RCT of an intersectional stigma intervention to sustain viral suppression among women living with serious mental illness and HIV in Botswana

对博茨瓦纳患有严重精神疾病和艾滋病毒的妇女进行交叉污名干预以维持病毒抑制的随机对照试验

• 批准号: 10650820
• 负责人: LAWRENCE H YANG
• 金额: $ 19.15万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650820
• 关键词: 2 arm randomized control trial; Acute; Address; Adherence; Africa South of the Sahara; Ambulatory Care; Articulation; Attention; Binding; Botswana; Caring; Client; Communities; Depressive disorder; Educational workshop; Ensure; Face; Family; Family Caregiver; Family member; Foundations; Funding; Future; Goals; HIV; Health system; Hospitalization; Household; Inpatients; Intervention; Measures; Mental Health; Modeling; Mothers; Outcome; Perception; Personhood; Persons; Pharmaceutical Preparations; Placebo Control; Policies; Policy Maker; Postpartum Period; Pregnant Women; Prevalence; Professional counselor; Public Health; Randomized; Randomized, Controlled Trials; Reporting; Research; Respondent; Risk; Schizophrenia; Services; Social outcome; Symptoms; Testing; Viral; Viral Load result; Woman; Women Status; antiretroviral therapy; arm; attentional control; community reintegration; compare effectiveness; coping; depressive symptoms; empowerment; experience; follow-up; high risk; improved; intervention effect; marginalization; marginalized population; medication nonadherence; novel; peer; personalized approach; post intervention; primary outcome; reduce symptoms; scale up; secondary outcome; severe mental illness; social stigma; therapy adherence; therapy design; treatment adherence

Abstract. Reducing stigma to ensure viral load (VL) suppression for women with serious mental illness (SMI) and HIV is a global priority, including in Botswana, where the intersectional stigma of SMI, HIV and womanhood is marginalizing in ways that impede adherence to both psychiatric medications and antiretroviral therapy (ART), which can threaten VL suppression. We apply our novel ‘what matters most’ (WMM) approach to target intersectional stigma faced by women with SMI and HIV in Botswana via a stigma-reduction intervention in the high-risk transition period after discharge from an initial psychiatric hospitalization. WMM conceptualizes how stigma is felt most acutely when people are unable to achieve ‘full personhood’ by participating in the activities that ‘matter most’ in their local context. In prior research, we found the core value for ‘full womanhood’ in Botswana is achieved by being the ‘foundation of the household’ and is threatened by perceived: 1) incompetence in fulfilling the duties of a family caregiver associated with SMI and 2) promiscuity associated with having HIV. In Botswana, family acceptance as a viable ‘family caregiver’ is also key to achieving ‘full status’ as a woman. As such, the risks of being identified as having SMI and HIV (e.g., partner/family abandonment) can deter psychiatric and ART treatment adherence. Promoting capabilities that ‘matter most’ for achieving ‘full womanhood’ could enable longer-term stigma reduction after psychiatric discharge, when women are reintegrating into their communities, and improve ART adherence and promote sustained VL suppression. Our group-based WMM stigma intervention is co-led by a peer woman who has coped effectively with SMI and HIV stigma. The WMM stigma intervention model was piloted among pregnant women with HIV in Botswana with promising reductions in stigma and depressive symptoms up to 4-months postpartum. We now test whether a WMM intervention tailored for women with SMI and HIV will reduce intersectional stigma and facilitate VL suppression. We propose a two-arm randomized controlled trial (RCT; N=180) with a 4-month follow-up to compare the effectiveness of 1) WMM-based intersectional stigma intervention delivered as clients transition from psychiatric hospitalization to outpatient care (‘WMM Stigma Intervention;’ n=90); and 2) attention control following a similar format to isolate the effects of the intervention (n=90). Because family are commonly involved in the care of people with SMI and face severe stigma, we propose a parallel, group stigma intervention among family members, as addressing familial stigma could facilitate treatment adherence. Finally, because intersectional stigma is reinforced at systemic levels, we seek to empower women with SMI and HIV to influence structural change by coleading policymaker workshops to reduce stigma among policymakers and spur policymakers to address the unique needs of women with SMI and HIV via future policies.

抽象。 减少污名化，以确保对患有严重精神疾病（SMI）和艾滋病毒的妇女的病毒载量（VL）抑制， 全球优先事项，包括在博茨瓦纳，在那里，对重度精神病感染、艾滋病毒和妇女的相互交织的耻辱感 边缘化的方式阻碍坚持精神病药物和抗逆转录病毒疗法， 这会威胁到VL抑制我们将我们新颖的“最重要的”（WMM）方法应用于目标 博茨瓦纳重度精神病感染和艾滋病毒妇女通过减少耻辱干预措施面临的交叉耻辱 从最初的精神病住院治疗出院后的高风险过渡期。WMM概念化如何 当人们无法通过参加活动实现“完整的人格”时， 在当地环境中“最重要的”。在之前的研究中，我们发现“完整的女性”的核心价值在于 博茨瓦纳是通过成为“家庭的基础”而实现的，并受到以下方面的威胁：1） 无法履行与重度精神分裂症相关的家庭照顾者的职责; 2）与重度精神分裂症相关的滥交 携带艾滋病毒。在博茨瓦纳，家庭接受作为一个可行的“家庭照顾者”也是实现“充分地位”的关键， 一个女人因此，被确定为患有SMI和HIV的风险（例如，家庭/伴侣遗弃）， 阻止精神病和抗逆转录病毒治疗的坚持。促进对实现“全面”目标“最重要”的能力 当女性被诊断为精神病患者时，“女性”可以在精神病出院后长期减少耻辱感。 重新融入他们的社区，提高抗逆转录病毒疗法的坚持率，促进持续的VL抑制。我们 一个以小组为基础的世界母亲运动污名干预活动由一名有效应对重度精神病感染和艾滋病毒的同龄妇女共同领导 耻辱在博茨瓦纳感染艾滋病毒的孕妇中试行了世界母亲运动的污名干预模式， 在产后4个月内，耻辱感和抑郁症状有望减少。我们现在测试是否 WMM为患有重度精神障碍和艾滋病毒的妇女量身定制的干预措施将减少交叉羞辱并促进VL 镇压我们提出了一项两组随机对照试验（RCT; N=180），随访4个月， 比较以下干预措施的有效性：（1）在客户过渡期提供基于WMM的交叉污名干预 从精神病住院到门诊治疗（“WMM污名干预”; n=90）; 2）注意力控制 遵循类似的格式以隔离干预的影响（n=90）。因为家人通常会 在照顾患有重度精神分裂症并面临严重耻辱的人时，我们提出了一个平行的小组耻辱干预， 家庭成员，因为解决家庭耻辱感可以促进坚持治疗。最后因为 交叉污名在系统层面得到加强，我们寻求赋予患有重度精神障碍和艾滋病毒的妇女权力， 通过共同领导政策制定者研讨会，减少政策制定者之间的耻辱感， * 政策制定者通过未来的政策解决患有重度精神疾病和艾滋病毒的妇女的独特需求。