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

项目摘要/摘要 青年艾滋病毒携带者(YLHIV)处于全球艾滋病毒流行的前沿，因为更多的人在围产期感染 儿童越来越多地存活到成年，世界各地有更多的年轻人被感染。与艾滋病毒相关的耻辱是 在YLHIV和相关的护理中坚持和保留抗逆转录病毒疗法(ART)的一个关键挑战 有精神健康问题，如抑郁和焦虑。对于年轻人来说，几乎没有减少耻辱的战略， 然而，特别是在低收入和中等收入国家。拟议研究的总体目标 是加深对越南青年艾滋病病毒所经历的耻辱光谱的了解，并确定相关的 调解策略。我们的具体目标(SA)是1)采用心理社会耻辱减少干预措施 越南的YLHIV基于认知行为疗法(CBT)原理并通过电话传递，使用 青年在干预发展过程中的关键投入；2)评估干预的可行性、可接受性和初步 这一创新方法在减少污名、改善心理社会健康和ART依从性方面的有效性 通过一项小型的事前和事后研究，在YLHIV中进行研究；3)探索YLHIV在 越南及其与艺术依从性和心理社会健康的关系 电子依从性监测；以及4)加强我们团队未来对污名进行研究的能力 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。第一阶段将 包括干预措施的制定，包括与YLHIV的初步访谈和为满足SA1而进行的试点测试。同相 2、将向河内40名在门诊接受艾滋病毒护理的青年艾滋病毒感染者提供远程干预； 社会人口学、心理社会和临床数据将在基线和终点收集，依从性将 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经历的多个级别的耻辱，使用支持性 自我管理技能；它植根于CBT原则和以前的研究，这些研究已经记录了 污名、心理社会幸福感和艺术坚持之间的相互关系。心理社会治疗的核心 该计划将包括为期四个月的每周电话辅导课程，然后是每月两次的“助推器” 会议，并将根据每个参与者的情况量身定做。基线、终点线和连续线的分析 依从性数据将使SA2和SA3的实现成为可能，从而有助于科学证据 以低成本策略为基础，减少耻辱，改善YLHIV的心理社会福祉和抗逆转录病毒治疗的依从性 在LMIC中。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 出色的进行研究的能力；我们密切的合作，辅以专门的技能培训 整个项目将有助于加强我们今后开展耻辱和心理社会工作的能力 干预措施，从而解决SA4。在越南官员和临床医生的大力支持下， 国际专家认为，我们的结果具有很高的政策和项目影响潜力。

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.