M-Suubi: A Multi-level integrated intervention to reduce the impact of HIV stigma on HIV treatment outcomes among adolescents living with HIV in Uganda

M-Suubi：多层次综合干预措施，以减少乌干达艾滋病毒感染青少年艾滋病毒耻辱对艾滋病毒治疗结果的影响

• 批准号: 10335996
• 负责人: Massy Mutumba
• 金额: $ 72.85万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-09 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10335996
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adolescent; Affect; Africa South of the Sahara; Appointment; Attention; Attitude; Beds; Caring; Child; Cluster randomized trial; Commuting; Continuity of Patient Care; Cost Analysis; Country; Coupled; Development; Disadvantaged; Disclosure; Discrimination; Drowsiness; Economics; Education; Enrollment; Environment; Exclusion; Family; Family Relationship; Feeling suicidal; Floor; Food; Fright; Gastric Emptying; Goals; HIV; Home; Inequality; Infection; Intervention; Intervention Studies; Literature; Living Arrangement; Mediation; Mental Depression; Nausea; Outcome; Parents; Participant; Personal Satisfaction; Pharmaceutical Preparations; Pharmacy facility; Policies; Poverty; Prevalence; Privacy; Psyche structure; Randomized; Reporting; Research; Schedule; Schools; Secondary Schools; Shame; Social Environment; Structure; Student Dropouts; Students; System; Testing; Thinking; Time; Training; Treatment outcome; Uganda; United States National Institutes of Health; Violence; Viral; antiretroviral therapy; arm; base; care outcomes; cost effectiveness; empowerment; experience; family support; food insecurity; improved; innovation; medication compliance; peer; pill; primary outcome; programs; recruit; response; secondary analysis; secondary outcome; side effect; social stigma; therapy adherence; treatment adherence; treatment as usual; treatment services

PROJECT ABSTRACT In response to PA-20-144 calling for innovations in HIV prevention, testing, adherence and retention to optimize HIV prevention and care continuum outcomes, we examine the impact and cost-effectiveness of an innovative multilevel intervention combining Multiple Family Groups (MFGs) for HIV stigma reduction (MFG-HIVSR) with a family economic empowerment (FEE) intervention versus a group-based HIV stigma reduction for Educators (GED-HIVSR) combined with MFG-HIVSR plus FEE (hereafter M-Suubi) on HIV treatment adherence and engagement in care among school-going adolescents living with HIV (ALHIV) in Uganda. HIV stigma remains a formidable barrier to HIV treatment adherence among adolescents in Uganda, contributing to low rates of medication adherence and viral suppression (less than 50%) and high attrition from HIV treatment services. ALHIV experience HIV stigma (internalized, anticipated and enacted) in various settings, including families and schools, the most important developmental contexts that should otherwise be supportive of their development and wellbeing. One of the unique features about education in Uganda and other countries in Sub-Saharan Africa is the high proportion (over 60%) of school-going adolescents enrolled in boarding secondary schools – which represent a form of parental opt-in institutionalized care. ALHIV in schools are more disadvantaged and have lower levels of HIV treatment adherence due to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support and food insecurity. Within families, HIV stigma is perpetuated in various forms including discrimination and violence, often due to unfounded fears of infection—hence undermining the quality of family relations and supports for ALHIV. Building on our research and current evidence on HIV stigma reduction, we propose a multi-level three-arm cluster randomized study (M-Suubi) with the following specific aims: Aim 1: Examine the impact of M-Suubi on HIV viral suppression (primary outcome); and adherence to HIV treatment (keeping appointments, pharmacy refills, pill counts), and retention in care (secondary outcome); Aim 2: Examine the effect of M-Suubi on HIV stigma (internalized, anticipated and enacted), with secondary analyses to explore hypothesized mechanisms of change (e.g. depression) and intervention mediation; Aim 3: Assess the cost and cost-effectiveness of each intervention condition; and Aim 4: Qualitatively examine: a) participants’ experiences with HIV stigma, HIV treatment adherence, and the intervention; and 2) educators’ attitudes towards ALHIV, experiences with GED-HIVSR, and program/policy implementation post-training. The study will enroll 840 ALHIV recruited from 42 schools located within the greater Masaka region, heavily affected by HIV (prevalence 12% vs 7.3% national average). M-Suubi will be provided for 20 months, with assessments at baseline, 12, 24 and 36 months. Findings may inform combination intervention efforts to optimize HIV treatment outcomes and engagements in care among ALHIV.

项目摘要 PA-20-144呼吁在艾滋病毒预防、检测、坚持和保留方面进行创新，以优化艾滋病毒预防和护理的连续成果，我们研究了一种创新的多层次干预措施的影响和成本效益，这种干预措施结合了多个家庭小组（MFG），以减少艾滋病毒的污名（MFG-HIVSR）与家庭经济赋权（FEE）干预相比，基于群体的艾滋病毒污名减少教育工作者（GED-HIVSR）与MFG-HIVSR加FEE（以下简称M-Suubi）相结合，对乌干达在校青少年艾滋病毒感染者（ALHIV）的艾滋病毒治疗依从性和护理参与情况进行了研究。艾滋病毒耻辱仍然是乌干达青少年坚持艾滋病毒治疗的巨大障碍，导致药物依从性和病毒抑制率较低（低于50%）以及艾滋病毒治疗服务的高流失率。艾滋病毒携带者在家庭和学校等各种环境中经历艾滋病毒污名化（内化、预期和实施），而家庭和学校是最重要的发展环境，本应有助于他们的发展和福祉。乌干达和撒哈拉以南非洲其他国家教育的一个独特之处是，在寄宿中学就读的在校青少年比例很高（超过60%），这是父母选择接受机构化照料的一种形式。学校中的艾滋病毒携带者处境更为不利，坚持接受艾滋病毒治疗的比例较低，原因是学校内艾滋病毒污名化程度高、学校结构和常规僵化、缺乏坚持治疗的支持以及粮食不安全。在家庭中，艾滋病毒的耻辱感以各种形式持续存在，包括歧视和暴力，这往往是由于毫无根据地担心感染，从而破坏了家庭关系的质量和对ALHIV的支持。基于我们的研究和目前关于减少艾滋病毒污名的证据，我们提出了一项多水平三臂随机分组研究（M-Suubi），具体目标如下：目标1：检查M-Suubi对艾滋病毒抑制的影响（主要结局）;以及坚持艾滋病毒治疗（保持预约，药房续药，药丸计数），并保留护理（次要结局）;目的2：检查M-Suubi对艾滋病毒污名化的影响（内化、预期和实施），并进行二次分析，以探索假设的变化机制（例如抑郁症）和干预调解;目标3：评估每种干预条件的成本和成本效益;目标4：定性检查：a）参与者对艾滋病毒耻辱、艾滋病毒治疗依从性和干预的经历;（2）教育工作者对ALHIV的态度、GED-HIVSR的经验以及培训后的计划/政策执行情况。该研究将招募840名来自大马萨卡地区42所学校的ALHIV患者，这些学校受HIV严重影响（患病率为12%，全国平均水平为7.3%）。M-Suubi将提供20个月，在基线、12、24和36个月进行评估。研究结果可能会告知联合干预努力，以优化艾滋病毒治疗结果和参与ALHIV之间的护理。