Multi-Level Intervention Addressing Intersectional Stigma to Improve HIV Testing in MSM

多层次干预解决交叉耻辱，改善男男性行为者的艾滋病毒检测

基本信息

批准号：
10213837
负责人：
LaRon Earnest Nelson
金额：
$ 57.08万
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：
2019-09-05 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10213837
关键词：
AIDS prevention Address Behavior Budgets Car Phone Caring Cities Clinic Counseling Discrimination Education Empathy Exposure to Face Feedback Focus Groups Frequencies Gender General Population Ghana HIV HIV Infections HIV diagnosis Health Health Policy Health Status Health care facility Human immunodeficiency virus test Individual Intervention Interview Life Location Maintenance Manuals Methods Modeling Motivation Outcome Peer Group Phase Prevalence Protocols documentation Randomized Randomized Controlled Trials Reporting Research Same-sex Sampling Science Social Network Social support Source Stigmatization Symptoms Testing Time Voice Work acceptability and feasibility arm base behavior test civil society community clinic efficacy trial empowerment evidence base gender nonconforming improved intervention effect member men men who have sex with men novel peer predictive modeling prevention service recruit rehearsal same sex behavior scale up self testing sex social norm social stigma standard of care starfish sampling testing services theories treatment as usual trial design

项目摘要

PROJECT SUMMARY HIV prevalence among men with have sex with men (MSM) in Ghana is at least eight times higher than that of the general population (2%). MSM in Ghana face high levels of stigma due to HIV status (actual or perceived), same-sex behavior, and gender non-conformity. These stigmas are documented barriers to HIV prevention and treatment. In our preliminary work in Ghana (N=137), one-third of MSM had never been tested for HIV. We propose a randomized controlled trial to evaluate the feasibility, acceptability and estimate effect size of a multi-component, multi-level (organizational, interpersonal, and intrapersonal-level) intersectional stigma-reduction intervention to increase HIV testing frequency among MSM in Ghana where HIV, same-sex behavior and gender non-conformity are highly stigmatized. To date, stigma-reduction interventions in Ghana have focused on uni-level targets (e.g., health care facilities (HCFs)) and addressed one type of stigma (e.g., HIV), without engaging the intersectional character of the multiple stigmas that MSM encounter. Our specific aims are: (1) to evaluate the feasibility and acceptability of a novel multi-component, multi-level intervention to address intersectional stigma and (2) to estimate effect size of the intervention for scale up to a definitive efficacy trial. We will combine three theory-based interventions that were previously implemented separately in Ghana for reducing stigma at HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. We will use the Convergence Framework for combining interventions. The ADAPT-ITT framework guides our approach to enhancing the interventions’ content on intersectional stigma. To achieve these aims we will undergo a systematic adaptation that will refine the individually developed HCF, peer- and individual-level interventions to produce a comprehensive multi-level intersectional stigma reduction intervention. This will consist of focus groups and in-depth interviews with HCF staff and MSM to sharpen content on drivers and manifestations of HIV, same-sex and gender non-conforming stigmas within HCFs and peer groups and how these intersecting stigmas undermine HIV testing. This information will be used to refine the content of the interventions which will then be reviewed by a workgroup of HCF and Ghanaian MSM. The trial involves 8 HCFs, matched on HCF staff size. Matched pairs will each be randomized to have an intervention and a control arm. Before assignment to HCFs, 216 MSM, recruited through Starfish Sampling (combined time-location and peer-referral sampling), will be randomized to receive the intervention or usual care. Each arm of MSM will have members randomized to one of the four clinics per city and asked to stay in the assigned community-clinic pipeline. Using the RCT design, we will formally test the following outcomes: HIV testing at 3 and 6 months, acceptability and feasibility. We will fit multi-level regression models for the predictor variables at the HCF, peer and individual-levels. Based on the study’s findings, we will finalize a protocol to test our intervention in a definitive efficacy trial.

项目概要加纳男男性行为者 (MSM) 的艾滋病毒感染率至少比一般人群高八倍加纳的男男性行为者因艾滋病毒状况（实际的或感知的）、同性行为和性行为而面临严重的耻辱。在我们的初步工作中，这些耻辱是艾滋病毒预防和治疗的障碍。在加纳 (N=137)，三分之一的 MSM 从未接受过 HIV 检测。我们建议进行一项随机对照试验来评估。多成分、多层次（组织、人际和社会）的可行性、可接受性和估计效果大小个人内部层面）交叉耻辱减少干预措施，以提高加纳 MSM 的 HIV 检测频率迄今为止，艾滋病毒、同性性行为和性别不一致都受到高度污名化。加纳的重点是单级目标（例如医疗保健设施 (HCF)）并解决一种耻辱问题（例如艾滋病毒），不考虑 MSM 遇到的多重耻辱的交叉特征，我们的具体目标是：(1) 评估新颖的多组成部分、多层次干预措施的可行性和可接受性，以解决交叉问题 (2) 估计干预措施的效果大小，以扩大到确定的疗效试验。之前在加纳单独实施的基于理论的干预措施，以减少 HCF 层面的耻辱，增加同伴群体层面的艾滋病毒检测，并增加个人层面的同伴社会支持。整合干预措施的趋同框架 ADAPT-ITT 框架指导我们加强干预措施的方法。为了实现这些目标，我们将进行系统性的调整。完善单独开发的 HCF、同行和个人层面的干预措施，以产生全面的多层次干预措施这将包括焦点小组和对 HCF 工作人员的深入访谈。 MSM 将加强关于 HCF 内艾滋病毒、同性和性别不合规耻辱的驱动因素和表现的内容和同侪群体以及这些相互交叉的耻辱如何破坏艾滋病毒检测。这些信息将用于完善艾滋病毒检测。干预措施的内容随后将由 HCF 和加纳 MSM 工作组进行审查该试验涉及 8 名患者。 HCF 与 HCF 人员规模相匹配，每组将随机分配一个干预组和一个对照组。分配给 HCF，通过海星抽样（结合时间-地点和同行推荐抽样）招募的 216 名男男性行为者，将被随机分配接受干预或常规护理。MSM 的每个部门都会将成员随机分配到其中一项。每个城市有四个诊所，并要求留在指定的社区诊所管道中，我们将使用 RCT 设计。正式测试以下结果：3 个月和 6 个月时的 HIV 检测、可接受性和可行性。我们将进行多层次的拟合。 HCF、同伴和个人层面的预测变量的回归模型根据研究结果，我们将。最终确定一项方案，以在明确的疗效试验中测试我们的干预措施。