Mitigating sexual stigma within healthcare interactions to improve engagement of MSM in HIV prevention

减轻医疗保健互动中的性耻辱，以提高 MSM 在艾滋病毒预防中的参与度

• 批准号: 10160243
• 负责人: Bryan A. Kutner
• 金额: $ 17.56万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10160243
• 关键词: AIDS prevention; Algorithms; Anal Sex; Anus; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Belief; Bisexual; Caring; Collaborations; Competence; Counseling; Data; Development Plans; Disclosure; Discrimination; E-learning; Educational workshop; Environment; Epidemic; Equipment and supply inventories; Evaluation; Evidence based program; Expert Opinion; Funding; Future; Gays; Goals; HIV; HIV Infections; HIV/STD; HIV/STI intervention; Health; Health Personnel; Healthcare; Human; Incidence; Information Resources; Intention; Intervention; Interview; Knowledge; Lead; Learning; Link; Longitudinal Surveys; Lubricants; Malignant Neoplasms; Mediation; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority Groups; Modeling; Outcome; Pamphlets; Persons; Physiology; Population; Prevention; Process; Prophylactic treatment; Provider; Quality of Care; Reading; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Sampling; Scientist; Services; Sex Behavior; Sexual Health; Sexual and Gender Minorities; Sexuality; Stigmatization; Structure; Techniques; Technology; Testing; Theoretical Domains framework; Theory of Change; Training; Triage; United States National Institutes of Health; Viremia; Visit; Well in self; Work; Workforce Development; base; behavior change; care outcomes; career; career development; condoms; design; effectiveness testing; follow-up; health care settings; health communication; hybrid type 2 design; implementation framework; implementation intervention; implementation outcomes; implementation science; improved; information model; mHealth; men; men who have sex with men; novel; prevent; rectal microbicide; response; screening; skills; social stigma; theories; therapy development; tool; transmission process; uptake

Long-term objective. My long-term objective is to explore, identify and evaluate acceptable, feasible and appropriate techniques and mechanisms to mitigate HIV-related stigma in healthcare, and thereby to improve the quality of care and outcomes for populations that would otherwise remain deterred from HIV services. Specific aims. I plan to integrate stigma and implementation science frameworks to delineate components of human behavior and environment that influence the manifestation—and mitigation—of stigma during healthcare interactions. I will target a high HIV incidence population, men who have sex with men (MSM), and a rarely studied but important marker of HIV-related stigma, anal sexuality. First, I will explore stigma drivers and mitigators by interviewing 30 healthcare workers (HCWs) responsible for HIV-related screening and care, as well as 30 MSM, both purposively sampled for diversity and variable comfort discussing anal sexuality during healthcare encounters. Then I will develop, with an 8-person advisory board of HCWs and MSM, an intersectional stigma-mitigation intervention to help HCWs navigate discussion of this sensitive topic, improve the quality of care, and thereby promote prevention. The intervention will include educational mHealth, workshop and coaching components. Finally, I will pilot the intervention in a stepped wedge hybrid type 2 design to evaluate acceptability, feasibility, and appropriateness; preliminary impact on HCW behavior (e.g., knowledge, comfort, screening practices); and remaining barriers. The pilot will be among 120 HCWs working in two high MSM incidence regions but who do not specialize in MSM care. Aims respond to OAR priorities, including evaluation of interventions that lead to behavior change by consumers or providers to improve the quality of care and engagement in services. Career-development plan. The above aims rely on a robust, mentored training plan that will prepare me for a career as an independent investigator. My plan involves coursework, directed readings, workshops, and visits to research labs of mentors, to advance my knowledge, proficiency and capacity across five training goals: (1) to learn how to leverage health communication to mitigate stigma; (2) to understand how to develop theory- informed behavioral interventions; (3) to acquire advanced knowledge in mHealth tools; (4) to build expertise in implementation science to accelerate the uptake of interventions in settings where mitigation of stigma is urgently needed; and (5) to strengthen professional skills to develop a successful NIH-funded research career. Environment. NYSPI/Columbia will host my research and training, with mentorship from a team of internal experts in sexuality studies, health communication, and workforce development, and external experts in intersectional stigma (UAB), mHealth (UNC), implementation science (UW), and structural stigma (Yale). In Year 4, I plan to submit an R01 to test the K23 intervention’s techniques, mechanisms, and implementation in a larger stepped wedge trial, with the goal of reducing incidence and viremia. Skills and findings from this award will be broadly applicable to HIV stigmas; future technologies, like rectal microbicides; and other related health domains.

长期目标。我的长期目标是探索、识别和评估可接受的、可行的和 适当的技术和机制，以减轻医疗保健中与艾滋病毒相关的耻辱，从而改善 为否则仍无法获得艾滋病毒服务的人群提供护理质量和结果。 具体目标。我计划整合耻辱和实施科学框架来描述组件 影响耻辱表现和缓解的人类行为和环境 医疗保健互动。我将针对艾滋病毒高发人群、男男性行为者 (MSM) 以及 很少有人研究，但却是艾滋病毒相关耻辱的重要标志，即肛交。首先，我将探讨污名驱动因素和 还采访了 30 名负责艾滋病毒相关筛查和护理的医护人员 (HCW) 作为 30 名男男性行为者，两人都是为了多样性和在讨论肛交时的舒适度而有目的地抽样的 医疗保健遭遇。然后，我将与一个由医护人员和男男性行为者组成的 8 人顾问委员会一起制定一个跨部门的计划 减轻污名化干预措施，帮助医护人员引导这个敏感话题的讨论，提高讨论的质量 护理，从而促进预防。干预措施将包括教育性移动医疗、研讨会和辅导 成分。最后，我将尝试对阶梯式楔形混合 2 型设计进行干预，以评估可接受性， 可行性和适当性；对医护人员行为的初步影响（例如知识、舒适度、筛查 做法）；以及剩余的障碍。该试点项目将在两个 MSM 高发地区工作的 120 名医护人员中进行 但不专门从事 MSM 护理。目标响应 OAR 优先事项，包括对以下干预措施的评估： 导致消费者或提供者的行为改变，以提高护理质量和服务参与度。 职业发展计划。上述目标依赖于一个强有力的、有指导的培训计划，该计划将使我做好准备 独立调查员的职业生涯。我的计划包括课程作业、定向阅读、研讨会和参观 到导师的研究实验室，以提高我在五个培训目标方面的知识、熟练程度和能力：(1) 了解如何利用健康沟通来减轻耻辱感； (2) 了解如何发展理论- 知情的行为干预； (3) 获得移动医疗工具的先进知识； (4) 积累专业知识 实施科学，以加速在迫切需要减轻耻辱的环境中采取干预措施 需要； (5) 加强专业技能，以成功开展 NIH 资助的研究事业。 环境。 NYSPI/哥伦比亚将在内部团队的指导下举办我的研究和培训 性研究、健康传播和劳动力发展方面的专家，以及以下领域的外部专家 交叉耻辱（UAB）、移动医疗（UNC）、实施科学（UW）和结构耻辱（耶鲁）。年份 4、我计划提交一份R01，在更大的范围内测试K23干预的技术、机制和实施情况 阶梯楔形试验，目的是减少发病率和病毒血症。该奖项的技能和发现将 广泛适用于艾滋病毒耻辱；未来的技术，如直肠杀菌剂；以及其他相关的健康领域。