Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: Protocol for translational research.
Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: Protocol for translational research.
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DOI：
10.1016/j.conctc.2022.100980
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发表时间：
2022-10
影响因子：
1.5
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中科院分区：
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该议定书详细介绍了多米尼加共和国对"尊重艾滋病毒并消除艾滋病毒污名“干预措施的调整和试点测试。FRESH是一项医疗保健环境下的减少污名干预措施，旨在减少影响艾滋病毒感染者（PLHIV）的污名，重点关注艾滋病毒和性少数和性别少数（SGM）艾滋病毒感染者所经历的交叉污名。在成功调整FRESH干预措施后，将通过进行试点逐步楔形分组随机对照试验对其进行试点测试。本研究包括三个目标：目标1包括探索性定性评估，特别是与男男性行为者（MSM）艾滋病毒感染者（n = 24-32）进行四个焦点小组，并与跨性别女性艾滋病毒感染者（n = 9-12）进行深入访谈，以探索他们在诊所的耻辱感。还将与艾滋病毒医护人员进行深入访谈，以阐明他们对SGM客户的看法和行为（n = 9-12）。在目标2中，根据目标1的数据，我们将使用ADAPT-ITT框架的连续阶段来迭代适应多米尼加共和国的FRESH干预。在目标3中，将通过一项群集阶梯楔形随机对照试验对适应性干预进行初步测试，以评估干预和研究方案的可行性和可接受性。如果这项试点试验成功，下一步将包括在多米尼加共和国或类似的西班牙语加勒比国家进行更大规模的试验，以评估在临床环境中减少对艾滋病毒感染者的羞辱的有效性。从南到北再到南的适应是有效的，但利用不足。从英语到西班牙语的干预适应需要注意文化的细微差别和当地背景。ADAPT-ITT是一个指导干预措施适应的实用框架，特别是在资源匮乏的环境中。分级楔形分组随机对照试验设计适用于临床水平的干预研究。在多米尼加共和国，从患者中收集基于片剂的临床数据是可行的。
This protocol details the adaptation and pilot testing of the Finding Respect and Ending Stigma around HIV (FRESH) intervention in Dominican Republic. FRESH is a healthcare setting stigma-reduction intervention designed to reduce stigmas affecting people living with HIV (PLHIV), focusing on HIV and intersectional stigmas experienced by sexual and gender minority (SGM) people living with HIV. After the successful adaptation of the FRESH intervention, it will be pilot-tested through the conduct of a pilot stepped wedge cluster randomized controlled trial. Three aims are included in this study; Aim 1 includes exploratory qualitative assessment, specifically the conduct four focus groups with men who have sex with men (MSM) living with HIV (n = 24–32) and in-depth interviews with transgender women living with HIV to explore their experiences with stigma in clinics (n = 9–12). In-depth interviews will also be held with HIV healthcare workers to elucidate their perceptions and behaviors towards their SGM clients (n = 9–12). In Aim 2, informed by Aim 1 data, we will use the sequential phases of the ADAPT-ITT framework to iteratively adapt the FRESH intervention for the Dominican Republic. In Aim 3, the adapted intervention will be pilot-tested via a cluster stepped wedge randomized controlled trial to assess feasibility and acceptability of the intervention and study protocols. If this pilot trial is successful, next steps will include testing the adapted intervention across Dominican Republic or in similar Spanish-speaking Caribbean nations in a larger trial to assess effectiveness in reducing stigma in clinical settings towards PLHIV. South to North to South adaptation is efficient but under-utilized. Intervention adaptation from English to Spanish requires notable attention to cultural nuance and local contexts. ADAPT-ITT is a pragmatic framework to guide intervention adaptation, particularly in resource poor settings. The stepped wedge cluster randomized controlled trial design is warranted for use in clinic-level intervention studies. In-clinic, tablet based data collection from patients is feasible in the Dominican Republic.