Status-neutral community-based multilevel intervention to address intersectional stigma and discrimination, and increase HIV testing, PrEP, and ART uptake among YGBMSM in Ghanaian Slums

地位中立、基于社区的多层次干预措施，以解决加纳贫民窟 YGBMSM 中的交叉污名和歧视问题，并增加 HIV 检测、PrEP 和 ART 的采用

• 批准号: 10838064
• 负责人: Gamji Rabiu Abu-Ba'are
• 金额: $ 49.92万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-20 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10838064
• 关键词: AIDS prevention; Address; Adherence; Africa; Age; Bisexual; Caring; Clinical; Communities; Consultations; Control Groups; Country; Data; Discrimination; Economics; Evaluation; Face; Focus Groups; Friends; Gays; Geography; Ghana; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Health Care Visit; Health care facility; Human immunodeficiency virus test; Intervention; Interview; Knowledge; Location; Longevity; Manuals; Measures; Modeling; Multiple Partners; Nurses; Participant; Persons; Prevalence; Provider; Randomized; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Resource-limited setting; Risk; Same-sex; Sample Size; Science; Scientific Advances and Accomplishments; Services; Slum; Stigmatization; Test Result; Testing; Training; Transact; Treatment Efficacy; Voice; Waiting Lists; behavior influence; beneficiary; design; experience; follow-up; gender expression; gender nonconforming; group intervention; high risk; high risk population; implementation outcomes; implementation strategy; improved; internalized stigma; marginalized community; men; men who have sex with men; poor communities; post intervention; pre-exposure prophylaxis; primary outcome; programs; scale up; secondary outcome; self testing; sex; social; social stigma; testing uptake; treatment arm; uptake

Project Summary Young gay, bisexual, and other men who have sex with men (YGBMSM) make up 63% of the HIV prevalence (18%) among GBMSM in Ghana. Our previous studies show that intersectional stigma and discrimination (ISD) (around HIV, sex, and gender expression) and insufficient HIV knowledge impede HIV testing, PrEP, and ART (HPART) adherence among GBMSM. Those in slums face additional stigma associated with their communities; hence the social and economic barriers in slum communities can intertwine with ISD to exacerbate the risk of HIV infections and discourage HPART adherence among YGBMSM as they internalized stigma and avoid HCF. A status-neutral approach to HIV care can reduce ISD among YGBMSM and HCFs and improve HPART among YGBMSM. Yet, current HIV interventions and programs in Ghana have focused on separate services and predominantly address only testing. To this effect, we propose to adapt a multilevel intervention (LAFIYA, meaning wellness) to address ISD and HPART using status neutrality among YGBMSM and HCF in Ghanaian slums. LAFIYA showed early efficacy in increasing HIV testing/self-testing among HIV-negative or unknown- status YGBMSM in Ghanaian slums. Adaptation to a status-neutral intervention will extend its utility for HIV prevention and care by utilizing scientific advancements around intersectional stigma, HIVST, PrEP, and linkage to care. LAFIYA also mainly focused on GBMSM and involved providers from two facilities who received ISD reduction training. The proposed LAFIYA will include HCF-wide training, PrEP, and ART components. Guided by the eight steps of the ADAPTT-IT model, we will implement the two aims. 1) Adapt a multilevel intervention to address ISD and HPART using status neutrality among YGBMSM. We will conduct FGDs and in-depth interviews (IDI) with YGBMSM (n=70), GBMSM providers (n=20), and NURSES/HCWs (n=80) to deepen understanding of ISD, barriers, and facilitators of HPART adherence among YGBMSM. In a summative analysis, we will integrate realities from providers and YGBMSM to optimize the intervention potential to address ISD and increase HPART. 2) Test the preliminary efficacy of the intervention to address ISD and increase HPART adherence using CRT Design. We will assign YGBMSM (n=240) friend groups to control or intervention groups (n=120) and HCF(n=6) to control or intervention (n=3). The intervention arm will receive LAFIYA. We will collect 3, 6, and 9 months post-intervention data among YGBMSM (n=240) and HCWs(n=300). to measure HPART adherence (primary outcomes), ISD reduction, HIV and status-neutral knowledge (secondary outcomes), and acceptability, appropriateness, and feasibility of the intervention (implementation outcomes). We will conduct additional focus groups and interviews post-intervention among implementers and participants (sample sizes same as in AIM1) to evaluate their experiences with the intervention. The findings will inform intersectional stigma reduction and HIV status-neutral implementation strategies among YGBMSM, slums, SSA, and other high-risk populations in different settings.

项目摘要 年轻的同性恋，双性恋和其他与男人发生性关系的男人（YGBMSM）占HIV患病率的63％ 加纳的GBMSM中（18％）。我们以前的研究表明，交叉污名和歧视（ISD） （围绕艾滋病毒，性别和性别表达）以及艾滋病毒知识不足阻碍艾滋病毒测试，准备和艺术 （HPART）GBMSM之间的依从性。那些贫民窟的人面临与社区相关的其他污名。 因此，贫民窟社区的社会和经济障碍可能与ISD交织在一起 HIV感染并阻止YGBMMSM之间的HPART遵守，因为它们将污名化并避免HCF。 艾滋病毒护理状态的方法可以减少YGBMSM和HCF中的ISD，并改善HPART YGBMSM。然而，加纳目前的HIV干预措施和计划都集中在单独的服务上 主要是仅解决测试。为此，我们建议适应多层次干预（Lafiya， 意思是健康），使用YGBMSM和HCF中的状态中立来解决ISD和HPART 贫民窟。 Lafiya在HIV阴性或未知 - 加纳贫民窟的状态YGBMSM。适应地位中性干预将扩大其艾滋病毒的效用 通过利用围绕交叉污名，HIVST，PREP和联系的科学进步，预防和护理 关心。 Lafiya也主要专注于GBMSM，并参与了来自ISD的两个设施的提供商 减少培训。拟议的Lafiya将包括HCF范围内的培训，准备和艺术成分。指导 通过Adaptt-IT模型的八个步骤，我们将实施两个目标。 1）调整多层次干预 使用YGBMSM之间的状态中立来解决ISD和HPART。我们将进行FGD和深入 与YGBMSM（n = 70），GBMSM提供商（n = 20）和护士/HCWS（n = 80）的访谈（IDI），以加深 了解YGBMSM中HPART依从性的ISD，障碍和促进者。在总结性分析中 我们将整合提供者和YGBMSM的现实，以优化解决ISD和问题的干预潜力 增加HPART。 2）测试干预措施的初步疗效以解决ISD并增加HPART 使用CRT设计依从性。我们将分配YGBMSM（n = 240）朋友组以控制或干预组 （n = 120）和HCF（n = 6）控制或干预（n = 3）。干预臂将获得Lafiya。我们将收集 YGBMSM（n = 240）和HCW（n = 300）之间的干预后数据3、6和9个月。测量HPART 依从性（主要结果），ISD降低，艾滋病毒和状态中立知识（次要结果）和 干预的可接受性，适当性和可行性（实施结果）。我们将进行 实施者和参与者之间干预后干预后的其他焦点小组和访谈（样本大小 与AIM1相同，以评估他们在干预中的经验。这些发现将告知交叉污名 YGBMSM，贫民窟，SSA和其他高风险 种群在不同的环境中。