Implementing Stigma Reduction Tools via a Popular Teletraining Platform to Reduce Clinician Stigma and Disparities in HIV Testing, Prevention, and Linkage to Care in Malaysia

通过流行的远程培训平台实施减少耻辱工具，以减少马来西亚临床医生在艾滋病毒检测、预防和护理方面的耻辱和差异

• 批准号: 10075426
• 负责人: Valerie Ann Earnshaw
• 金额: $ 20.58万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10075426
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Applications Grants; Award; Caring; Clinic; Communities; Community Healthcare; Counseling; Country; Criminal Law; Data; Diagnosis; Discrimination; Disease; Education; Elements; Family Practice; Focus Groups; Funding; General Population; General Practitioners; Goals; Guidelines; HIV; Health Services; Hepatitis C virus; Human immunodeficiency virus test; Hybrids; Individual; Injecting drug user; Intervention; Intervention Studies; Interview; Learning; Link; Malaysia; Malaysian; Medical Students; Modeling; Outcome; Palliative Care; Participant; Perception; Phase; Population; Populations at Risk; Prejudice; Prevention; Protocols documentation; Randomized; Religion and Spirituality; Research; Research Personnel; Same-sex; Social Environment; Specialist; Stereotyping; Technology; Test Result; Testing; Training Support; Universities; Videoconferencing; Work; addiction; care outcomes; care systems; community setting; efficacy trial; empowered; evidence base; experience; female sex worker; gender expression; illicit drug use; implementation research; implementation science; implementation trial; insight; medical specialties; member; men who have sex with men; social norm; social stigma; success; three-arm study; tool; transgender; transgender women

PROJECT SUMMARY A scalable intervention is needed to remove one of the most potent and persistent drivers of disparities in HIV testing, prevention, and linkage to care globally: clinician stigma toward key populations. Key populations at risk of HIV who experience and/or anticipate stigma from clinicians are less likely to initiate, engage in, and adhere to care, including HIV testing, prevention, and linkage to care services. Researchers have uncovered evidence-based stigma reduction tools that hold promise to reduce stigma among clinicians and narrow HIV disparities globally. Yet, a vehicle to deliver these tools to clinicians at large scale (i.e., beyond single clinics) is currently lacking. The long-term goal of this work is to address clinician stigma globally via the widespread implementation of evidence-based stigma reduction tools via a popular teletraining platform. Project ECHO® (Extension for Community Healthcare Outcomes) trains, supports, and empowers clinicians to provide a wide range of specialty care services globally, including HIV testing, prevention, and linkage to care. It uses a “hub and spoke” model, wherein non-specialists in community setting “spokes” learn from and collaborate with specialists at academic “hubs” via videoconferencing technology. The objective of this R34 project is to incorporate evidence-based stigma reduction tools into Project ECHO® and pilot test the resulting intervention with clinicians in Malaysia. Malaysia is an optimal testing ground for this project because it exemplifies many social contexts globally, and in the U.S., wherein clinician stigma and HIV disparities are substantial; and the University of Malaya is already a Project ECHO® hub for several diseases. The first aim of this project is to evaluate key elements that will influence the implementation of evidence-based stigma reduction tools via Project ECHO®, including evidence, context, and facilitation, and is guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. In Phase 1 of this aim, Photovoice will be used to collect evidence regarding experiences of clinician stigma among 30-35 key stakeholders, including key populations at risk of HIV and PLWH. In Phase 2, additional evidence will be collected regarding Malaysian clinician perspectives and the intervention context will be assessed via online focus groups with 30-40 general practitioners and family medicine clinicians. In Phase 3, factors related to facilitation will be assessed by pre-testing the intervention protocol with 5 clinicians. The second aim is to pilot test Project ECHO® for HIV Prevention and Stigma Reduction among Malaysian clinicians and evaluate its acceptability, feasibility, and preliminary impact on clinician stigma and HIV testing, prevention, and linkage to care services among key populations. General practitioner and family medicine clinicians (n=78) will be randomized to one of 3 study arms: (1) Project ECHO® for HIV Prevention and Stigma Reduction, (2) Project ECHO® for HIV Prevention only, or (3) control. Following guidelines for Hybrid Type 1 Implementation Trials, the acceptability and feasibility of the intervention will be assessed as well as its preliminary impact. If results support the feasibility, acceptability, and preliminary impact of the intervention, funding will be sought to conduct a large-scale efficacy trial. This line of research will ultimately yield a highly scalable intervention that can be disseminated to practicing clinicians in Malaysia and other countries via an existing, popular teletraining platform to address clinician stigma toward key populations and reduce HIV disparities globally.

项目概要 需要采取可扩展的干预措施来消除艾滋病毒检测差异最有力和最持久的驱动因素之一， 预防以及与全球护理的联系：临床医生对重点艾滋病毒高危人群的耻辱。 经历和/或预期来自敌人的耻辱的人不太可能发起、参与和坚持护理，包括艾滋病毒 研究人员发现了基于证据的减少耻辱的工具。 有望减少新教徒的耻辱并缩小全球艾滋病毒差异，然而，这是提供这些工具的工具。 目前缺乏大规模（即超越单一诊所）这项工作的长期目标是解决。 通过广泛实施基于证据的耻辱减少工具，通过流行的方法在全球范围内消除临床医生的耻辱 ECHO® 项目（社区医疗保健成果扩展）提供培训、支持和授权。 Fortress 在全球范围内提供广泛的专业护理服务，包括艾滋病毒检测、预防和护理联系。 “中心和辐射”模型，但是社区设置“辐射”方面的非专家可以向以下领域的专家学习并与之合作 R34 项目的目标是通过视频会议技术建立学术“中心”。 将减少工具纳入 Project ECHO® 并在马来西亚对顾客进行试点测试，这是最佳的干预措施。 该项目的试验场，因为它体现了全球和美国的许多社会背景，因此临床医生感到耻辱 艾滋病毒差异巨大；马来亚大学已经是多种疾病的 ECHO® 项目中心。 该项目的首要目标是评估影响基于证据的减少耻辱实施的关键因素 通过 ECHO® 项目提供的工具，包括证据、背景和促进，并以研究促进行动为指导 在卫生服务 (PARiHS) 框架中的实施 在该目标的第一阶段，Photovoice 将用于收集证据。 关于 30-35 个关键利益相关者（包括有艾滋病毒风险的关键人群）的临床医生耻辱经历 在第二阶段，将收集有关马来西亚临床医生观点和干预措施的更多证据。 将通过由 30-40 名全科医生和家庭医学信徒组成的在线焦点小组对背景情况进行评估。 3、与便利化相关的因素将通过 5 名民兵预先测试干预方案来评估。 在马来西亚爱好者中试点测试 ECHO® 项目，以预防艾滋病毒和减少耻辱感，并评估其效果 可接受性、可行性以及对临床医生耻辱感和艾滋病毒检测、预防以及与护理服务的联系的初步影响 重点人群中的全科医生和家庭医学 (n=78) 将被随机分配到 3 项研究中的一项。 部门：(1) 用于艾滋病毒预防和减少耻辱的 ECHO® 项目，(2) 仅用于艾滋病毒预防的 ECHO® 项目，或 (3) 遵循混合类型 1 实施试验的指南，干预措施的可接受性和可行性。 如果结果支持可行性、可接受性和初步影响，将对其进行评估。 干预后，将寻求资金进行大规模功效试验，该研究最终将产生结果。 高度可扩展的干预措施，可以通过现有的、 受欢迎的远程培训平台，旨在解决临床医生对重点人群的耻辱并减少全球艾滋病毒差异。