RCT of an intersectional stigma intervention to sustain viral suppression among women living with serious mental illness and HIV in Botswana

对博茨瓦纳患有严重精神疾病和艾滋病毒的妇女进行交叉污名干预以维持病毒抑制的随机对照试验

• 批准号: 10542992
• 负责人: LAWRENCE H YANG
• 金额: $ 19.43万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542992
• 关键词: Acute; Address; Adherence; Africa South of the Sahara; Ambulatory Care; Articulation; Attention; Botswana; Caring; Client; Communities; Depressive disorder; Educational workshop; Ensure; Face; Family; Family Caregiver; Family member; Foundations; Funding; Future; Goals; HIV; Health system; Hospitalization; Household; Inpatients; Intervention; Lead; Measures; Mental Health; Modeling; Mothers; Outcome; Perception; Personhood; Persons; Pharmaceutical Preparations; Placebo Control; Policies; Postpartum Period; Pregnant Women; Prevalence; Professional counselor; Psychiatric therapeutic procedure; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research; Respondent; Risk; Social outcome; Symptoms; Testing; Viral; Viral Load result; Woman; Women Status; antiretroviral therapy; arm; attentional control; base; community reintegration; compare effectiveness; depressive symptoms; experience; follow-up; high risk; improved; intervention effect; marginalized population; medication nonadherence; novel; peer; personalized approach; post intervention; primary outcome; reduce symptoms; scale up; schizophrenia-spectrum disorder; secondary outcome; service intervention; severe mental illness; social stigma; therapy adherence; therapy design; treatment adherence

Abstract. Reducing stigma to ensure viral load (VL) suppression for women with serious mental illness (SMI) and HIV is a global priority, including in Botswana, where the intersectional stigma of SMI, HIV and womanhood is marginalizing in ways that impede adherence to both psychiatric medications and antiretroviral therapy (ART), which can threaten VL suppression. We apply our novel ‘what matters most’ (WMM) approach to target intersectional stigma faced by women with SMI and HIV in Botswana via a stigma-reduction intervention in the high-risk transition period after discharge from an initial psychiatric hospitalization. WMM conceptualizes how stigma is felt most acutely when people are unable to achieve ‘full personhood’ by participating in the activities that ‘matter most’ in their local context. In prior research, we found the core value for ‘full womanhood’ in Botswana is achieved by being the ‘foundation of the household’ and is threatened by perceived: 1) incompetence in fulfilling the duties of a family caregiver associated with SMI and 2) promiscuity associated with having HIV. In Botswana, family acceptance as a viable ‘family caregiver’ is also key to achieving ‘full status’ as a woman. As such, the risks of being identified as having SMI and HIV (e.g., partner/family abandonment) can deter psychiatric and ART treatment adherence. Promoting capabilities that ‘matter most’ for achieving ‘full womanhood’ could enable longer-term stigma reduction after psychiatric discharge, when women are reintegrating into their communities, and improve ART adherence and promote sustained VL suppression. Our group-based WMM stigma intervention is co-led by a peer woman who has coped effectively with SMI and HIV stigma. The WMM stigma intervention model was piloted among pregnant women with HIV in Botswana with promising reductions in stigma and depressive symptoms up to 4-months postpartum. We now test whether a WMM intervention tailored for women with SMI and HIV will reduce intersectional stigma and facilitate VL suppression. We propose a two-arm randomized controlled trial (RCT; N=180) with a 4-month follow-up to compare the effectiveness of 1) WMM-based intersectional stigma intervention delivered as clients transition from psychiatric hospitalization to outpatient care (‘WMM Stigma Intervention;’ n=90); and 2) attention control following a similar format to isolate the effects of the intervention (n=90). Because family are commonly involved in the care of people with SMI and face severe stigma, we propose a parallel, group stigma intervention among family members, as addressing familial stigma could facilitate treatment adherence. Finally, because intersectional stigma is reinforced at systemic levels, we seek to empower women with SMI and HIV to influence structural change by coleading policymaker workshops to reduce stigma among policymakers and spur policymakers to address the unique needs of women with SMI and HIV via future policies.

抽象的。 减少耻辱感以确保患有严重精神疾病 (SMI) 和艾滋病毒的女性的病毒载量 (VL) 受到抑制是一项 全球优先事项，包括在博茨瓦纳，在那里，SMI、艾滋病毒和女性身份的交叉耻辱是 边缘化阻碍了对精神科药物和抗逆转录病毒治疗（ART）的坚持， 这可能会威胁到 VL 抑制，我们将我们新颖的“最重要的”（WMM）方法应用于目标。 通过减少耻辱干预措施，博茨瓦纳患有 SMI 和艾滋病毒的妇女面临交叉耻辱 首次精神病住院出院后的高风险过渡期 WMM 概念化了如何进行。 当人们无法通过参与活动来实现“完整的人格”时，耻辱感最为强烈 在之前的研究中，我们发现了“完整女性气质”的核心价值。 博茨瓦纳通过成为“家庭的基础”而实现，并受到以下感知的威胁：1) 无法履行与 SMI 相关的家庭照顾者的职责，以及 2) 与 SMI 相关的滥交 在博茨瓦纳，家庭接受作为可行的“家庭照顾者”也是获得“完整地位”的关键。 因此，被识别为患有 SMI 和 HIV 的风险（例如，伴侣/家人遗弃）可能会增加。 阻止精神病学和抗逆转录病毒治疗的依从性，促进“最重要”的能力，以实现“全面”。 “女性身份”可以在女性出院后长期减少耻辱感 重新融入社区，提高 ART 依从性并促进持续的 VL 抑制。 基于群体的 WMM 耻辱干预措施由一位有效应对 SMI 和 HIV 的女性同伴共同领导 WMM 耻辱干预模式在博茨瓦纳感染艾滋病毒的孕妇中进行了试点 我们现在测试是否可以在产后 4 个月内减少耻辱感和抑郁症状。 为患有 SMI 和 HIV 的女性量身定制的 WMM 干预措施将减少交叉耻辱并促进 VL 我们建议开展一项双组随机对照试验（RCT；N=180），并进行 4 个月的随访。 比较 1) 在客户转变时提供的基于 WMM 的交叉耻辱干预的有效性 从精神病院住院到门诊护理（“WMM 耻辱干预”；n=90）；2）注意力控制 遵循类似的格式来隔离干预的影响（n=90），因为家庭通常参与其中。 在照顾患有 SMI 并面临严重耻辱的人时，我们建议对他们进行并行的群体耻辱干预 家庭成员，因为解决家庭耻辱可以促进治疗依从性。 跨部门耻辱在系统层面得到加强，我们寻求赋予 SMI 和艾滋病毒感染者女性影响力 通过共同主持政策制定者研讨会来减少政策制定者之间的耻辱并刺激结构变革 政策制定者通过未来的政策满足患有 SMI 和艾滋病毒的妇女的独特需求。