M-Suubi: A Multi-level integrated intervention to reduce the impact of HIV stigma on HIV treatment outcomes among adolescents living with HIV in Uganda

M-Suubi：多层次综合干预措施，以减少乌干达艾滋病毒感染青少年艾滋病毒耻辱对艾滋病毒治疗结果的影响

• 批准号: 10673023
• 负责人: Massy Mutumba
• 金额: $ 60.1万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-09 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673023
• 关键词: AIDS prevention; Address; Adherence; Adolescent; Affect; Africa South of the Sahara; Appointment; Attention; Attitude; Caring; Child; Cluster randomized trial; Commuting; Continuity of Patient Care; Cost Analysis; Country; Coupled; Development; Disadvantaged; Disclosure; Discrimination; Drowsiness; Economics; Education; Enrollment; Exclusion; Family; Family Relationship; Feeling suicidal; Floor; Food; Fright; Gastric Emptying; Goals; HIV; HIV Infections; HIV/AIDS; Home; Inequality; Infection; Institution; Institutionalization; Intervention; Intervention Studies; Literature; Living Arrangement; Mediation; Mental Depression; Mental Health; Nausea; Outcome; Parents; Participant; Personal Satisfaction; Pharmaceutical Preparations; Pharmacy facility; Policies; Poverty; Prevalence; Privacy; Randomized; Reporting; Research; Schedule; School Drop-Outs; Schools; Secondary Schools; Shame; Social Environment; Structure; Student Dropouts; Students; Systems Theory; Testing; Thinking; Time; Training; Treatment outcome; Uganda; United States National Institutes of Health; Violence; Viral; antiretroviral therapy; arm; care outcomes; cost effectiveness; empowerment; experience; family support; food insecurity; improved; innovation; internalized stigma; medication compliance; peer; pill; post implementation; primary outcome; programs; recruit; response; school environment; secondary analysis; secondary outcome; side effect; social stigma; theories; therapy adherence; treatment adherence; treatment as usual; treatment services; AIDS prevention; Address; Adherence; Adolescent; Affect; Africa South of the Sahara; Appointment; Attention; Attitude; Caring; Child; Cluster randomized trial; Commuting; Continuity of Patient Care; Cost Analysis; Country; Coupled; Development; Disadvantaged; Disclosure; Discrimination; Drowsiness; Economics; Education; Enrollment; Exclusion; Family; Family Relationship; Feeling suicidal; Floor; Food; Fright; Gastric Emptying; Goals; HIV; HIV Infections; HIV/AIDS; Home; Inequality; Infection; Institution; Institutionalization; Intervention; Intervention Studies; Literature; Living Arrangement; Mediation; Mental Depression; Mental Health; Nausea; Outcome; Parents; Participant; Personal Satisfaction; Pharmaceutical Preparations; Pharmacy facility; Policies; Poverty; Prevalence; Privacy; Randomized; Reporting; Research; Schedule; School Drop-Outs; Schools; Secondary Schools; Shame; Social Environment; Structure; Student Dropouts; Students; Systems Theory; Testing; Thinking; Time; Training; Treatment outcome; Uganda; United States National Institutes of Health; Violence; Viral; antiretroviral therapy; arm; care outcomes; cost effectiveness; empowerment; experience; family support; food insecurity; improved; innovation; internalized stigma; medication compliance; peer; pill; post implementation; primary outcome; programs; recruit; response; school environment; secondary analysis; secondary outcome; side effect; social stigma; theories; therapy adherence; treatment adherence; treatment as usual; treatment services

