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: 10536609
• 负责人: Bryan A. Kutner
• 金额: $ 3.36万
• 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 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536609
• 关键词: AIDS prevention; Acceleration; Algorithms; Anal Sex; Anus; Attitude; Award; Behavior; Behavior Therapy; Behavioral; Belief; Bisexual; Caring; Collaborations; Communication; Competence; Counseling; Data; Dedications; Development Plans; Disclosure; Discrimination; E-learning; Education; 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; Intention; Intervention; Interview; Knowledge; Learning; Link; Longitudinal Surveys; Lubricants; Malignant Neoplasms; Mediation; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Outcome; Pamphlets; Persons; Physiology; Population; Prevention; Process; Prophylactic treatment; Provider; Quality of Care; Recording of previous events; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Sampling; Scientist; Services; Sex Behavior; Sexual Health; Sexuality; Stigmatization; Techniques; Technology; Testing; Theoretical Domains framework; Theory of Change; Training; Triage; United States National Institutes of Health; Viremia; Visit; Visualization; Well in self; Work; Workforce Development; behavior change; career; career development; condoms; design; effectiveness testing; follow-up; gender minority group; health care settings; health communication; health training; hybrid type 2 design; implementation framework; implementation intervention; implementation outcomes; implementation science; improved; 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、确定和评估可接受的、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有关的耻辱感，从而改善 （c）提高护理质量，并为那些否则将继续对艾滋病毒服务望而却步的人口提供成果。 具体目标。我计划整合污名化和实施科学框架， 人类行为和环境的影响，表现和减轻耻辱， 保健互动。我将针对艾滋病毒高发病率人群，男男性行为者（MSM）， 很少被研究，但却是艾滋病相关耻辱的重要标志，肛交。首先，我将探讨污名化的驱动因素， 通过采访30名负责艾滋病毒相关筛查和护理的医护人员（HCW）， 作为30男男性接触者，在讨论肛交时， 医疗保健遭遇。然后我将与HCW和MSM组成的8人顾问委员会一起制定一个交叉的 减轻耻辱的干预，以帮助HCW导航这一敏感话题的讨论，提高质量， 关心，从而促进预防。干预措施将包括教育mHealth，研讨会和辅导 件.最后，我将在阶梯楔形混合2型设计中进行干预试验，以评估可接受性， 可行性和适当性;对HCW行为的初步影响（例如，知识，舒适，筛选 （三）其他障碍。该试点将在两个高MSM发病率地区工作的120名HCW中进行 但他们并不专门从事男男性接触者的护理。目标符合业务成果报告的优先事项，包括评价干预措施， 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大的，指导性的培训计划，将为我做好准备， 独立调查员的职业生涯我的计划包括课程作业、指导阅读、工作坊和参观 研究导师的实验室，以提高我的知识，熟练程度和能力在五个培训目标：（1） 学习如何利用健康传播来减轻耻辱感;（2）了解如何发展理论- 知情的行为干预措施;（3）获得移动健康工具的先进知识;（4）建立专业知识， 实施科学，以加快在迫切需要减轻污名化的环境中采取干预措施 （5）加强专业技能，以发展成功的NIH资助的研究事业。 环境NYSPI/哥伦比亚大学将主办我的研究和培训，并由内部 性研究、健康传播和劳动力发展方面的专家，以及 交叉污名（UAB），移动健康（MHEALTH），实施科学（UW）和结构性污名（耶鲁）。年级 4、我计划提交一份R 01，在一个更大的 逐步楔形试验，目的是降低发病率和病毒血症。该奖项的技能和发现将 广泛适用于艾滋病毒的耻辱;未来的技术，如直肠杀微生物剂;和其他相关的健康领域。