Interrupting HIV and TB stigma in the household during TB contact investigation in Uganda

乌干达结核病接触者调查期间消除家庭中艾滋病毒和结核病的耻辱

基本信息

批准号：
9914145
负责人：
John Lucian Davis
金额：
$ 18.03万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-15 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9914145
关键词：
Address Adolescent Africa South of the Sahara Area Awareness Behavior Behavior Therapy Behavioral Sciences Caring Cause of Death Child Cities Clinic Clinical Complex Consent Counseling Data Data Collection Decision Making Effectiveness Environment Evaluation Focus Groups Fright Funding Opportunities Future Goals HIV HIV diagnosis HIV/TB Health Health system Home environment Household Human immunodeficiency virus test Individual Interdisciplinary Study Interruption Intervention Interview Investigation Judgment Link Measures Methods Oral Patients Perception Personal Satisfaction Persons Population Prospective cohort Public Health Randomized Research Risk Salivary Sampling Series Social Interaction Social Sciences Standardization Surveys Testing Time Tuberculosis Uganda United States National Institutes of Health Universities Visit authority base care seeking case finding cost design doctoral student experience high risk implementation research implementation science improved indexing innovation insight instrument interest low income country member novel novel strategies oral HIV peer prevent primary outcome programs prospective psychologic recruit social social stigma symposium uptake young man

项目摘要

PROJECT SUMMARY/ABSTRACT With widespread access to high-quality HIV treatment, awareness of HIV status remains among the most important barriers to public health control of HIV in sub-Saharan Africa, especially among key populations including adolescents, men, and close contacts of TB patients. Household testing by lay health workers offers a proven approach for reaching such populations, but rates of test acceptance remain unacceptably low. Stigma related to both HIV and TB contribute to low uptake, and may be reinforced by social interactions at the household level. A century of behavioral science research on individual decision-making in group contexts strongly suggests that optimizing the order of test invitations to establish testing as the normative choice, framing testing as a prosocial behavior, and offering a less invasive test is likely to reduce stigma and improve uptake of testing. Therefore, this application proposes a series of preliminary, prospective, mixed-methods studies with household members of TB patients and lay health workers delivering routine household contact investigation for TB and HIV in Kampala, Uganda. The overall objective of these studies will be to evaluate the feasibility, acceptability, and preliminary effectiveness of a complex behavioral intervention to reduce stigma and promote HIV testing uptake among household members of TB patients. The innovative testing strategy includes three components, 1) acceptance-optimized sequencing of test invitations, 2) prosocial messaging, and 3) oral HIV testing. In Aim 1, the novel test invitation strategy will be evaluated and iteratively refined based on serial qualitative data collection with health workers and household contacts, as well as before-and-after surveys of contacts using validated stigma scales selected for their utility for TB- and HIV-specific stigma at the household level. In Aim 2, the strategy will be prospectively evaluated for its effects on stigma and test uptake in a pre-post implementation design. A multi-disciplinary research team includes experts in case-finding for TB-HIV, social sciences, and implementation research working in close partnership with public health officials; they also have experience in building local research capacity in implementation science. The expected impact is to generate preliminary data on a novel approach to offering home testing that reduces layered HIV-TB stigma in households, and on its effects on testing and linkage to and retention in care, built on the strong scientific premise of longstanding research on social decision-making. The project will also enhance local capacity by supporting a local doctoral student on the project team and sponsoring annual scientific symposia on HIV-TB stigma at Makerere University, with the goal of engaging a broad group of stakeholders to advance a local research agenda in this area. These data will inform a future randomized study evaluating the clinical impact of these innovative stigma-reducing approaches to offering and delivering TB and HIV counseling and testing in household settings.

项目概要/摘要随着高质量艾滋病毒治疗的广泛普及，对艾滋病毒状况的认识仍然是最重要的撒哈拉以南非洲地区，特别是重点人群中艾滋病毒公共卫生控制的重要障碍包括青少年、男性和结核病患者的密切接触者。由非专业卫生工作者进行的家庭检测提供了已经行之有效的方法可以覆盖这些人群，但测试接受率仍然低得令人无法接受。柱头与艾滋病毒和结核病相关的因素导致了低接受率，并且可能通过社会互动而得到加强家庭级别。一个世纪以来关于群体环境中个人决策的行为科学研究强烈建议优化测试邀请的顺序，将测试建立为规范选择，框架将测试作为一种亲社会行为，并提供侵入性较小的测试可能会减少耻辱感并提高接受度测试。因此，本申请提出了一系列初步的、前瞻性的、混合方法的研究结核病患者的家庭成员和非专业卫生工作者对结核病患者进行例行家庭接触调查乌干达坎帕拉的结核病和艾滋病毒。这些研究的总体目标是评估可行性，复杂行为干预的可接受性和初步有效性，以减少耻辱并促进结核病患者家庭成员的艾滋病毒检测情况。创新的测试策略包括三个组成部分，1) 测试邀请的接受优化排序，2) 亲社会消息传递，以及 3) 口服 HIV 测试。在目标1中，新颖的测试邀请策略将基于序列进行评估和迭代细化与卫生工作者和家庭接触者一起收集定性数据，以及前后调查使用经过验证的耻辱量表的接触者，该量表根据其在家庭中针对结核病和艾滋病毒的特定耻辱的效用而选择等级。在目标 2 中，将前瞻性评估该策略对耻辱感的影响以及事前测试的采用情况实施设计。多学科研究团队包括结核病艾滋病毒病例发现、社会与公共卫生官员密切合作的科学和实施研究；他们也有建设当地实施科学研究能力的经验。预期影响是产生有关提供家庭检测的新方法的初步数据，该方法可减少家庭中分层的艾滋病毒结核病耻辱感，以及它对测试、联系和保留护理的影响，建立在强有力的科学前提之上长期研究社会决策。该项目还将通过支持项目团队中的当地博士生并赞助了关于艾滋病毒结核病耻辱的年度科学研讨会麦克雷雷大学的目标是让广泛的利益相关者参与推进当地的研究议程在这个区域。这些数据将为未来评估这些创新的临床影响的随机研究提供信息在家庭环境中提供和提供结核病和艾滋病毒咨询和检测的减少耻辱的方法。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial.

DOI：
10.1136/bmjopen-2022-061508
发表时间：
2022-05-25
期刊：
BMJ OPEN
影响因子：
2.9
作者：
Armstrong-Hough, Mari;Ggita, Joseph;Gupta, Amanda J.;Shelby, Tyler;Nangendo, Joanita;Ayen, Daniel Okello;Davis, J. L.;Katamba, Achilles
通讯作者：
Katamba, Achilles