Controlled Trial of Game Changers: A Group Intervention to Train HIV Clients to be Change Agents for HIV Prevention in Uganda

游戏规则改变者的对照试验：培训艾滋病患者成为乌干达艾滋病毒预防变革推动者的集体干预

• 批准号: 10848836
• 负责人: Laura M Bogart
• 金额: $ 18.8万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-06 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10848836
• 关键词: AIDS prevention; Address; Advocacy; Advocate; Behavior; Caring; Client; Cognitive; Communicable Diseases; Communities; Cost Effectiveness Analysis; Diffusion; Disclosure; Epidemic; Family; Focus Groups; Friends; Funding; Government; HIV; HIV risk; Health; Health Personnel; High Prevalence; Household; Human immunodeficiency virus test; Incidence; Individual; Information Networks; Intervention; Investments; Mediating; National Institute of Mental Health; Outcome; Participant; Penetration; Persons; Policy Maker; Politics; Positioning Attribute; Prevalence; Prevention; Process; Randomized; Randomized, Controlled Trials; Research; Risk; Social Network; Surveys; Testing; Touch sensation; Training; Uganda; Unsafe Sex; Viral; Viral Load result; Woman; Work; acceptability and feasibility; aged; antiretroviral therapy; arm; attentional control; behavior change; condoms; empowerment; fighting; group intervention; health training; improved; innovation; internalized stigma; intervention effect; member; men; peer; pre-exposure prophylaxis; primary outcome; public-private partnership; recruit; secondary outcome; sex; social; social engagement; social influence; social stigma; theories; therapy development; tool; uptake; virtual

PROJECT SUMMARY In Uganda, HIV prevalence is estimated to be 6.2% among those aged 15-64, and is higher (6.9%) in Kampala, the proposed study setting. Political and cultural barriers, including limited government funding and HIV stigma, impede HIV prevention and have led to projections of rapid increases in HIV incidence. The proposed research will be a randomized controlled trial (RCT) of Game Changers, a 6-session peer-led group intervention that aims to empower and mobilize people living with HIV (PLWH) to be agents for HIV prevention in their social networks. By decreasing stigma among PLWH and their social network members, and training PLWH on strategies to engage social network members in discussions around HIV, Game Changers provides PLWH with the tools to do prevention advocacy. Game Changers was developed through an NIMH R34 that found high feasibility and acceptability, and preliminary intervention effects on increased HIV prevention advocacy between PLWH and their social network members, reduced internalized stigma, and increased HIV-serostatus disclosure to social network members among PLWH, and medium to large effects on increased condom use and HIV testing among a subsample of network members. The Specific Aims are: (1) To conduct an RCT of Game Changers, a peer- led group intervention for PLWH in Uganda, to test intervention effects on the primary outcomes of reduced condomless sex, increased HIV testing, and decreased enacted HIV stigma among social network members; (2) To test intervention effects on the secondary outcomes of reduced internalized HIV stigma, increased HIV serostatus disclosure, and increased viral load suppression among PLWH, and PrEP uptake among social network members; (3) To examine whether increased HIV prevention advocacy by PLWH mediates intervention effects on social network members’ increased condom use and HIV testing, and whether increased HIV disclosure by PLWH mediates intervention effects on social network members’ reduced enacted HIV stigma; and (4) To conduct a cost-effectiveness analysis of the intervention. We will recruit 210 PLWH, randomizing 105 to the intervention and 105 to an attention control. Each PLWH will be asked to recruit social network members to complete assessments (736 total, 368/arm), to test intervention effects on social networks. All participants will complete surveys at baseline and 6-, 12-, and 18-months post-baseline; PLWH will also complete social network assessments. The cost-effectiveness analysis will inform policymakers about whether Game Changers is a feasible intervention in which to invest. Our approach is particularly timely in the era of biomedical interventions, which require widespread penetration of effective HIV prevention messaging into communities. Positioning PLWH as central to the solution for controlling (vs. causing) the HIV epidemic has the potential to reduce HIV stigma and improve prevention outcomes at the individual, household, and network levels.

项目概要 在乌干达，15-64 岁人群中艾滋病毒感染率估计为 6.2%，坎帕拉的感染率更高（6.9%）， 拟议的研究背景。政治和文化障碍，包括有限的政府资助和艾滋病毒耻辱， 阻碍艾滋病毒预防并导致艾滋病毒发病率迅速上升的预测。 将是一项关于游戏规则改变者的随机对照试验 (RCT)，这是一项为期 6 节的同行主导小组干预措施，旨在 赋权并动员艾滋病毒感染者 (PLWH) 成为其社交网络中艾滋病毒预防的推动者。 通过减少感染者及其社交网络成员的耻辱感，并对感染者进行策略培训 让社交网络成员参与有关艾滋病毒的讨论，游戏改变者为 PLWH 提供了工具 预防倡导者是通过 NIMH R34 开发的，该项目具有很高的可行性和有效性。 艾滋病毒感染者和艾滋病患者之间加强艾滋病毒预防宣传的可接受性和初步干预效果 他们的社交网络成员，减少了内在的耻辱，并增加了向社会披露艾滋病毒血清状况 感染者中的网络成员，以及对增加安全套使用和艾滋病毒检测的中等至较大影响 网络成员的子样本 具体目标是： (1) 进行游戏改变者随机对照试验，即同行- 在乌干达领导了针对艾滋病病毒感染者的群体干预，以测试干预措施对减少感染的主要结果的影响 无套性行为、增加艾滋病毒检测以及减少社交网络成员中艾滋病毒耻辱感 (2) 测试干预措施对减少内化艾滋病毒耻辱、增加艾滋病毒的次要结果的影响 血清状态披露、PLWH 中病毒载量抑制的增加以及社会人群中 PrEP 的吸收 网络成员；(3) 检查艾滋病病毒感染者增加的艾滋病毒预防宣传是否会介导干预措施 对社交网络成员增加安全套使用和艾滋病毒检测的影响，以及艾滋病毒是否增加 艾滋病病毒感染者的披露可以调节对社交网络成员减少艾滋病毒耻辱的干预效果； (4) 对干预措施进行成本效益分析 我们将招募 210 名感染者，随机分配 105 名。 干预措施和注意力控制措施 105 将要求每个感染者招募社交网络成员。 完成评估（总共 736 项，每组 368 项），测试对社交网络的干预效果。 完成基线调查以及基线后 6、12 和 18 个月的调查，感染者也将完成社交网络； 成本效益分析将告知政策制定者是否是游戏规则改变者。 在生物医学干预时代，我们的方法尤其及时， 这需要将有效的艾滋病毒预防信息广泛渗透到社区中。 艾滋病病毒感染者作为控制（而不是导致）艾滋病毒流行的解决方案的核心，有可能减少艾滋病毒 耻辱并改善个人、家庭和网络层面的预防结果。

项目成果

Social network-based group intervention to promote HIV prevention in Uganda: study protocol for a cluster randomized controlled trial of Game Changers.

• DOI: 10.1186/s13063-022-06186-z
• 发表时间: 2022-03-28
• 期刊: Trials
• 影响因子: 2.5
• 作者: Wagner GJ;Bogart LM;Green HD;Storholm ED;Klein DJ;McBain RK;Serunkuuma R;Mubiru K;Matovu JKB;Okoboi S
• 通讯作者: Okoboi S