Implementing Stigma Reduction Tools via a Popular Teletraining Platform to Reduce Clinician Stigma and Disparities in HIV Testing, Prevention, and Linkage to Care in Malaysia

通过流行的远程培训平台实施减少耻辱工具，以减少马来西亚临床医生在艾滋病毒检测、预防和护理方面的耻辱和差异

• 批准号: 10424432
• 负责人: Valerie Ann Earnshaw
• 金额: $ 18.62万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10424432
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Applications Grants; Award; Caring; Clinic; Communities; Community Healthcare; Counseling; Country; Criminal Law; Data; Diagnosis; Discrimination; Disease; Education; Elements; Family Practice; Focus Groups; Funding; General Population; General Practitioners; Goals; Guidelines; HIV; Health Services; Hepatitis C virus; Human immunodeficiency virus test; Hybrids; Individual; Injecting drug user; Intervention; Intervention Studies; Interview; Learning; Link; Malaysia; Malaysian; Medical Students; Modeling; Outcome; Palliative Care; Participant; Perception; Persons; Phase; Population; Populations at Risk; Prejudice; Prevention; Promoting Action on Research Implementation in Health Services framework; Protocols documentation; Randomized; Religion and Spirituality; Research; Research Personnel; Same-sex; Social Environment; Specialist; Stereotyping; Technology; Test Result; Testing; Training Support; Universities; Videoconferencing; Work; acceptability and feasibility; addiction; care outcomes; care systems; community setting; efficacy trial; empowered; evidence base; experience; female sex worker; gender expression; illicit drug use; implementation science; implementation trial; insight; intervention refinement; medical specialties; member; men who have sex with men; pilot test; social norm; social stigma; success; three-arm study; tool; transgender; transgender women

PROJECT SUMMARY A scalable intervention is needed to remove one of the most potent and persistent drivers of disparities in HIV testing, prevention, and linkage to care globally: clinician stigma toward key populations. Key populations at risk of HIV who experience and/or anticipate stigma from clinicians are less likely to initiate, engage in, and adhere to care, including HIV testing, prevention, and linkage to care services. Researchers have uncovered evidence-based stigma reduction tools that hold promise to reduce stigma among clinicians and narrow HIV disparities globally. Yet, a vehicle to deliver these tools to clinicians at large scale (i.e., beyond single clinics) is currently lacking. The long-term goal of this work is to address clinician stigma globally via the widespread implementation of evidence-based stigma reduction tools via a popular teletraining platform. Project ECHO® (Extension for Community Healthcare Outcomes) trains, supports, and empowers clinicians to provide a wide range of specialty care services globally, including HIV testing, prevention, and linkage to care. It uses a “hub and spoke” model, wherein non-specialists in community setting “spokes” learn from and collaborate with specialists at academic “hubs” via videoconferencing technology. The objective of this R34 project is to incorporate evidence-based stigma reduction tools into Project ECHO® and pilot test the resulting intervention with clinicians in Malaysia. Malaysia is an optimal testing ground for this project because it exemplifies many social contexts globally, and in the U.S., wherein clinician stigma and HIV disparities are substantial; and the University of Malaya is already a Project ECHO® hub for several diseases. The first aim of this project is to evaluate key elements that will influence the implementation of evidence-based stigma reduction tools via Project ECHO®, including evidence, context, and facilitation, and is guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. In Phase 1 of this aim, Photovoice will be used to collect evidence regarding experiences of clinician stigma among 30-35 key stakeholders, including key populations at risk of HIV and PLWH. In Phase 2, additional evidence will be collected regarding Malaysian clinician perspectives and the intervention context will be assessed via online focus groups with 30-40 general practitioners and family medicine clinicians. In Phase 3, factors related to facilitation will be assessed by pre-testing the intervention protocol with 5 clinicians. The second aim is to pilot test Project ECHO® for HIV Prevention and Stigma Reduction among Malaysian clinicians and evaluate its acceptability, feasibility, and preliminary impact on clinician stigma and HIV testing, prevention, and linkage to care services among key populations. General practitioner and family medicine clinicians (n=78) will be randomized to one of 3 study arms: (1) Project ECHO® for HIV Prevention and Stigma Reduction, (2) Project ECHO® for HIV Prevention only, or (3) control. Following guidelines for Hybrid Type 1 Implementation Trials, the acceptability and feasibility of the intervention will be assessed as well as its preliminary impact. If results support the feasibility, acceptability, and preliminary impact of the intervention, funding will be sought to conduct a large-scale efficacy trial. This line of research will ultimately yield a highly scalable intervention that can be disseminated to practicing clinicians in Malaysia and other countries via an existing, popular teletraining platform to address clinician stigma toward key populations and reduce HIV disparities globally.

