Improving HIV treatment outcomes for people who use drugs: adapting and piloting a drug-use use stigma-reduction intervention in HIV care and treatment clinics in Tanzania

改善吸毒者的艾滋病毒治疗结果：在坦桑尼亚的艾滋病毒护理和治疗诊所中调整和试点减少吸毒污名的干预措施

• 批准号: 10227203
• 负责人: Laura Nyblade
• 金额: $ 18.46万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227203
• 关键词: Achievement; Address; Analgesics; Caring; Client; Clinic; Clinical; Consultations; Country; Drug usage; Drug user; Educational Intervention; Educational workshop; Evaluation; Evidence based intervention; Face; Feedback; Focus Groups; Foundations; Future; General Population; Geography; Goals; Grant; HIV; Health; Health Personnel; Health Policy; Health Services; Health care facility; Heroin; Improve Access; Individual; Ingestion; Inhalation; Intervention; Interview; Manuals; Measurement; Measures; Mental Health; Methods; Modeling; Needle-Exchange Programs; Operative Surgical Procedures; Outcome; Participant; Pharmaceutical Preparations; Phase; Population; Prevalence; Process; Research; Research Personnel; Risk; Science; Seasons; Source; Surveys; Tanzania; Testing; Time; Training; Treatment outcome; Vulnerable Populations; Wait Time; base; behavior measurement; care systems; experience; improved; intervention participants; member; opioid use; outreach services; physical conditioning; post intervention; response; service utilization; social stigma; therapy development; transmission process; treatment services

PROJECT SUMMARY/ABSTRACT The goal of this study is to adapt and pilot an effective health facility HIV stigma-reduction intervention to address drug use stigma in HIV care and treatment clinics (CTCs) in Tanzania, a barrier to linkage and retention in HIV care for people living with HIV (PLWH) who use drugs. In Tanzania, there are an estimated 300,000 people who use drugs (PWUD), primarily heroin. Although most heroin is inhaled or ingested, an estimated 10% (30,000) of PWUD inject. HIV prevalence among PWUD who do not inject (18–25%) and those who do inject (35%) is 4–7 times higher than in the general population (5%). PWUD face high levels of stigma, including when they try to seek HIV treatment at HIV CTCs, presenting a barrier to linkage and retention in HIV treatment for this highly HIV vulnerable group. Therefore, reducing drug use stigma in HIV CTCs is critical to improving access to and retention in HIV treatment services for PWUD. In response to this need, we will: 1. Adapt a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV CTCs (Aim 1). 2. Pilot test the adapted drug use stigma-reduction intervention for acceptability, appropriateness, and feasibility. (Aim 2). We will achieve Aim 1 through a systematic, multi-stage adaptation process that will include a formative phase of in-depth interviews with PLWH who use drugs and CTC staff to inform initial adaptation of the Health Policy Plus (HP+) intervention. Stakeholders, including PLWH who use opioids and CTC staff, will provide feedback on the initial materials through a participatory workshop, leading to a training manual that will be reviewed by topic experts and then finalized. Experienced Tanzanian HIV stigma-reduction trainers, including people with lived experience of opioid use, will be trained to deliver the intervention to CTC staff. The pilot test will include 150 health workers based in seven CTCs in Dar-es-Salaam. A mixed methods evaluation will comprise pre-post surveys, observation of trainings, and post-training focus group discussions with intervention participants and trainers. Changes in CTC staff's mean scores on stigma scales from pre- to post-intervention will be assessed, along with measures of intervention acceptability, appropriateness, and feasibility. Focus groups will explore themes around the experience of participating in the opioid use stigma- reduction training.

项目总结/文摘