Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

在南非艾滋病毒和药物使用护理参与的背景下，研究同龄人对内在药物使用耻辱的影响

• 批准号: 10707515
• 负责人: Kristen Satu Regenauer
• 金额: $ 5.25万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10707515
• 关键词: Adherence; Alcohol consumption; Alcohols; Appointment; Awareness; Behavioral; COVID-19 pandemic; Caring; Clinic; Communities; Country; Data; Effectiveness; Epidemic; Future; Grant; HIV; Health; Health Personnel; Healthcare; Individual; Inferior; Infrastructure; Intervention; Intervention Studies; Interview; Life; Maintenance; Measures; Mediating; Mental Health; Modeling; Motivation; National Institute of Drug Abuse; Participant; Patients; Persons; Prevalence; Randomized; Records; Recovery; Research; Research Assistant; Research Personnel; Resource-limited setting; Resources; Role; Running; South Africa; Stigmatization; Strategic Planning; Structure; Substance Use Disorder; Training; Viral; Viremia; Work; acceptability and feasibility; antiretroviral therapy; care outcomes; design; experience; falls; follow up assessment; follow-up; health disparity; high risk; improved; internalized stigma; low and middle-income countries; patient engagement; peer; peer recovery; primary outcome; programs; skills; social stigma; substance use; substance use treatment; therapy adherence; transmission process; treatment as usual; treatment center; treatment program; uptake

Project Summary South Africa (SA) has the highest number of people living with HIV in the world (PLWH) and a high burden of untreated substance use disorder (SUD), which contributes both to poor engagement in HIV care and HIV transmission. Internalized substance use (SU) stigma is barrier to PLWH engaging in both HIV care and treatment. Integrating peer recovery coaches (PRCs)—or persons with lived SUD experience—into existing teams aiming to re-engage PLWH in HIV care may be a promising way to reduce internalized SU stigma among PLWH who have fallen out of care, and consequently, increase retention in HIV care and SUD treatment. Yet, despite the prevalent assumption that PRCs reduce internalized SU stigma, few studies have examined this quantitatively, and none have examined this in the context of HIV care. Further, although PRC models have been rapidly scaled in the US, little research has examined PRC models in low- and middle-income countries. In an ongoing study (R21DA053212), our team is evaluating the feasibility and acceptability of a PRC model integrated into existing HIV retention teams, and its preliminary effectiveness in shifting health worker stigma towards substance use and improving patient HIV care engagement. Adding to this ongoing study, the overall aim of this proposal is to evaluate the preliminary effectiveness of this PRC model in shifting patient internalized SU stigma and to examine if patient internalized SU stigma is associated with engagement in SUD treatment along with HIV care for PLWH and SUD who have fallen out of HIV care (n=50). Our conceptual model integrates the Stage Model of Self-Stigma and the situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance framework. We propose three aims: (1) First, we will evaluate if PRCs shift internalized SU stigma among PLWH with SUD who have fallen out of HIV care by comparing changes in internalized SU stigma scores of patients receiving care from the PRC integrated re-engagement team to a matched non-PRC re- engagement team between baseline and follow-up (about six-months post-baseline) assessments. (2) Next, we will evaluate if changes in internalized SU stigma are associated with HIV care and SUD treatment engagement over six-months via HIV clinic and SUD treatment attendance records. (3) Our final aim will be to capture patient perspectives on how internalized SU stigma and other intersecting stigmas relate to HIV/SUD care engagement, and how these may be related to PRC contact, by qualitatively interviewing patients receiving care from the PRC integrated re-engagement team. This study will use the existing infrastructure of ongoing study R21DA053212. Findings will inform future efforts to evaluate scalable SU stigma reduction interventions to improve HIV and SUD care engagement for PLWH with SUD. This project will additionally enable the PI’s pursuit of becoming an independent researcher focused on designing and adapting interventions to increase treatment engagement among people with SUD in resource-limited settings.

项目摘要 南非（SA）的人数最多 未经治疗的药物使用障碍（SUD）既导致参与艾滋病毒护理和艾滋病毒 传播。内部用品使用（SU）污名是PLWH参与艾滋病毒护理和 治疗。整合同行恢复教练（PRC）或具有现场泡沫经验的人 - 现有 团队的目标是重新参与艾滋病毒护理中的PLWH，可能是减少内在化SU污名的一种承诺方式 PLWH失败了，因此增加了在HIV护理和SUD治疗中的保留率。然而， 尽管普遍认为PRC降低了内在的SU污名，但很少有研究对此进行了研究 定量，没有人在艾滋病毒护理的背景下对此进行了检查。此外，尽管中国模型有 在美国迅速扩大了缩放，几乎没有研究在低收入和中等收入国家中研究了PRC模型。 在正在进行的研究（R21DA053212）中，我们的团队正在评估中国模型的可行性和可接受性 集成到现有的HIV保留小组中，及其在转移卫生工作者污名方面的初步效力 致力于使用并改善患者艾滋病毒护理的参与。加入了这项正在进行的研究，总体 该建议的目的是评估该中国模型在转移患者内部化的初步效果 SU污名并检查患者内部化的SU污名是否与参与SUD治疗有关 以及脱离艾滋病毒护理的PLWH和SUD的艾滋病毒护理（n = 50）。我们的概念模型集成了 自我污名的舞台模型和所在的信息动机行为技能模型启动 和维护框架。我们提出了三个目标：（1）首先，我们将评估中国是否转移内在化su PLWH中的污名与SUD通过比较内部化SU污名的变化而脱离HIV护理的SUD 从中国综合重新参与团队接受护理的数十名患者到匹配的非PRC重新 基线和随访（大约六个月后）评估之间的参与团队。 （2）接下来，我们 将评估内部化SU污名的变化是否与HIV护理和SUD治疗参与有关 超过六个月通过HIV诊所和SUD治疗出勤记录。 （3）我们的最终目标是捕获病人 关于如何内在化的污名的观点 和其他相交的污名 与HIV/SUD护理参与有关， 以及通过定性采访从中国接受护理的患者，与中国接触有关 集成的重新参与团队。这项研究将使用正在进行的研究R21DA053212的现有基础设施。 调查结果将为未来的努力提供评估可扩展的污名降低干预措施，以改善艾滋病毒和 SUD护理与SUD的PLWH参与。该项目还将使PI追求成为一个 独立研究人员致力于设计和调整干预措施以增加治疗参与 在资源有限的设置中有SUD的人中。