Multi-Level Intervention Addressing Intersectional Stigma to Improve HIV Testing in MSM

多层次干预解决交叉耻辱，改善男男性行为者的艾滋病毒检测

• 批准号: 10213837
• 负责人: LaRon Earnest Nelson
• 金额: $ 57.08万
• 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: 2019-09-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213837
• 关键词: AIDS prevention; Address; Behavior; Budgets; Car Phone; Caring; Cities; Clinic; Counseling; Discrimination; Education; Empathy; Exposure to; Face; Feedback; Focus Groups; Frequencies; Gender; General Population; Ghana; HIV; HIV Infections; HIV diagnosis; Health; Health Policy; Health Status; Health care facility; Human immunodeficiency virus test; Individual; Intervention; Interview; Life; Location; Maintenance; Manuals; Methods; Modeling; Motivation; Outcome; Peer Group; Phase; Prevalence; Protocols documentation; Randomized; Randomized Controlled Trials; Reporting; Research; Same-sex; Sampling; Science; Social Network; Social support; Source; Stigmatization; Symptoms; Testing; Time; Voice; Work; acceptability and feasibility; arm; base; behavior test; civil society; community clinic; efficacy trial; empowerment; evidence base; gender nonconforming; improved; intervention effect; member; men; men who have sex with men; novel; peer; predictive modeling; prevention service; recruit; rehearsal; same sex behavior; scale up; self testing; sex; social norm; social stigma; standard of care; starfish sampling; testing services; theories; treatment as usual; trial design

PROJECT SUMMARY HIV prevalence among men with have sex with men (MSM) in Ghana is at least eight times higher than that of the general population (2%). MSM in Ghana face high levels of stigma due to HIV status (actual or perceived), same-sex behavior, and gender non-conformity. These stigmas are documented barriers to HIV prevention and treatment. In our preliminary work in Ghana (N=137), one-third of MSM had never been tested for HIV. We propose a randomized controlled trial to evaluate the feasibility, acceptability and estimate effect size of a multi-component, multi-level (organizational, interpersonal, and intrapersonal-level) intersectional stigma-reduction intervention to increase HIV testing frequency among MSM in Ghana where HIV, same-sex behavior and gender non-conformity are highly stigmatized. To date, stigma-reduction interventions in Ghana have focused on uni-level targets (e.g., health care facilities (HCFs)) and addressed one type of stigma (e.g., HIV), without engaging the intersectional character of the multiple stigmas that MSM encounter. Our specific aims are: (1) to evaluate the feasibility and acceptability of a novel multi-component, multi-level intervention to address intersectional stigma and (2) to estimate effect size of the intervention for scale up to a definitive efficacy trial. We will combine three theory-based interventions that were previously implemented separately in Ghana for reducing stigma at HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. We will use the Convergence Framework for combining interventions. The ADAPT-ITT framework guides our approach to enhancing the interventions’ content on intersectional stigma. To achieve these aims we will undergo a systematic adaptation that will refine the individually developed HCF, peer- and individual-level interventions to produce a comprehensive multi-level intersectional stigma reduction intervention. This will consist of focus groups and in-depth interviews with HCF staff and MSM to sharpen content on drivers and manifestations of HIV, same-sex and gender non-conforming stigmas within HCFs and peer groups and how these intersecting stigmas undermine HIV testing. This information will be used to refine the content of the interventions which will then be reviewed by a workgroup of HCF and Ghanaian MSM. The trial involves 8 HCFs, matched on HCF staff size. Matched pairs will each be randomized to have an intervention and a control arm. Before assignment to HCFs, 216 MSM, recruited through Starfish Sampling (combined time-location and peer-referral sampling), will be randomized to receive the intervention or usual care. Each arm of MSM will have members randomized to one of the four clinics per city and asked to stay in the assigned community-clinic pipeline. Using the RCT design, we will formally test the following outcomes: HIV testing at 3 and 6 months, acceptability and feasibility. We will fit multi-level regression models for the predictor variables at the HCF, peer and individual-levels. Based on the study’s findings, we will finalize a protocol to test our intervention in a definitive efficacy trial.

项目摘要 在加纳，男男性行为者（MSM）的艾滋病毒感染率至少是一般人群的八倍。 人口（2%）。加纳的男男性行为者由于艾滋病毒状况（实际或感知）、同性行为和 性别不一致。这些耻辱是艾滋病毒预防和治疗的障碍。在我们的初步工作中 在加纳（N=137），三分之一的男男性行为者从未接受过艾滋病毒检测。我们建议进行一项随机对照试验， 多因素、多水平（组织、人际和 个人层面）跨部门减少耻辱干预，以提高加纳男男性行为者的艾滋病毒检测频率 在那里，艾滋病、同性行为和性别不一致被高度污名化。迄今为止，减少污名的干预措施 在加纳，卫生保健设施（HCF）），并解决一种类型的耻辱（例如，HIV）， 而不涉及男男性接触者所遇到的多重污名的交叉特征。我们的具体目标是：（1） 评价一种新的多成分、多层次干预措施的可行性和可接受性， 污名和（2）估计干预措施的效果大小，以扩大到一个明确的疗效试验。我们将联合收割机 以前在加纳单独实施的以理论为基础的干预措施，以减少氟氯烃一级的耻辱感， 在同伴群体一级增加艾滋病毒检测，在个人一级增加同伴社会支持。我们将使用 合并干预措施的趋同框架。ADAPT-ITT框架指导我们增强 干预措施的内容交叉污名。为了实现这些目标，我们将进行系统的调整， 完善个人制定的HCF，同侪和个人层面的干预措施，以产生一个全面的多层次 跨部门减少污名化干预。这将包括焦点小组和深入采访HCF工作人员， 男男性行为者在HCF中加强关于艾滋病毒、同性和性别不一致的污名的驱动因素和表现的内容 以及这些相互交叉的耻辱如何破坏艾滋病毒检测。这些信息将用于改进 干预措施的内容，然后将由一个由HCF和加纳男男性行为者组成的小组进行审查。审判涉及8名 HCF，与HCF工作人员规模相匹配。匹配的配对将被随机分为干预组和对照组。 分配到HCF，216名MSM，通过海星抽样（结合时间-地点和同行推荐抽样）招募， 将随机接受干预或常规护理。MSM的每个手臂将有成员随机分配到其中一个 每个城市的四个诊所，并要求留在指定的社区诊所管道。使用RCT设计，我们将 正式测试以下结果：3个月和6个月时的艾滋病毒检测、可接受性和可行性。我们将适合多层次 回归模型的预测变量在HCF，同行和个人水平。根据研究结果，我们将 最后敲定一个方案，在一个确定的疗效试验中测试我们的干预措施。