Intervention to Reduce Internalized Stigma (IRIS) among People Living with HIV who use Substances

减少使用药物的艾滋病毒感染者的内在耻辱 (IRIS) 的干预措施

• 批准号: 10548369
• 负责人: Jesse Bradford Fletcher
• 金额: $ 21.21万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548369
• 关键词: Address; Adult; African American; Anxiety; Belief; Bisexual; Clinical; Cocaine use disorder; Cognitive Therapy; Data; Depressed mood; Discrimination; Distal; Effectiveness; Ethnic Origin; Evidence based intervention; Exercise; Face; Feedback; Foundations; Funding; Future; Gays; HIV; HIV Seropositivity; Health; Individual; Intervention; Interview; Learning; Learning Skill; Literature; Low income; Measures; Mental Depression; Mental Health; Meta-Analysis; Modeling; Online Systems; Outcome; Pamphlets; Participant; Patient Self-Report; Persons; Pilot Projects; Population; Population Intervention; Prejudice; Preparation; Process; Public Health; Publishing; Race; Randomized Clinical Trials; Reporting; Research; Sampling; Self Concept; Sex Orientation; Social Identification; Stereotyping; Stigmatization; Stress; Substance Use Disorder; Suggestion; Target Populations; Testing; Toxic effect; Toxicology; Urine; Viral Load result; acceptability and feasibility; antiretroviral therapy; base; coping; depressive symptoms; design; evidence base; experience; follow-up; improved; improved functioning; informant; innovation; internalized stigma; intervention delivery; intervention effect; learning strategy; marginalized population; men; opioid use disorder; perceived stress; physical conditioning; pilot test; service delivery; skills; social cognitive theory; social stigma; study population; substance use; therapy adherence; treatment as usual; virtual; virtual delivery; virtual intervention

ABSTRACT Different facets of stigma (anticipated, enacted, internalized) associated with substance use disorder (SUD) and with HIV positive status impede cessation of substance use and HIV health outcomes including antiretroviral therapy adherence and viral load suppression.1-6 Although public stigma is pervasive surrounding both, individuals can learn to reduce its internalization and mitigate stigma’s negative impacts on their health. However, interventions promoting this are non-existent in the published literature. To this end, we propose to adapt an evidence-based stigma-impact reduction intervention, Ending Self- Stigma (ESS) to reduce stigma and its negative impacts on health. ESS has shown efficacy in reducing internalized and anticipated stigma in populations experiencing mental health conditions.7 The 9-session group-based intervention, which uses cognitive behavioral therapy strategies and social cognitive theory constructs, employs didactic learning and interactive activities to facilitate reductions in internalized and anticipated stigma. The purpose of the proposed study is to adapt the ESS intervention for people living with HIV (PLWH) who also have opioid use disorder (OUD) and/or cocaine use disorder (CUD). In the first year, we will use an iterative process that starts with formative interviews with service delivery key informants and people living with PLWH with OUD and/or CUD, and ends with two successive pilot studies with the study population. Through this process, intervention content will be adapted for this population and intervention delivery will be adapted for a virtual format via a web-based platform. Then, in years 2-3, a small randomized clinical trial of the resulting Ending Self-Stigma intervention adapted for PLWH with Substance Use disorder (ESS-HSU) will be conducted with 70 participants to determine its feasibility and acceptability in addition to collecting data on proximal outcomes including internalized and anticipated stigma, depressive symptoms, anxiety and perceived stress associated with stigma. We will also measure distal outcomes including ART adherence, viral load and substance use (SU) at 6-month follow-up. The ESS-HSU intervention has the potential for high public health impact by reducing the negative effects of internalized and anticipated stigma resulting from the pervasive public stigmatization of HIV seropositive status and SUD on HIV health outcomes and cessation of SU. ESS-HSU would be the first virtual intervention of this type to be evaluated in a randomized clinical trial. If results are promising, we will seek R01 funding for a full-scale test of this innovative intervention to determine its effects on a range of health outcomes and characterize mechanisms of intervention effects.

抽象的 与物质使用障碍 (SUD) 相关的耻辱的不同方面（预期的、实施的、内化的） 艾滋病毒呈阳性状态会阻碍物质使用的停止和艾滋病毒健康结果，包括 抗逆转录病毒治疗依从性和病毒载量抑制。1-6 尽管公众普遍存在耻辱感 两者都可以，个人可以学会减少其内在化并减轻耻辱对其健康的负面影响。 然而，已发表的文献中不存在促进这一点的干预措施。 为此，我们建议采用基于证据的耻辱影响减少干预措施，结束自我- 减少耻辱感及其对健康的负面影响 ESS 已显示出减少耻辱感的功效。 经历人群心理健康状况时内在的和预期的耻辱。7 9 次会议 基于群体的干预，使用认知行为治疗策略和社会认知理论 构建、采用教学学习和互动活动，以促进减少内化和 预期的耻辱。 拟议研究的目的是针对艾滋病毒感染者 (PLWH) 调整 ESS 干预措施 也患有阿片类药物使用障碍 (OUD) 和/或可卡因使用障碍 (CUD) 在第一年，我们将使用一种药物。 迭代过程，首先对服务提供的关键信息提供者和居住者进行形成性访谈 PLWH 与 OUD 和/或 CUD，并以对研究人群进行的两项连续试点研究结束。 在此过程中，干预内容将针对该人群进行调整，干预实施方式也将进行调整 然后，在第 2-3 年，通过基于网络的平台进行虚拟形式的小型随机临床试验。 由此产生的适用于患有物质使用障碍的 PLWH 的结束自我污名干预 (ESS-HSU) 将是 与 70 名参与者一起进行，除了收集相关数据外，还确定其可行性和可接受性 近期结果包括内在的和预期的耻辱、抑郁症状、焦虑和感知 我们还将测量与耻辱相关的压力，包括 ART 依从性、病毒载量和 6 个月随访时的物质使用 (SU)。 ESS-HSU 干预措施通过减少负面影响，有可能对公共卫生产生重大影响 普遍存在的公众对艾滋病毒血清反应呈阳性的污名化所导致的内化和预期的耻辱 HIV 健康结果的状况和 SUD 以及停止 ESS-HSU 将是第一个虚拟干预措施。 这种类型的药物将在随机临床试验中进行评估，如果结果有希望，我们将寻求 R01 资助。 对这种创新干预措施进行全面测试，以确定其对一系列健康结果的影响， 表征干预效果的机制。