Reducing the intersecting stigmas of HIV, violence victimization, and mental health: a randomized controlled pilot integrating Project YES! Youth Engaging for Success and Problem Management Plus amon

减少艾滋病毒、暴力受害和心理健康的交叉耻辱：整合“YES！”项目的随机对照试点

• 批准号: 10542948
• 负责人: Julie Anne Denison
• 金额: $ 22.89万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542948
• 关键词: 19 year old; AIDS prevention; AIDS/HIV problem; Address; Adherence; Adolescence; Adolescent; Adolescent Health Services; Adolescent and Young Adult; Adult; Africa South of the Sahara; Age; Anti-Retroviral Agents; Anxiety; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Childhood; Chronic Disease; Clinic; Cognitive; Complex; Data; Data Collection; Development; Emotions; Ensure; Evidence based intervention; Failure; Feeling; Frequencies; Future; Goals; Guilt; HIV; Health; Interruption; Intervention; Link; Literature; Measurement; Measures; Mental Depression; Mental Health; Mentors; Odds Ratio; Outcome; PF4 Gene; Participant; Pathway interactions; Pediatric Hospitals; Population; Process; Randomized; Randomized Controlled Trials; Research; Risk; Services; Shame; Social Identification; South African; System; Testing; Thailand; United States National Institutes of Health; Victimization; Violence; Viral; Viral Load result; World Health Organization; Youth; Zambia; acceptability and feasibility; age group; antiretroviral therapy; base; cognitive interview; depressive symptoms; design; emotional abuse; experience; feasibility testing; health training; improved; internalized stigma; low and middle-income countries; medication compliance; peer; peer coaching; programs; psychologic; psychological violence; reduce symptoms; response; sexual violence; skills; social; social stigma; standard of care; success; systematic review; therapy adherence; violence victimization

PROJECT SUMMARY / ABSTRACT Stigma is increasingly recognized as a modifiable factor impacting antiretroviral therapy adherence and viral suppression among adolescents and young adults living with HIV (AYALHIV), however few interventions have effectively reduced stigma or address intersectional stigma among this population. In this study we will address internalized HIV stigma among AYALHIV, as well as internalized stigmas related to the prevalent youth experiences of violence and depression. Further, we will also focus on intersectional stigma, capturing anticipated stigma associated with the complex reality of AYALHIV’s multiple social identities. We will create an intervention to reduce these multiple stigmas by building upon the evidence-based intervention Project YES! Youth Engaging for Success. Project YES! is a peer mentoring program that effectively reduced HIV-internalized stigma among 15-to 24-year old AYALHIV in Zambia, and among a subset of pediatric clinic participants, increased their viral suppression. Project YES! data also highlighted critical intervention gaps, including high levels of physical, sexual and/or emotional violence victimization among AYALHIV, and how participants who screened positive for depression had lower levels of viral suppression. This data aligns with a growing body of evidence linking violence victimization and depression with internalized stigma and viral failure. Project YES! peer mentors would refer participants with violence experiences or depression and anxiety to the clinic health staff in a system that provides minimal mental health training or services for AYALHIV. This research seeks to address this gap by integrating the stigma reducing EBI youth peer mentoring program (Project YES!) with the World Health Organization endorsed and proven mental health approaches that reduce symptoms of depression and anxiety (Problem Management Plus (PM+) and Early Adolescent Skills for Emotions (EASE)) that are delivered by lay health workers. By adapting and integrating PM+/EASE to create Project YES+, we will specifically provide AYALHIV with problem-management skills that we hypothesize will interrupt the bi-directional pathways among violence victimization, depression and internalized and intersectional stigmas. We will also refine our measures of internalized stigmas related to violence and depression, and intersectional stigma. Specific study aims include: AIM 1: Adapt and integrate the WHO problem management-based PM+/EASE approaches for AYA (15-24 years) to create Project YES+ for implementation by lay youth mentors to improve viral status by reducing the internalized and intersectional stigmas related to HIV, violence, and depression. Aim 2: Use cognitive interviewing to adapt scales of violence- and depression-related internalized stigma and intersectional stigma to improve stigma measurement among AYAHLIHV. Aim 3: Assess the feasibility and acceptability of a Project YES+ intersectional stigma reduction intervention among 100 AYALHIV through a pilot randomized controlled trial.

项目摘要 /摘要 污名越来越多地被认为是影响抗逆转录病毒疗法遵守和病毒的一种可修改因素 青少年和艾滋病毒（Ayalhiv）的年轻人中的抑制，但是很少有干预措施有 有效地降低了该人群中的污名或解决交叉污名。在这项研究中，我们将解决 Ayalhiv中的内在艾滋病毒污名以及与普遍的青年有关的内在污名 暴力和抑郁的经历。此外，我们还将专注于交叉污名，捕获 与Ayalhiv多种社会身份的复杂现实相关的预期污名。我们将创建一个 干预措施通过建立基于证据的干预项目来减少这些多个污名！ 青年参与成功。项目是的！是一个同伴心理计划，可有效地减少HIV内部化 赞比亚15至24岁的Ayalhiv的污名，以及一部分儿科诊所参与者 增加了病毒抑制。项目是的！数据还强调了关键的干预差距，包括高 Ayalhiv之间的身体，性和/或情感暴力的胜利水平，以及参与者如何 筛查阳性的抑郁症的病毒抑制水平较低。这些数据与不断增长的体系一致 将暴力胜利和抑郁症与内在的污名和病毒失败联系起来的证据。项目是的！ 同伴导师会将暴力经历或抑郁和焦虑的参与者转介给诊所健康 为Ayalhiv提供最少心理健康培训或服务的系统中的员工。这项研究试图 通过整合减少EBI青年同伴心理计划（项目！）的污名来解决这一差距 世界卫生组织认可并证明了减少抑郁症状的心理健康方法 和动画（问题管理加上（PM+）和早期的情绪早期技能（轻松）） 由外行卫生工作者提供。通过适应和集成PM+/轻松创建项目Yes+，我们将 特别为AYYHIV提供了我们假设的问题管理技能，将中断双向 暴力胜利，沮丧以及内在化和交叉污名之间的途径。我们也会 完善我们对与暴力和抑郁症以及交叉污名有关的内部污名的测量。 特定的研究目的包括： 目标1：适应并整合了基于问题管理的PM+/轻松方法AYA（15-24） 几年）创建项目+，以供外行青年导师实施，以通过减少 与艾滋病毒，暴力和抑郁症有关的内在和交叉污名。 目标2：使用认知访谈来适应暴力和抑郁症相关的内在污名和 相交的污名以改善Ayahlihv之间的污名测量。 AIM 3：评估项目是YES+交叉污名干预的可行性和可接受性 在100个Ayalhiv中，通过试验随机对照试验。