"Sống vui, Live happily": A psychosocial tele-health intervention to address multi-level stigma among youth living with HIV in Vietnam

项目概要/摘要 青年艾滋病毒感染者（YLHIV）处于全球艾滋病毒流行的最前沿， 越来越多的儿童能够活到成年，世界各地越来越多的青年受到感染。与艾滋病毒有关的耻辱感是 抗逆转录病毒治疗（ART）的依从性和保留在YLHIV护理中的关键挑战， 抑郁和焦虑等心理健康问题。几乎没有针对青年的减少耻辱感战略， 特别是在低收入和中等收入国家（LMIC）。拟议研究的总体目标 是为了加深对越南YLHIV所经历的一系列耻辱的了解，并确定相关的 调解战略。我们的具体目标（SA）是：1）采用心理社会污名减少干预措施， YLHIV在越南基于认知行为疗法（CBT）的原则，通过电话提供，使用 在制定干预措施期间，青年的关键投入; 2）评估可行性、可接受性和初步的 这一创新方法在减少耻辱感、改善心理健康和抗逆转录病毒治疗依从性方面的有效性 通过一项小型的前后研究，在YLHIV中进行; 3）探索YLHIV在 越南及其与ART依从性和心理社会健康的关系，通过定量调查， 电子依从性监测;以及4）加强我们团队未来进行污名研究的能力 以及减少耻辱的干预措施。这项研究将分三个阶段进行，为期两年。第1阶段将 包括制定干预措施，包括与YLHIV的初步面谈和试点测试，以满足SA 1。同相 2.干预措施将远程提供给河内门诊诊所接受艾滋病毒治疗的40名YLHIV感染者; 将在基线和终点收集社会人口统计学、心理社会学和临床数据， 通过无线药丸容器进行持续监控。第三阶段将涉及数据分析和传播 活动我们建议的干预措施将针对YLHIV所经历的多个层面的耻辱， 自我管理技能;它基于CBT原则和以前的研究， 污名，心理健康和ART坚持之间的相互关系。核心心理治疗 该计划将包括为期四个月的每周电话辅导课程，然后是两个月的“助推器” 会议，并将根据每个参与者的情况进行调整。基线、终点和持续时间分析 依从性数据将有助于实现SA 2和SA 3，从而有助于提供科学证据 以低成本战略为基础，减少对艾滋病毒的污名化，改善心理社会健康和抗逆转录病毒疗法的依从性 在中低收入国家。这项研究的团队由经验丰富的多学科越南和美国研究人员组成， 进行研究的特殊能力;我们的密切合作辅以特定技能的培训 在整个项目中，这将有助于我们加强未来开展污名和心理社会工作的能力。 #21440;，从而解决了SA 4？在越南官员和临床医生的大力支持下， 国际专家，我们的研究结果具有很高的潜力，政策和计划的影响。

Project Summary/Abstract Youth living with HIV (YLHIV) are at the forefront of the HIV epidemic globally, as more perinatally infected children increasingly survive into adulthood, and more youth become infected worldwide. HIV-related stigma is a critical challenge to antiretroviral therapy (ART) adherence and retention in care of YLHIV and is associated with mental health issues such as depression and anxiety. Few stigma-reduction strategies exist for youth, however, particularly in low and middle income countries (LMICs). The overall goals of the proposed research are to deepen understanding of the spectrum of stigma experienced by YLHIV in Vietnam and to identify relevant mediation strategies. Our Specific Aims (SA) are to 1) adapt a psychosocial stigma-reduction intervention for YLHIV in Vietnam based on cognitive-behavioral therapy (CBT) principles and delivered by telephone, using critical input from youth during intervention development; 2) assess the feasibility, acceptability and preliminary efficacy of this innovative approach to reduce stigma, and improve psychosocial wellbeing and ART adherence among YLHIV through a small pre-post study; 3) explore the multiple facets of stigma experienced by YLHIV in Vietnam and their relationships with ART adherence and psychosocial wellbeing via quantitative surveys and electronic adherence monitoring; and 4) strengthen our team's capacity to conduct future research on stigma and stigma-reduction interventions. The research will be conducted over two years in three phases. Phase 1 will comprise intervention development including initial interviews with YLHIV and pilot testing to meet SA1. In Phase 2, the intervention will be provided remotely to 40 YLHIV accessing HIV care at outpatient clinics in Hanoi; sociodemographic, psychosocial, and clinical data will be collected at baseline and endline, and adherence will be monitored continuously via wireless pill containers. Phase 3 will involve data analysis and dissemination activities. Our proposed intervention will target multiple levels of stigma experienced by YLHIV using supportive self-management skills; it is grounded in CBT principles and in previous research which has documented interrelationships among stigma, psychosocial wellbeing, and ART adherence. The core psychosocial treatment plan will comprise four months of weekly coaching sessions by phone, followed by two monthly “booster” sessions, and will be tailored to the situation of each participant. Analysis of baseline, endline, and the continuous adherence data will enable the achievement of SA2 and SA3 and thereby contribute to the scientific evidence base on low-cost strategies to reduce stigma and improve psychosocial wellbeing and ART adherence for YLHIV in LMICs. The study's team of experienced multi-disciplinary Vietnamese and American researchers has exceptional capacity to conduct the study; our close collaboration supplemented by skill-specific training throughout the project will help us to strengthen our capacity to conduct future work on stigma and psychosocial interventions, thus addressing SA4. With strong support from Vietnamese officials and clinicians, as well as international experts, our results have high potential for policy and program impact.