Interrupting HIV and TB stigma in the household during TB contact investigation in Uganda

乌干达结核病接触者调查期间消除家庭中艾滋病毒和结核病的耻辱

• 批准号: 9914145
• 负责人: John Lucian Davis
• 金额: $ 18.03万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9914145
• 关键词: Address; Adolescent; Africa South of the Sahara; Area; Awareness; Behavior; Behavior Therapy; Behavioral Sciences; Caring; Cause of Death; Child; Cities; Clinic; Clinical; Complex; Consent; Counseling; Data; Data Collection; Decision Making; Effectiveness; Environment; Evaluation; Focus Groups; Fright; Funding Opportunities; Future; Goals; HIV; HIV diagnosis; HIV/TB; Health; Health system; Home environment; Household; Human immunodeficiency virus test; Individual; Interdisciplinary Study; Interruption; Intervention; Interview; Investigation; Judgment; Link; Measures; Methods; Oral; Patients; Perception; Personal Satisfaction; Persons; Population; Prospective cohort; Public Health; Randomized; Research; Risk; Salivary; Sampling; Series; Social Interaction; Social Sciences; Standardization; Surveys; Testing; Time; Tuberculosis; Uganda; United States National Institutes of Health; Universities; Visit; authority; base; care seeking; case finding; cost; design; doctoral student; experience; high risk; implementation research; implementation science; improved; indexing; innovation; insight; instrument; interest; low income country; member; novel; novel strategies; oral HIV; peer; prevent; primary outcome; programs; prospective; psychologic; recruit; social; social stigma; symposium; uptake; young man

PROJECT SUMMARY/ABSTRACT With widespread access to high-quality HIV treatment, awareness of HIV status remains among the most important barriers to public health control of HIV in sub-Saharan Africa, especially among key populations including adolescents, men, and close contacts of TB patients. Household testing by lay health workers offers a proven approach for reaching such populations, but rates of test acceptance remain unacceptably low. Stigma related to both HIV and TB contribute to low uptake, and may be reinforced by social interactions at the household level. A century of behavioral science research on individual decision-making in group contexts strongly suggests that optimizing the order of test invitations to establish testing as the normative choice, framing testing as a prosocial behavior, and offering a less invasive test is likely to reduce stigma and improve uptake of testing. Therefore, this application proposes a series of preliminary, prospective, mixed-methods studies with household members of TB patients and lay health workers delivering routine household contact investigation for TB and HIV in Kampala, Uganda. The overall objective of these studies will be to evaluate the feasibility, acceptability, and preliminary effectiveness of a complex behavioral intervention to reduce stigma and promote HIV testing uptake among household members of TB patients. The innovative testing strategy includes three components, 1) acceptance-optimized sequencing of test invitations, 2) prosocial messaging, and 3) oral HIV testing. In Aim 1, the novel test invitation strategy will be evaluated and iteratively refined based on serial qualitative data collection with health workers and household contacts, as well as before-and-after surveys of contacts using validated stigma scales selected for their utility for TB- and HIV-specific stigma at the household level. In Aim 2, the strategy will be prospectively evaluated for its effects on stigma and test uptake in a pre-post implementation design. A multi-disciplinary research team includes experts in case-finding for TB-HIV, social sciences, and implementation research working in close partnership with public health officials; they also have experience in building local research capacity in implementation science. The expected impact is to generate preliminary data on a novel approach to offering home testing that reduces layered HIV-TB stigma in households, and on its effects on testing and linkage to and retention in care, built on the strong scientific premise of longstanding research on social decision-making. The project will also enhance local capacity by supporting a local doctoral student on the project team and sponsoring annual scientific symposia on HIV-TB stigma at Makerere University, with the goal of engaging a broad group of stakeholders to advance a local research agenda in this area. These data will inform a future randomized study evaluating the clinical impact of these innovative stigma-reducing approaches to offering and delivering TB and HIV counseling and testing in household settings.

项目摘要/摘要 随着广泛获得高质量的艾滋病毒治疗的机会，对艾滋病毒状况的认识仍然是最大的 撒哈拉以南非洲的艾滋病毒公共卫生控制的重要障碍，尤其是在关键人群中 包括青少年，男性和结核病患者的密切接触。外行健康工作者的家庭测试提供 熟悉的人群的经过验证的方法，但是测试接受率仍然不可接受。柱头 与艾滋病毒和结核病有关 家庭水平。一个世纪的行为科学研究在小组背景下个人决策 强烈建议优化测试邀请的顺序以建立测试作为规范选择，框架 作为亲社会行为进行测试，提供较小的侵入性测试可能会减少污名并改善吸收率 测试。因此，该应用提出了一系列初步的，前瞻性的混合方法研究 结核病患者的家庭成员和外行卫生工作者提供常规的家庭联系调查 乌干达坎帕拉的结核病和艾滋病毒。这些研究的总体目的是评估可行性， 复杂的行为干预措施的可接受性和初步有效性，以减少污名并促进 HIV测试结核病患者的家庭成员的吸收。创新的测试策略包括三个 组件，1）测试邀请的接受测序，2）亲社会消息和3）口服HIV 测试。在AIM 1中，将评估新颖的测试邀请策略，并根据串行进行迭代精制 与卫生工作者和家庭联系人以及之前和之后的调查有关的定性数据收集 使用经过验证的污名量表的触点，以用于其对家庭的TB和HIV特异性污名的效用 等级。在AIM 2中，该策略将被预期评估其对污名的影响并测试预先吸收 实施设计。多学科研究团队包括针对TB-HIV，社交的案例调查专家 科学和实施研究与公共卫生官员密切合作；他们也有 在实施科学方面建立本地研究能力的经验。预期的影响是产生 有关提供家庭测试的新方法的初步数据，该方法可减少家庭中分层的HIV-TB污名， 以及它对测试和连接到与护理中的测试和链接的影响，建立在强大的科学前提的基础上 长期研究社会决策。该项目还将通过支持 项目团队的当地博士生，并赞助了HIV-TB污名的年度科学研讨会 Makerere University，目的是吸引一大批利益相关者推进本地研究议程 在这个区域。这些数据将为未来的随机研究提供评估，以评估这些创新的临床影响 在家庭环境中提供和提供结核病和艾滋病毒咨询和测试的污名方法。

项目成果

Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial.

• DOI: 10.1136/bmjopen-2022-061508
• 发表时间: 2022-05-25
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Armstrong-Hough, Mari;Ggita, Joseph;Gupta, Amanda J.;Shelby, Tyler;Nangendo, Joanita;Ayen, Daniel Okello;Davis, J. L.;Katamba, Achilles
• 通讯作者: Katamba, Achilles