PROJECT ABSTRACT In response to PA-20-144 calling for innovations in HIV prevention, testing, adherence and retention to optimize HIV prevention and care continuum outcomes, we examine the impact and cost-effectiveness of an innovative multilevel intervention combining Multiple Family Groups (MFGs) for HIV stigma reduction (MFG-HIVSR) with a family economic empowerment (FEE) intervention versus a group-based HIV stigma reduction for Educators (GED-HIVSR) combined with MFG-HIVSR plus FEE (hereafter M-Suubi) on HIV treatment adherence and engagement in care among school-going adolescents living with HIV (ALHIV) in Uganda. HIV stigma remains a formidable barrier to HIV treatment adherence among adolescents in Uganda, contributing to low rates of medication adherence and viral suppression (less than 50%) and high attrition from HIV treatment services. ALHIV experience HIV stigma (internalized, anticipated and enacted) in various settings, including families and schools, the most important developmental contexts that should otherwise be supportive of their development and wellbeing. One of the unique features about education in Uganda and other countries in Sub-Saharan Africa is the high proportion (over 60%) of school-going adolescents enrolled in boarding secondary schools – which represent a form of parental opt-in institutionalized care. ALHIV in schools are more disadvantaged and have lower levels of HIV treatment adherence due to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support and food insecurity. Within families, HIV stigma is perpetuated in various forms including discrimination and violence, often due to unfounded fears of infection—hence undermining the quality of family relations and supports for ALHIV. Building on our research and current evidence on HIV stigma reduction, we propose a multi-level three-arm cluster randomized study (M-Suubi) with the following specific aims: Aim 1: Examine the impact of M-Suubi on HIV viral suppression (primary outcome); and adherence to HIV treatment (keeping appointments, pharmacy refills, pill counts), and retention in care (secondary outcome); Aim 2: Examine the effect of M-Suubi on HIV stigma (internalized, anticipated and enacted), with secondary analyses to explore hypothesized mechanisms of change (e.g. depression) and intervention mediation; Aim 3: Assess the cost and cost-effectiveness of each intervention condition; and Aim 4: Qualitatively examine: a) participants’ experiences with HIV stigma, HIV treatment adherence, and the intervention; and 2) educators’ attitudes towards ALHIV, experiences with GED-HIVSR, and program/policy implementation post-training. The study will enroll 840 ALHIV recruited from 42 schools located within the greater Masaka region, heavily affected by HIV (prevalence 12% vs 7.3% national average). M-Suubi will be provided for 20 months, with assessments at baseline, 12, 24 and 36 months. Findings may inform combination intervention efforts to optimize HIV treatment outcomes and engagements in care among ALHIV.

项目摘要 为了回应PA-20-144呼吁在艾滋病毒预防，测试，依从性和保留方面进行优化预防和护理的创新，我们研究了创新多层次干预的影响和成本效益，结合了多个家庭群体（MFGS）与HIV污名化（MFG-HIV A ATMECEMATIG）（MFG-HIV ATMMA EMPOLITY HYPOLITY HYPOLITY HYPOLITY HYPOLITY HYPOLISTION）的创新多级干预（MFGS）的影响和成本效益，教育工作者（GED-HIVSR）与MFG-HIVSR Plus Fee（以下称M-Suubi）结合使用HIV治疗的青少年（ALHIV）（ALHIV）。艾滋病毒的污名仍然是乌干达青少年中HIV治疗青少年的巨大障碍，导致药物较低的青少年（少于50％）和HIV治疗服务的高损耗。在包括家庭和学校在内的各种环境中，ALHIV经历了艾滋病毒污名（内部化，预期和制定），这是最重要的发展环境，否则应支持其发展和福祉。乌干达和撒哈拉以南非洲其他国家的教育的独特特征之一是，在寄宿中学的校学生中，高比例（超过60％） - 代表了父母选择加入制度化护理的一种形式。由于学校内部的艾滋病毒污名，僵化的学校结构和日常工作，缺乏依从性支持和粮食不安全感，学校的ALHIV更为弱势症，艾滋病毒治疗依从性较低。在家庭内部，艾滋病毒的污名在各种形式上都存在，包括歧视和暴力，通常是由于对感染的毫无根据的恐惧，从而破坏了家庭关系的质量和对ALHIV的支持。在我们的研究和当前有关艾滋病毒污名的证据的基础上，我们提出了一项具有以下具体目的的多级三臂聚类随机研究（M-Suubi）：目标1：检查M-Suubi对HIV病毒抑制的影响（主要结果）；并遵守艾滋病毒治疗（保留预约，药房补充，药丸计数）和保留率（次要结果）； AIM 2：检查M-Suubi对HIV污名（内部化，预期和制定）的影响，并进行了二次分析，以探索假设的变化机制（例如抑郁症）和干预调解；目标3：评估每个干预条件的成本和成本效益；目标4：定性检查：a）参与者对艾滋病毒污名，艾滋病毒治疗依从性和干预的经历； 2）教育工作者的参与者参加ALHIV，GED-HIVSR的经验以及培训后的计划/政策实施。这项研究将招募840名ALHIV从位于大马萨卡地区的42所学校招募，受艾滋病毒的影响很大（患病率为12％，全国平均水平为7.3％）。 M-Suubi将提供20个月，并在基线，12、24和36个月时进行评估。调查结果可能会为组合干预工作提供优化ALHIV之间的艾滋病毒治疗结果和关怀的参与。