M-Suubi: A Multi-level integrated intervention to reduce the impact of HIV stigma on HIV treatment outcomes among adolescents living with HIV in Uganda

M-Suubi：多层次综合干预措施，以减少乌干达艾滋病毒感染青少年艾滋病毒耻辱对艾滋病毒治疗结果的影响

• 批准号: 10673023
• 负责人: Massy Mutumba
• 金额: $ 60.1万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-09 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673023
• 关键词: AIDS prevention; Address; Adherence; Adolescent; Affect; Africa South of the Sahara; Appointment; Attention; Attitude; Caring; Child; Cluster randomized trial; Commuting; Continuity of Patient Care; Cost Analysis; Country; Coupled; Development; Disadvantaged; Disclosure; Discrimination; Drowsiness; Economics; Education; Enrollment; Exclusion; Family; Family Relationship; Feeling suicidal; Floor; Food; Fright; Gastric Emptying; Goals; HIV; HIV Infections; HIV/AIDS; Home; Inequality; Infection; Institution; Institutionalization; Intervention; Intervention Studies; Literature; Living Arrangement; Mediation; Mental Depression; Mental Health; Nausea; Outcome; Parents; Participant; Personal Satisfaction; Pharmaceutical Preparations; Pharmacy facility; Policies; Poverty; Prevalence; Privacy; Randomized; Reporting; Research; Schedule; School Drop-Outs; Schools; Secondary Schools; Shame; Social Environment; Structure; Student Dropouts; Students; Systems Theory; Testing; Thinking; Time; Training; Treatment outcome; Uganda; United States National Institutes of Health; Violence; Viral; antiretroviral therapy; arm; care outcomes; cost effectiveness; empowerment; experience; family support; food insecurity; improved; innovation; internalized stigma; medication compliance; peer; pill; post implementation; primary outcome; programs; recruit; response; school environment; secondary analysis; secondary outcome; side effect; social stigma; theories; therapy adherence; treatment adherence; treatment as usual; treatment services

PROJECT ABSTRACT In response to PA-20-144 calling for innovations in HIV prevention, testing, adherence and retention to optimize HIV prevention and care continuum outcomes, we examine the impact and cost-effectiveness of an innovative multilevel intervention combining Multiple Family Groups (MFGs) for HIV stigma reduction (MFG-HIVSR) with a family economic empowerment (FEE) intervention versus a group-based HIV stigma reduction for Educators (GED-HIVSR) combined with MFG-HIVSR plus FEE (hereafter M-Suubi) on HIV treatment adherence and engagement in care among school-going adolescents living with HIV (ALHIV) in Uganda. HIV stigma remains a formidable barrier to HIV treatment adherence among adolescents in Uganda, contributing to low rates of medication adherence and viral suppression (less than 50%) and high attrition from HIV treatment services. ALHIV experience HIV stigma (internalized, anticipated and enacted) in various settings, including families and schools, the most important developmental contexts that should otherwise be supportive of their development and wellbeing. One of the unique features about education in Uganda and other countries in Sub-Saharan Africa is the high proportion (over 60%) of school-going adolescents enrolled in boarding secondary schools – which represent a form of parental opt-in institutionalized care. ALHIV in schools are more disadvantaged and have lower levels of HIV treatment adherence due to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support and food insecurity. Within families, HIV stigma is perpetuated in various forms including discrimination and violence, often due to unfounded fears of infection—hence undermining the quality of family relations and supports for ALHIV. Building on our research and current evidence on HIV stigma reduction, we propose a multi-level three-arm cluster randomized study (M-Suubi) with the following specific aims: Aim 1: Examine the impact of M-Suubi on HIV viral suppression (primary outcome); and adherence to HIV treatment (keeping appointments, pharmacy refills, pill counts), and retention in care (secondary outcome); Aim 2: Examine the effect of M-Suubi on HIV stigma (internalized, anticipated and enacted), with secondary analyses to explore hypothesized mechanisms of change (e.g. depression) and intervention mediation; Aim 3: Assess the cost and cost-effectiveness of each intervention condition; and Aim 4: Qualitatively examine: a) participants’ experiences with HIV stigma, HIV treatment adherence, and the intervention; and 2) educators’ attitudes towards ALHIV, experiences with GED-HIVSR, and program/policy implementation post-training. The study will enroll 840 ALHIV recruited from 42 schools located within the greater Masaka region, heavily affected by HIV (prevalence 12% vs 7.3% national average). M-Suubi will be provided for 20 months, with assessments at baseline, 12, 24 and 36 months. Findings may inform combination intervention efforts to optimize HIV treatment outcomes and engagements in care among ALHIV.

项目摘要 为了响应 PA-20-144 号召在艾滋病毒预防、检测、依从性和保留方面进行创新以优化艾滋病毒预防和护理连续结果的呼声，我们研究了一种创新性多层次干预措施的影响和成本效益，该干预措施将多家庭群体 (MFG) 减少艾滋病毒耻辱感 (MFG-HIVSR) 与家庭经济赋权 (FEE) 干预措施与基于群体的减少艾滋病毒耻辱感的干预措施相结合。 教育工作者 (GED-HIVSR) 与 MFG-HIVSR 加 FEE（以下简称 M-Suubi）相结合，研究乌干达感染艾滋病毒 (ALHIV) 的在校青少年的艾滋病毒治疗依从性和护理参与度。艾滋病毒耻辱仍然是乌干达青少年艾滋病毒治疗依从性的巨大障碍，导致药物依从性和病毒抑制率低（低于 50%）以及艾滋病毒治疗服务的高流失率。 ALHIV 在各种环境中经历了艾滋病毒耻辱（内化、预期和实施），包括家庭和学校，这些最重要的发展环境本应支持他们的发展和福祉。乌干达和撒哈拉以南非洲其他国家教育的一个独特特征是，在寄宿中学就读的在校青少年比例很高（超过 60%），这代表了家长选择入院的一种形式的机构化照顾。由于学校内艾滋病毒耻辱感较高、学校结构和惯例僵化、缺乏依从性支持以及粮食不安全，学校中的 ALHIV 感染者处境更为不利，其艾滋病毒治疗依从性较低。在家庭中，艾滋病毒耻辱以各种形式长期存在，包括歧视和暴力，通常是由于对感染毫无根据的恐惧，从而破坏了家庭关系的质量和对 ALHIV 的支持。基于我们的研究和当前关于减少 HIV 耻辱的证据，我们提出了一项多层次三臂整群随机研究 (M-Suubi)，其具体目标如下： 目标 1：检查 M-Suubi 对 HIV 病毒抑制的影响（主要结果）；遵守艾滋病毒治疗（预约、药房补充、药片计数）和保留护理（次要结果）；目标 2：检查 M-Suubi 对 HIV 耻辱感（内在的、预期的和实施的）的影响，并通过二次分析来探索假设的变化机制（例如抑郁症）和干预调解；目标 3：评估每种干预条件的成本和成本效益；目标 4：定性检查：a) 参与者的艾滋病毒耻辱经历、艾滋病毒治疗依从性和干预措施； 2) 教育工作者对 ALHIV 的态度、GED-HIVSR 的经验以及培训后计划/政策的实施。该研究将从受艾滋病毒影响严重的大马萨卡地区 42 所学校招募 840 名 ALHIV 患者（患病率 12%，全国平均水平 7.3%）。 M-Suubi 将提供 20 个月，并在基线、12、24 和 36 个月进行评估。研究结果可能为联合干预措施提供信息，以优化艾滋病毒治疗结果和 ALHIV 患者的护理参与。