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.

项目概要 年轻同性恋、双性恋和其他男男性行为者 (YGBMSM) 占艾滋病毒感染率的 63% (18%) 在加纳的 GBMSM 中。我们之前的研究表明交叉耻辱和歧视（ISD） （围绕艾滋病毒、性和性别表达）和艾滋病毒知识不足阻碍了艾滋病毒检测、PrEP 和 ART (HPART) GBMSM 的依从性。贫民窟居民面临着与其社区相关的更多耻辱； 因此，贫民窟社区的社会和经济障碍可能与 ISD 交织在一起，从而加剧了贫民窟社区的风险 HIV 感染会阻碍 YGBMSM 遵守 HPART，因为他们将耻辱内在化并避免 HCF。 状态中立的 HIV 护理方法可以减少 YGBMSM 和 HCF 中的 ISD，并改善 HPART YGBMSM。然而，加纳目前的艾滋病毒干预措施和计划侧重于单独的服务和 主要仅解决测试问题。为此，我们建议采取多层次干预措施（LAFIYA， 意思是“健康”），利用加纳语中 YGBMSM 和 HCF 之间的地位中立来解决 ISD 和 HPART 贫民窟。 LAFIYA 在增加 HIV 阴性或未知人群中的 HIV 检测/自我检测方面显示出早期功效 加纳贫民窟中的 YGBMSM 地位。适应状态中立干预措施将扩大其对艾滋病毒的效用 利用围绕交叉耻辱、HIVST、PrEP 和联系的科学进步进行预防和护理 去关心。 LAFIYA 还主要关注 GBMSM，并涉及来自两个接受 ISD 的机构的提供者 减量训练。拟议的 LAFIYA 将包括 HCF 范围内的培训、PrEP 和 ART 组成部分。引导 通过ADAPTT-IT模型的八个步骤，我们将实现这两​​个目标。 1）采取多层次干预 使用 YGBMSM 之间的状态中立来解决 ISD 和 HPART。我们将进行 FGD 并深入 与 YGBMSM (n=70)、GBMSM 提供者 (n=20) 和护士/医护人员 (n=80) 进行访谈 (IDI) 以加深了解 了解 YGBMSM 中 ISD、HPART 依从性的障碍和促进因素。在总结性分析中， 我们将整合供应商和 YGBMSM 的实际情况，以优化干预潜力，以解决 ISD 和 增加 HPART。 2) 测试干预措施解决 ISD 和增加 HPART 的初步效果 坚持使用 CRT 设计。我们将 YGBMSM (n=240) 朋友组分配给对照组或干预组 (n=120) 和 HCF(n=6) 进行控制或干预 (n=3)。干预组将接受 LAFIYA。我们将收集 YGBMSM (n=240) 和 HCWs (n=300) 干预后 3、6 和 9 个月的数据。测量 HPART 依从性（主要结果）、ISD 减少、艾滋病毒和状态中立知识（次要结果）以及 干预措施的可接受性、适当性和可行性（实施结果）。我们将进行 在实施者和参与者之间进行额外的焦点小组和干预后访谈​​（样本量 与 AIM1 相同）来评估他们的干预经验。研究结果将为交叉耻辱提供信息 YGBMSM、贫民窟、SSA 和其他高风险地区的减少和艾滋病毒状况中立实施战略 不同环境下的人群。