Reducing Stigma in People Who Inject Drugs with HIV Using a Rapid Start Antiretroviral Therapy Intervention

使用快速启动抗逆转录病毒治疗干预措施减少艾滋病毒注射者的耻辱

基本信息

批准号：
10756389
负责人：
FREDERICK LEWIS ALTICE
金额：
$ 17.03万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-15 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10756389
关键词：
Address Adherence Administrator Affect Africa South of the Sahara Anti-Retroviral Agents Architecture Asia Behavior Behavioral Clinical Cohort Studies Collaborations Consensus Country Data Decision Making Development Diagnosis Discrimination Drug usage Education Elements Eligibility Determination Epidemic Face Future Goals Guidelines HIV Health Health Personnel Healthcare Hepatitis C virus Hybrids Imprisonment Incidence Income Individual Infection Injecting drug user Intention Intervention Life Malaysia Mediating Medical Students Methods Needle-Exchange Programs Opportunistic Infections Pathway interactions Patients Perception Persons Physicians Policies Population Prejudice Prevalence Process Productivity Protocols documentation Provider Recommendation Research Research Methodology Resources Sexual Partners Social Class Social support Stereotyping System Techniques Testing Therapeutic Intervention Time Treatment outcome Trust Universities Viral Vitamins Work addiction antiretroviral therapy anxiety reduction clinically relevant comorbidity design evidence base experience future implementation implementation trial improved improved outcome intervention refinement low and middle-income countries medication for opioid use disorder mortality opioid use disorder peer pilot test rapid test sex social stigma systematic review therapy adherence therapy design therapy development tool transmission process treatment as prevention

项目摘要

HIV transmission continues in low- and middle-income countries (LMIC), especially among key affected populations (KAP) and in settings of high stigma and discrimination. In Malaysia, a LMIC in SE Asia, HIV incidence and mortality is increasing. HIV is concentrated among KAPs, especially people who inject drugs (PWID), a group that has substantially lower ART prescription and viral suppression (VS) levels relative to other KAPs, undermining HIV treatment as prevention (TasP) goals. PWID are especially vulnerable to overlapping and intersectional stigmas due to criminalization drug use and sex work, experiences with incarceration, social class and the presence of HIV itself. Our preliminary studies confirm high levels of negative stereotypes, prejudice and stigma toward PWID among medical students and HIV experts, with clear evidence of intention to discriminate against PWID by withholding ART prescription. Stigma-reducing interventions have mostly centered on educational and contact-based strategies. Such strategies, however, appear less effective where stereotypes and stigma are deeply entrenched, as in Malaysia, thus requiring the introduction and testing of alternative strategies. Behavioral design interventions are potentially effective ways to address stigma in such settings. Behavioral design interventions use tools like framing, nudges, and choice architecture, which can be used to re-design how physicians behave – or make non-discriminatory healthcare decisions. Rapid start antiretroviral (RS-ART) is an evidence-based strategy to initiate ART immediately, thereby supporting TasP goals by reducing time to VS, achieving VS and improving individual health. It has not been tested among PWID. It fits the criteria for behavioral design interventions by re-arranging clinician decision-making by first focusing on eligibility criteria (i.e., presence of opportunistic infections) rather than inaccurate perceptions of ART adherence or deservedness. Behavioral design interventions have not been tested in HIV stigma research, nor has they been assessed longitudinally or infusing clinically relevant dyads analyses of patients and clinicians. To guide the behavioral design of RS-ART among PWID, we will use the Delphi method to develop guidelines. Then we will use nominal group technique, a rank-ordering mixed method strategy to assess the multi-level barriers and facilitators to RS-ART for PWID, in order to adapt existing RS-ART protocols for PWID. Once the new guideline concordant RS-ART protocol is developed, we will pilot test it in 125 PWID over six months and conduct a longitudinal dyadic analysis of patients and clinicians of stigma, physician trust and social support. The RS-ART protocol will be refined further during pilot-testing to determine its utility as a stigma-reducing intervention that can be tested in a future implementation trial. This proposal brings over 17 years of productive collaboration between Yale and University of Malaya, with expertise in clinical HIV and addiction treatment, participation in clinical guidelines development, mixed methods research, intervention development and refinement, multi-level stigma assessment and intervention and dyadic analyses.

在低收入和中等收入国家（LMIC）中，艾滋病毒的传播持续了，尤其是在受影响的主要关键中种群（KAP）以及高污名和歧视的环境。在马来西亚，艾滋病毒的LMIC 发病率和死亡率正在增加。艾滋病毒集中于卡普斯，尤其是注射毒品的人（PWID），相对于其他的ART处方和病毒抑制（VS）的群体大大降低 KAPS，破坏HIV治疗作为预防（TASP）目标。 PWID特别容易受到重叠的影响以及由于犯罪毒品使用和性工作，事件的经验，社会的经验而引起的交叉污名阶级和艾滋病毒本身的存在。我们的初步研究证实了高水平的负刻板印象，在医学生和艾滋病毒专家中对PWID的偏见和污名，有明确的证据表明通过预扣艺术处方来歧视PWID。降低污名的干预措施主要集中关于教育和基于联系的策略。但是，在刻板印象的情况下，这种策略似乎不太有效就像马来西亚一样，污名深深地根深蒂固，因此需要引入和测试替代方案策略。行为设计干预措施是在这种情况下解决污名的潜在有效方法。行为设计干预措施使用框架，推销和选择体系结构等工具，可用于重新设计医师的行为方式 - 或做出非歧视性医疗保健决定。快速启动抗逆转录病毒（RS-ART）是一种基于证据的策略，可以立即发起艺术，从而通过减少来支持TASP目标是时候与VS，实现VS和改善个人健康。它尚未在PWID中进行测试。它符合标准通过首先关注资格标准，通过重新分配临床决策来进行行为设计干预措施（即，机会性感染的存在）而不是对艺术依从性或应得的。行为设计干预措施尚未在HIV污名研究中进行测试，也没有对患者和临床医生进行纵向评估或注入临床相关的二元组分析。指导 RS-ART在PWID中的行为设计，我们将使用Delphi方法来制定准则。然后我们会使用名义组技术，一种排序订购的混合方法策略来评估多层次障碍和为了改编PWID现有的RSART协议，促进rs-Art的rs-Art。一旦新指南开发了一致的RSART协议，我们将在六个月内在125个PWID中进行试点测试，并进行一次对污名，物理信任和社会支持的患者和临床医生的纵向二元分析。 RS-ART 试点测试期间，协议将进一步完善，以确定其效用作为降低污名的干预措施，可以在以后的实施试验中进行测试。该建议带来了17年的产品合作在耶鲁大学和马来亚大学之间，具有临床艾滋病毒和成瘾治疗方面的专业知识，参与临床准则开发，混合方法研究，干预开发和改进，多层次污名评估和干预以及二元分析。