV and up to a 25% of PLHIV have co-morbid depression. As depression treatment is increasingly integrated into HIV care, interventions helping to reduce stigma for patients facing multiple and intersecting stigmas— HIV, MI, and intersectional stigma— are crucial for engagement in care and improvement of health outcomes. Yet, most individual-level stigma-reduction interventions address only one type of stigma. As such, there is a missed opportunity to address multiple stigmas at once to serve patients. The overall aim of this proposal is to consolidate an evidence-based HIV-MI stigma-reduction intervention with depression treatment for PLHIV and conduct a hybrid effectiveness-implementation pilot to evaluate its implementation and impact on patient outcomes in Malawi. My long-term career goal is to become a leading researcher on implementing and evaluating intersectional interventions that address stigma and meet the mental health (MH) needs of PLHIV. This K01 award will enable me to build upon my strong foundations in epidemiology, qualitive methods, and implementation science to address gaps in my training and develop the necessary expertise to transition into an independent investigator. My training goals are to obtain: 1) substantive knowledge in intersectional stigma and individual-level stigma-reduction interventions; 2) theoretical and methodological skills to combine and consolidate multiple evidence-based interventions using a participatory community-based research approach; and 3) expertise in designing and executing hybrid effectiveness-implementation studies to evaluate both implementation and clinical (e.g., HIV and MH) outcomes. These goals will be achieved through a combination of direct mentorship, coursework, seminars, directed readings, workshops, conferences and hands-on experience. In my proposed research, I will first combine interventions that address HIV, MI and intersectional stigma, consolidate with depression care for PLHIV and develop plans for implementation drawing from focus groups and interviews (Aim 1). I will then evaluate the implementation of the consolidated HIV-MI stigma- reduction intervention and its impact on patient stigma, depression, and HIV care engagement in a two-site pilot hybrid effectiveness-implementation trial (Aim 2). This innovative research will (a) address HIV, MI and intersectional stigma while leveraging existing MH services, (b) prepare for multi-level stigma-reduction intervention packages, and c) yield detailed insights into barriers and facilitators of implementing stigma- reduction interventions in low-resource settings. Ultimately, the proposed study and training will provide me with the skills and preliminary data for an R01 proposal to conduct a full hybrid effectiveness-implementation trial to implement and evaluate a multi-level stigma-reduction intervention in Malawi.

抽象的 在艾滋病毒（PLHIV），污名和精神疾病（MI）（例如抑郁症）中 护理和最糟糕的健康状况，特别是在马拉维这样的国家，有10％的成年人患有艾滋病毒 多达25％的PLHIV具有合并抑郁症。随着抑郁症治疗越来越多地整合到 HIV护理，干预措施有助于减少面临多个污名和相交污名的患者的污名 - 艾滋病毒， MI和交叉污名 - 对于从事护理和改善健康成果至关重要。然而， 大多数个人水平的污名干预措施仅处理一种类型的污名。因此，有一个 错过的机会立即解决多个污名来服务患者。该提议的总体目的是 通过抑郁症治疗PLHIV和 进行混合有效性实施试验，以评估其实施并对患者的影响 马拉维的结果。我的长期职业目标是成为实施和 评估解决污名并满足PLHIV心理健康（MH）需求的跨间干预措施。 这项K01奖将使我能够在流行病学，定性方法和 实施科学，以解决我的培训中差距，并发展必要的专业知识，以过渡到 独立研究者。我的培训目标是获得：1）交叉污名中的实质性知识 和个人污名化干预措施； 2）理论和方法论技巧合并和 使用基于社区的研究方法来巩固多种基于证据的干预措施； 3）设计和执行混合有效性 - 实现研究以评估这两者的专业知识 实施和临床（例如，艾滋病毒和MH）结果。这些目标将通过组合实现 直接训练有素，课程工作，半手，定向阅读，讲习班，会议和动手 经验。在我提出的研究中，我将首先结合解决HIV，MI和Intercientional的干预措施 污名，合并为PLHIV的抑郁症护理和从重点进行实施的开发计划 小组和访谈（目标1）。然后，我将评估合并的HIV-MI污名的实施 减少干预及其对患者污名，抑郁和艾滋病毒护理的影响 试点混合有效性实施试验（AIM 2）。这项创新的研究将（a）介绍艾滋病毒，密歇根州和 在利用现有MH服务的同时，（b）为减少污名做准备 干预包，c）对实施污名的障碍和促进者产生详细的见解 - 低资源设置的减少干预措施。最终，拟议的研究和培训将为我提供 借助R01提案的技能和初步数据，以进行完整的混合有效性实施 试验以在马拉维实施和评估多层污名干预措施。