项目摘要 需要采取可扩展的干预措施，以消除艾滋病毒检测差异的最有力和最持久的驱动因素之一， 预防和全球护理的联系：临床医生对关键人群的污名化。有艾滋病毒风险的主要人群， 经历和/或预期来自临床医生的耻辱不太可能开始，参与和坚持护理，包括艾滋病毒 检测、预防和与护理服务的联系。研究人员发现了基于证据的减少耻辱感的工具， 有望减少临床医生之间的耻辱感，缩小全球艾滋病毒差距。然而，提供这些工具的工具 对于大规模的临床医生（即，目前，医院缺乏。这项工作的长期目标是解决 通过广泛实施基于证据的污名减少工具，全球临床医生污名化， 远程培训平台ECHO®项目（社区医疗保健成果扩展）培训、支持和授权 我们将与临床医生合作，在全球范围内提供广泛的专业护理服务，包括艾滋病毒检测、预防和护理联系。它使用 一种“中心辐射”模式，其中社区设置“辐射”中的非专家向专家学习并与专家合作， 通过视频会议技术建立学术“中心”。这个R34项目的目标是将基于证据的污名化 在马来西亚，ECHO®项目将减少工具纳入到项目中，并与临床医生一起对由此产生的干预进行试点测试。马来西亚是最佳选择 这个项目的试验场，因为它简化了全球许多社会背景，在美国，其中临床医生的污名 和艾滋病毒的差距是巨大的;马来亚大学已经是几种疾病的ECHO®项目中心。的 本项目的首要目标是评估影响循证减少污名化实施的关键因素 通过ECHO®项目提供的工具，包括证据、背景和促进，并以促进研究行动为指导 保健服务执行伙伴关系框架。在该目标的第一阶段，Photovoice将用于收集证据 关于30-35个关键利益相关者中的临床医生污名化经历，包括艾滋病毒高危人群， PLWH。在第2阶段，将收集有关马来西亚临床医生观点和干预措施的其他证据。 将通过有30-40名全科医生和家庭医学临床医生参加的在线焦点小组对背景进行评估。同相 3、与易化相关的因素将通过与5名临床医生预测试干预方案来评估。第二个目标是 在马来西亚临床医生中进行ECHO®艾滋病毒预防和减少污名项目的试点测试，并评估其 可接受性，可行性和对临床医生污名和艾滋病毒检测，预防和护理服务的联系的初步影响 在关键人群中。全科医生和家庭医学临床医生（n=78）将被随机分配至3项研究之一 （1）ECHO®项目预防艾滋病毒和减少污名，（2）ECHO®项目仅用于预防艾滋病毒，或（3） 控制根据混合1型实施试验指南， 将评估其初步影响。如果结果支持可行性、可接受性和初步影响， 干预措施，将寻求资金进行大规模的疗效试验。这一系列研究最终将产生一个 高度可扩展的干预措施，可以通过现有的， 这是一个广受欢迎的远程培训平台，旨在解决临床医生对关键人群的污名化问题，并减少全球艾滋病毒感染的差异。