Improving HIV and Depression Outcomes by Reducing HIV-Mental Illness Stigma in Malawi: a pilot effectiveness-implementation trial

在马拉维通过减少艾滋病毒精神疾病耻辱来改善艾滋病毒和抑郁症的结果：试点有效性实施试验

• 批准号: 10484751
• 负责人: Melissa Ann Stockton
• 金额: $ 17.99万
• 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: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10484751
• 关键词: Address; Adult; Affect; Africa South of the Sahara; Antidepressive Agents; Caring; Clinical; Communities; Country; Data; Depressed mood; Educational workshop; Epidemic; Epidemiology; Evidence based intervention; Focus Groups; Foundations; Goals; Government; Group Interviews; HIV; Health; Health Sciences; Health Services Accessibility; Hybrids; Individual; Intervention; Interview; Investments; Knowledge; Level of Evidence; Malawi; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentored Research Scientist Development Award; Mentorship; Methodology; Methods; Modeling; Morbidity - disease rate; Nature; Outcome; Patient-Focused Outcomes; Patients; Personal Satisfaction; Persons; Phase; Policies; Provider; Psychotherapy; Reading; Reporting; Research; Research Personnel; Research Training; Resource-limited setting; Site; Stereotyping; Stigmatization; Strategic Planning; Testing; Time; Training; Work; base; career; community based participatory research; comorbid depression; coping mechanism; depressed patient; design; effectiveness implementation study; effectiveness implementation trial; evidence base; experience; implementation barriers; implementation evaluation; implementation facilitators; implementation intervention; implementation outcomes; implementation science; improved; innovation; insight; intersectionality; mortality; pilot trial; programs; psychoeducation; scale up; skills; social stigma; symposium; treatment program; treatment services

ABSTRACT Among people living with HIV (PLHIV), stigma and mental illness (MI), such as depression, bar access to care and worsen health outcomes, particularly in countries like Malawi where 10% of adults are living with HIV and up to a 25% of PLHIV have co-morbid depression. As depression treatment is increasingly integrated into HIV care, interventions helping to reduce stigma for patients facing multiple and intersecting stigmas— HIV, MI, and intersectional stigma— are crucial for engagement in care and improvement of health outcomes. Yet, most individual-level stigma-reduction interventions address only one type of stigma. As such, there is a missed opportunity to address multiple stigmas at once to serve patients. The overall aim of this proposal is to consolidate an evidence-based HIV-MI stigma-reduction intervention with depression treatment for PLHIV and conduct a hybrid effectiveness-implementation pilot to evaluate its implementation and impact on patient outcomes in Malawi. My long-term career goal is to become a leading researcher on implementing and evaluating intersectional interventions that address stigma and meet the mental health (MH) needs of PLHIV. This K01 award will enable me to build upon my strong foundations in epidemiology, qualitive methods, and implementation science to address gaps in my training and develop the necessary expertise to transition into an independent investigator. My training goals are to obtain: 1) substantive knowledge in intersectional stigma and individual-level stigma-reduction interventions; 2) theoretical and methodological skills to combine and consolidate multiple evidence-based interventions using a participatory community-based research approach; and 3) expertise in designing and executing hybrid effectiveness-implementation studies to evaluate both implementation and clinical (e.g., HIV and MH) outcomes. These goals will be achieved through a combination of direct mentorship, coursework, seminars, directed readings, workshops, conferences and hands-on experience. In my proposed research, I will first combine interventions that address HIV, MI and intersectional stigma, consolidate with depression care for PLHIV and develop plans for implementation drawing from focus groups and interviews (Aim 1). I will then evaluate the implementation of the consolidated HIV-MI stigma- reduction intervention and its impact on patient stigma, depression, and HIV care engagement in a two-site pilot hybrid effectiveness-implementation trial (Aim 2). This innovative research will (a) address HIV, MI and intersectional stigma while leveraging existing MH services, (b) prepare for multi-level stigma-reduction intervention packages, and c) yield detailed insights into barriers and facilitators of implementing stigma- reduction interventions in low-resource settings. Ultimately, the proposed study and training will provide me with the skills and preliminary data for an R01 proposal to conduct a full hybrid effectiveness-implementation trial to implement and evaluate a multi-level stigma-reduction intervention in Malawi.

摘要 在艾滋病毒感染者中，耻辱感和精神疾病，如抑郁症，阻碍了获得 护理和恶化的健康结果，特别是在马拉维这样的国家，10%的成年人感染艾滋病毒， 高达25%的艾滋病感染者患有抑郁症。随着抑郁症治疗越来越多地融入 艾滋病毒护理，有助于减少对面临多重和交叉耻辱的患者的耻辱的干预措施-艾滋病毒， MI和交叉污名-对于参与护理和改善健康结果至关重要。然而， 大多数个人层面的减少耻辱干预措施只针对一种类型的耻辱。因此，有一个 错过了一次解决多种耻辱问题以服务患者的机会。本建议的总体目标是 巩固以证据为基础的减少艾滋病毒-心肌梗死污名的干预措施，并对艾滋病毒感染者进行抑郁症治疗， 进行混合有效性-实施试点，以评估其实施情况和对患者的影响 马拉维的成果。我的长期职业目标是成为一名领先的研究人员， 评估跨部门干预措施，以解决耻辱和满足心理健康（MH）的需要，艾滋病毒感染者。 这个K 01奖将使我能够建立在我在流行病学，定性方法， 实施科学，以解决我的培训差距，并发展必要的专业知识，过渡到 独立调查员我的培训目标是获得：1）交叉污名的实质性知识 和个人层面的减少耻辱干预措施; 2）理论和方法技能，以联合收割机， 采用参与性社区研究方法，整合多种循证干预措施; 以及3）设计和执行混合有效性-实施研究以评估两者的专业知识 实施和临床（例如，HIV和MH）结果。这些目标将通过以下方式实现： 直接指导，课程，研讨会，指导阅读，研讨会，会议和实践 体验.在我提议的研究中，我将首先将联合收割机干预措施结合起来， 污名化，巩固与抑郁症护理艾滋病毒感染者，并制定计划，从重点 小组和面试（目标1）。然后，我将评估综合艾滋病毒-MI耻辱的实施情况， 减少干预及其对患者耻辱，抑郁和艾滋病毒护理参与的影响，在两个地点 混合动力效益-实施试点试验（目标2）。这项创新研究将（a）解决艾滋病毒、MI和 在充分利用现有卫生保健服务同时，（B）为多层次减少污名做好准备 干预措施，以及c）对实施污名化的障碍和促进因素产生详细的见解- 在低资源环境中采取减少干预措施。最终，拟议的学习和培训将为我提供 具备R 01提案的技能和初步数据，以进行全面的混合动力有效性实施 在马拉维试行实施和评估一项多层次的减少耻辱感干预措施。