Planning a Multi-Level Intervention to Reduce Substance Use Stigma in HIV Prevention and Care

规划多层次干预措施以减少艾滋病毒预防和护理中的药物使用耻辱

基本信息

批准号：
10669764
负责人：
Mark K Greenwald
金额：
$ 22.22万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10669764
关键词：
AIDS prevention Address Adherence Administrator Affect Anti-Retroviral Agents Area Attitude Behavior Biometry Buprenorphine Caring Clinical Collaborations Communicable Diseases Contracts Data Decision Making Discrimination Drug user Education Educational Curriculum Educational Intervention Exhibits Federally Qualified Health Center Future Goals HCV screening HIV HIV Infections Harm Reduction Health Health Professional Health Services Health Services Research Health care facility Healthcare Human Resources Individual Intervention Intervention Studies Interview Knowledge Lead Literature Medical Medical Students Mental Health Methadone Methodology Needle-Exchange Programs Organizational Policy Outcome Patient Care Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Pharmacotherapy Policies Prejudice Prevention Process Professional Education Professional Organizations Protocols documentation Provider Public Health Research Research Methodology Risk Role Services Social Sciences Source Stigmatization Substance Use Disorder Syringes Techniques Testing Work antiretroviral therapy barrier to care care outcomes community engaged research design effective intervention experience falls health care quality health care service organization health care service utilization improved opioid overdose physical conditioning pilot test practical application pre-exposure prophylaxis programs randomized trial reduced substance use social social stigma substance use treatment services trial design

项目摘要

SUMMARY ABSTRACT Both substance use disorders (SUDs) and HIV are subject to stigma, namely, the process by which an attribute is deemed deeply discrediting and prone to prejudice and discrimination. Stigma toward SUDs and HIV arises from multiple sources, including policies or individuals who carry out policies (“structural stigma”) and health professionals (“provider-based stigma”). Stigma from health professionals experienced or anticipated by people with SUDs can create barriers to accessing high-quality health services. For people with SUDs who need HIV prevention or care, the added stigma of HIV may compound substance use-related stigma to enhance social barriers to healthcare. However, few studies have examined the role of substance use stigma in HIV healthcare contexts, or how to intervene on substance use stigma in this doubly-sensitive area of healthcare. Extant studies on substance use stigma in other healthcare contexts found that educational interventions incorporating critical reflection techniques and opportunities for contact with people who use drugs may significantly reduce provider- based stigma. An even greater limitation is that provider-based stigma intervention studies fall short of practical application: they largely focus on attitudinal outcomes among professionals, but do not measure the effects of policies or how stigma interventions affect healthcare utilization or patient health outcomes. For HIV prevention and care contexts to improve healthcare quality and outcomes among people with SUDs, interventions are needed to reduce provider-based and structural stigma perennially attached to substance use. Our goal is to adapt and refine a multi-level stigma intervention that leverages professional education and organizational policy to address structural drivers of stigma and the stigmatizing professional attitudes and behaviors that determine patient care and health. To achieve this goal, this planning project will work with federally qualified health centers (FQHCs) to address three Specific Aims: 1) Create a substance use curriculum for HIV prevention and care contexts that pilot testing demonstrates significantly improves knowledge, attitudes, and planned actions related to professional stigma towards people who use drugs; 2) Use qualitative interviews with FQHC administrators and personnel to identify organizational policies that improve conditions of professional decision-making and may enhance the effects of professional education on stigma reduction; and 3) Develop, optimize, and finalize a trial design and protocol that is intended to test how the multi-level SUD stigma intervention influences intermediate outcomes related to SUDs and professional and patient stigma, as well as principal HIV outcomes related to prevention and care. This project will use community-engaged research methods with FQHCs to develop a multi-level stigma intervention and trial protocol that seeks to test whether combining educational and organizational policy interventions addresses substance use stigma in HIV prevention and care contexts, and ultimately affects patient outcomes. The subsequent results of the trial research are expected to inform future professional and organizational interventions seeking to improve HIV services for people with SUDs.

摘要摘要物质使用障碍 (SUD) 和艾滋病毒都受到耻辱，即一种属性被认为是严重损害名誉并容易产生对 SUD 和艾滋病毒的耻辱和歧视。来自多个来源，包括政策或执行政策的个人（“结构性耻辱”）和健康专业人士（“基于提供者的耻辱”）。来自人们经历过或预期的卫生专业人员的耻辱。患有 SUD 的人可能会为需要艾滋病毒的 SUD 患者获得高质量的卫生服务造成障碍。预防或护理方面，艾滋病毒的增加的耻辱可能会加剧与药物使用相关的耻辱，以增强社会然而，很少有研究探讨物质使用耻辱在艾滋病毒医疗保健中的作用。背景，或如何在现有研究的双重敏感领域干预药物使用耻辱。关于其他医疗保健环境中药物使用耻辱的研究发现，教育干预措施纳入了关键的反思技巧和与吸毒者接触的机会可能会大大减少提供者- 一个更大的限制是基于提供者的耻辱干预研究缺乏实用性。应用：它们主要关注专业人员的态度结果，但不衡量其影响政策或耻辱干预措施如何影响医疗保健利用或患者健康结果。和护理环境，以提高 SUD 患者的医疗质量和结果，干预措施包括需要减少长期与药物使用相关的基于提供者的和结构性的耻辱。调整和完善利用专业教育和组织政策的多层次耻辱干预措施解决污名化的结构性驱动因素以及决定污名化的职业态度和行为为了实现这一目标，该规划项目将与联邦合格的医疗中心合作。 (FQHC) 旨在实现三个具体目标：1) 创建艾滋病毒预防和护理药物使用课程试点测试显示的环境显着提高了相关知识、态度和计划行动消除对吸毒者的职业耻辱； 2) 对 FQHC 管理人员进行定性访谈；和人员确定改善专业决策条件的组织政策和可以增强专业教育对减少耻辱的效果；以及 3) 制定、优化和最终确定旨在测试多层次 SUD 耻辱干预如何影响的试验设计和方案与 SUD 和专业人士和患者耻辱相关的中间结果，以及主要的艾滋病毒结果该项目将使用 FQHC 的社区参与研究方法来制定多层次的耻辱干预和试验方案，旨在测试是否将教育和组织政策干预措施解决艾滋病毒预防和护理背景下的药物使用耻辱问题，以及最终影响患者的结果。后续的试验研究结果预计将为未来提供信息。寻求改善针对 SUD 患者的艾滋病毒服务的专业和组织干预措施。