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.

项目概要/摘要 耻辱越来越被认为是影响抗逆转录病毒治疗依从性和病毒传播的可改变因素 艾滋病毒感染者（AYALHIV）的青少年和年轻人受到抑制，但很少有干预措施 有效减少耻辱或解决该人群中的交叉耻辱。 AYALHIV 中内在的艾滋病毒耻辱，以及与流行的年轻人相关的内在耻辱 此外，我们还将关注交叉耻辱，捕捉暴力和抑郁的经历。 我们将创建一个与 AYALHIV 的多重社会身份的复杂现实相关的预期耻辱。 通过建立基于证据的干预项目 YES! 来减少这些多重耻辱的干预措施！ “青年参与成功”项目是一项同伴指导计划，可有效减少艾滋病毒内化。 赞比亚 15 至 24 岁的 AYALHIV 患者以及部分儿科诊所参与者中存在耻辱感， YES! 项目的数据还强调了关键的干预措施差距，包括高水平的干预措施。 AYALHIV 人群遭受身体、性和/或情感暴力的程度，以及参与者如何 抑郁症筛查呈阳性的人的病毒抑制水平较低，这一数据与越来越多的人相符。 有证据表明暴力受害和抑郁症与内在的耻辱和病毒式失败有关。 同伴导师会将暴力经历或抑郁和焦虑转介给诊所健康 本研究旨在为 AYALHIV 提供最低限度的心理健康培训或服务。 通过将减少耻辱的 EBI 青年同伴指导计划（项目 YES！）与 世界卫生组织认可并经过验证的可减轻抑郁症状的心理健康方法 和焦虑（问题管理增强版 (PM+) 和青少年早期情绪技能 (EASE)） 通过调整和整合 PM+/EASE 来创建 YES+ 项目，我们将由非专业卫生工作者提供。 专门为 AYALHIV 提供我们所采用的问题管理技能，这将中断双向 我们还将探讨暴力受害、抑郁以及内在和交叉耻辱之间的途径。 完善我们对与暴力和抑郁相关的内在耻辱以及交叉耻辱的衡量标准。 具体研究目标包括： 目标 1：针对 AYA 调整和整合世卫组织基于问题管理的 PM+/EASE 方法（15-24 年）创建 YES+ 项目，由非专业青年导师实施，通过减少 与艾滋病毒、暴力和抑郁症相关的内在和交叉的耻辱。 目标 2：使用认知访谈来调整与暴力和抑郁相关的内在耻辱和 交叉耻辱以改善 AYAHLIHV 中的耻辱测量。 目标 3：评估 YES+ 项目跨部门耻辱减少干预措施的可行性和可接受性 通过一项试点随机对照试验对 100 名 AYALHIV 患者进行了研究。