Exploring the Impact of Illness Identity on Intersectional Stigma Through the Care Continuum

通过护理连续体探索疾病身份对交叉耻辱的影响

• 批准号: 10548036
• 负责人: Alanna J Bergman
• 金额: $ 4.68万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10548036
• 关键词: AIDS prevention; Active Learning; Address; Adherence; Africa South of the Sahara; Analysis of Variance; Caring; Clinic; Clinical; Cohort Studies; Communicable Diseases; Continuity of Patient Care; Data; Data Collection; Diagnosis; Directly Observed Therapy; Disease; Drug resistance in tuberculosis; Enrollment; Event; Fostering; Foundations; Future; Goals; HIV; HIV drug resistance; HIV/TB; Health; Hospitals; Illness impact; Individual; Interruption; Intervention; Interview; Measurement; Measures; Mediating; Mentorship; Methods; Modeling; Morbidity - disease rate; Outcome; Parents; Participant; Patient-Focused Outcomes; Patients; Persons; Population; Prejudice; Prospective cohort; Province; Psychometrics; Publishing; Randomized; Randomized Controlled Trials; Research; Research Personnel; Resource Allocation; Resource-limited setting; Risk; Science; South Africa; South African; Specific qualifier value; Stereotyping; Stigmatization; Time; Training; Translating; Treatment outcome; Tuberculosis; Variant; Viral; Viral Load result; Well in self; Work; antiretroviral therapy; barrier to care; career; cohort; curative treatments; design; efficacy evaluation; experience; health care disparity; improved; infectious disease treatment; instrument; low and middle-income countries; marginalized population; mortality; physical conditioning; predictive tools; prevent; programs; prospective; recruit; research study; response; skills; social; social stigma; theories; tool; treatment adherence; treatment as usual; tuberculosis treatment

PROJECT SUMMARY Tuberculosis (TB) and HIV stigma causes significant morbidity and mortality in South Africa. Despite curative treatments for TB and antiretroviral therapies that suppress HIV viral load, both diseases continue to spread in low- and middle-income countries. Stigma is a significant barrier to care engagement and treatment adherence for HIV and TB. Intersectional stigma theory acknowledges the infinite combination of identities that contribute to stigma and social erasure. However, this wholistic approach of social constructs is not easily translated into measurement science. The applicant's proposed study, Exploring the Impact of Illness Identity on Intersectional Stigma Through the Care Continuum, will address this gap. The purpose of this project is to explore intersectional TB/HIV stigma through the care continuum to determine whether HIV viral suppression, and TB culture/smear conversion represent changes in illness identity that mitigate stigma. Aim 1 will quantify TB/HIV stigma using the Van Rie Patient Perspectives on TB/HIV Scales and use repeated measures ANOVA to evaluate significance in changes of stigma over time. In Aim 2, the applicant will use in-depth qualitative interviews to explore nuance and variation of intersectional stigma throughout the care continuum as experienced by people living with TB and HIV in South Africa that may not be captured within the Van Rie Scales. From the qualitative interviews, the applicant will develop and pilot four to five additional instrument items to address the overlap in TB/HIV stigma that is not captured within the parallel items of the Van Rie Scales. Finally, in aim 3, the applicant will interpret and integrate the qualitative and quantitative data to create a deeper understanding of intersectional TB/HIV stigma in South Africa and to assess its impact on treatment engagement across the care continuum. The applicant will use data from this proposal to improve the accuracy of stigma measurement in South Africa. This study will lay the foundation for future career in global stigma analysis and intervention work. It is therefore, an important first step in an exciting program of research to reduce stigma and improve TB and HIV treatment outcomes for global populations.

项目摘要 在南非，结核病和艾滋病毒污名化造成了严重的发病率和死亡率。尽管治疗 结核病治疗和抑制艾滋病毒载量的抗逆转录病毒治疗，这两种疾病继续在非洲蔓延， 低收入和中等收入国家。污名是参与护理和治疗的一个重大障碍 坚持治疗艾滋病和结核病。交叉污名理论承认身份的无限组合， 导致耻辱和社会排斥。然而，这种社会结构的整体方法并不容易 转化为测量科学。申请人提出的研究，探索疾病身份的影响 通过护理连续性交叉污名，将解决这一差距。该项目的目的是 通过连续护理探索结核病/艾滋病毒交叉污名，以确定是否抑制艾滋病毒， 和结核病培养/涂片转换代表疾病身份的变化，减轻耻辱。目标1将量化 使用货车Rie结核病/艾滋病患者视角量表和重复测量进行结核病/艾滋病污名化的方差分析 评估污名随时间变化的意义。在目标2中，申请人将使用深入的定性 访谈，探讨在整个护理过程中交叉污名的细微差别和变化， 南非的结核病和艾滋病感染者所经历的可能无法在货车里捕捉到的疾病 鳞片通过定性面试，申请人将开发和试验四到五种额外的工具， 项目，以解决货车Rie的平行项目中没有涵盖的结核病/艾滋病毒耻辱的重叠问题 鳞片最后，在目标3中，申请人将解释和整合定性和定量数据， 更深入地了解南非结核病/艾滋病交叉羞辱问题，并评估其对治疗的影响 在整个护理过程中的参与。申请人将使用本提案中的数据来改善 在南非的耻辱测量的准确性。本研究将为今后的全球职业生涯奠定基础 污名分析和干预工作。因此，这是一个令人兴奋的研究计划的重要的第一步， 减少耻辱感并改善全球人口的结核病和艾滋病毒治疗结果。