Implementing Stigma Reduction Tools via a Popular Teletraining Platform to Reduce Clinician Stigma and Disparities in HIV Testing, Prevention, and Linkage to Care in Malaysia

通过流行的远程培训平台实施减少耻辱工具，以减少马来西亚临床医生在艾滋病毒检测、预防和护理方面的耻辱和差异

• 批准号: 10424432
• 负责人: Valerie Ann Earnshaw
• 金额: $ 18.62万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10424432
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Applications Grants; Award; Caring; Clinic; Communities; Community Healthcare; Counseling; Country; Criminal Law; Data; Diagnosis; Discrimination; Disease; Education; Elements; Family Practice; Focus Groups; Funding; General Population; General Practitioners; Goals; Guidelines; HIV; Health Services; Hepatitis C virus; Human immunodeficiency virus test; Hybrids; Individual; Injecting drug user; Intervention; Intervention Studies; Interview; Learning; Link; Malaysia; Malaysian; Medical Students; Modeling; Outcome; Palliative Care; Participant; Perception; Persons; Phase; Population; Populations at Risk; Prejudice; Prevention; Promoting Action on Research Implementation in Health Services framework; Protocols documentation; Randomized; Religion and Spirituality; Research; Research Personnel; Same-sex; Social Environment; Specialist; Stereotyping; Technology; Test Result; Testing; Training Support; Universities; Videoconferencing; Work; acceptability and feasibility; addiction; care outcomes; care systems; community setting; efficacy trial; empowered; evidence base; experience; female sex worker; gender expression; illicit drug use; implementation science; implementation trial; insight; intervention refinement; medical specialties; member; men who have sex with men; pilot test; social norm; social stigma; success; three-arm study; tool; transgender; transgender women

PROJECT SUMMARY A scalable intervention is needed to remove one of the most potent and persistent drivers of disparities in HIV testing, prevention, and linkage to care globally: clinician stigma toward key populations. Key populations at risk of HIV who experience and/or anticipate stigma from clinicians are less likely to initiate, engage in, and adhere to care, including HIV testing, prevention, and linkage to care services. Researchers have uncovered evidence-based stigma reduction tools that hold promise to reduce stigma among clinicians and narrow HIV disparities globally. Yet, a vehicle to deliver these tools to clinicians at large scale (i.e., beyond single clinics) is currently lacking. The long-term goal of this work is to address clinician stigma globally via the widespread implementation of evidence-based stigma reduction tools via a popular teletraining platform. Project ECHO® (Extension for Community Healthcare Outcomes) trains, supports, and empowers clinicians to provide a wide range of specialty care services globally, including HIV testing, prevention, and linkage to care. It uses a “hub and spoke” model, wherein non-specialists in community setting “spokes” learn from and collaborate with specialists at academic “hubs” via videoconferencing technology. The objective of this R34 project is to incorporate evidence-based stigma reduction tools into Project ECHO® and pilot test the resulting intervention with clinicians in Malaysia. Malaysia is an optimal testing ground for this project because it exemplifies many social contexts globally, and in the U.S., wherein clinician stigma and HIV disparities are substantial; and the University of Malaya is already a Project ECHO® hub for several diseases. The first aim of this project is to evaluate key elements that will influence the implementation of evidence-based stigma reduction tools via Project ECHO®, including evidence, context, and facilitation, and is guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. In Phase 1 of this aim, Photovoice will be used to collect evidence regarding experiences of clinician stigma among 30-35 key stakeholders, including key populations at risk of HIV and PLWH. In Phase 2, additional evidence will be collected regarding Malaysian clinician perspectives and the intervention context will be assessed via online focus groups with 30-40 general practitioners and family medicine clinicians. In Phase 3, factors related to facilitation will be assessed by pre-testing the intervention protocol with 5 clinicians. The second aim is to pilot test Project ECHO® for HIV Prevention and Stigma Reduction among Malaysian clinicians and evaluate its acceptability, feasibility, and preliminary impact on clinician stigma and HIV testing, prevention, and linkage to care services among key populations. General practitioner and family medicine clinicians (n=78) will be randomized to one of 3 study arms: (1) Project ECHO® for HIV Prevention and Stigma Reduction, (2) Project ECHO® for HIV Prevention only, or (3) control. Following guidelines for Hybrid Type 1 Implementation Trials, the acceptability and feasibility of the intervention will be assessed as well as its preliminary impact. If results support the feasibility, acceptability, and preliminary impact of the intervention, funding will be sought to conduct a large-scale efficacy trial. This line of research will ultimately yield a highly scalable intervention that can be disseminated to practicing clinicians in Malaysia and other countries via an existing, popular teletraining platform to address clinician stigma toward key populations and reduce HIV disparities globally.

项目摘要 需要进行可扩展的干预措施来删除艾滋病毒测试中最有效，最持久的分布驱动因素之一， 预防，与全球护理联系：与关键人群的临床污名。有艾滋病毒风险的关键人群 临床医生的经验和/或预期的污名不太可能发起，参与和遵守护理，包括艾滋病毒 测试，预防和与护理服务的联系。研究人员发现了基于证据的污名化工具 有望在全球范围内减少临床医生和狭窄的HIV差异的污名。但是，交付这些工具的工具 对于目前缺乏大规模的临床医生（即超越单诊所）。这项工作的长期目标是解决 全球临床污名通过宽度实施基于证据的污名工具通过流行 远程平台。 ProjectEcho®（社区医疗保健成果的扩展）火车，支持和授权者 临床医生在全球范围内提供广泛的专业护理服务，包括艾滋病毒测试，预防和与护理的联系。它使用 一个“枢纽和讲话”模型，社区中的非专业主义者在“发言”中与专家一起学习并与专家合作 通过视频会议技术学术“枢纽”。该R34项目的目的是纳入基于证据的污名 将工具减少到ProjectEcho®和试点测试中，由马来西亚的临床医生进行干预。马来西亚是最佳的 该项目的测试场面是因为它在全球范围内以及在美国的许多社会背景 艾滋病毒的差异很大；马来亚大学已经是多种疾病的Echo®枢纽项目。这 该项目的第一个目标是评估将影响基于证据污名的实施的关键要素 通过ProjectEcho®工具，包括证据，上下文和设施，并以促进研究行动为指导 卫生服务（PARIHS）框架实施。在此目标的第一阶段，光载将用于收集证据 关于30-35个主要利益相关者之间临床污名的经历，包括有艾滋病毒和艾滋病毒风险的关键人群 plwh。在第2阶段，将收集有关马来西亚临床观点和干预的其他证据 环境将通过在线焦点小组与30-40名全科医生和家庭医学临床医生进行评估。在阶段 3，将通过与5位临床医生预先测试干预方案来评估与促进性有关的因素。第二个目标是 试点测试项目Echo®用于预防HIV和污名化的马来西亚临床医生，并评估其 可接受性，可行性和对临床污名和艾滋病毒测试，预防和与护理服务联系的初步影响 在关键人群中。全科医生和家庭医学临床医生（n = 78）将被随机分为3个研究之一 武器：（1）Echo®预防HIV和污名化项目，（2）仅用于预防HIV的项目Echo®，或（3） 控制。遵循混合1型实施试验的指南，干预的可接受性和可行性 将评估及其初步影响。如果结果支持可行性，可接受性和初步影响 干预措施，资金将被视为进行大规模的有效试验。这项研究最终将产生 高度可扩展的干预措施可以通过现有的， 流行的远程远程伸缩平台，以解决对关键人群的临床污名并减少全球HIV差异。