Mitigating the Impact of Stigma and Shame as a Barrier to Viral Suppression Among MSM Living with HIV and Substance Use Disorders

减轻耻辱感和羞耻感对感染艾滋病毒和药物滥用的 MSM 的病毒抑制造成的影响

基本信息

项目摘要

ABSTRACT Men who have sex with men (MSM) make up 69% of people living with HIV in the US. Among MSM and gender minority individuals who have sex with men living with HIV, substance use disorders (SUDs) are associated with inadequate engagement in HIV care, often leading to episodic unsuppressed viral load (VL) or viral rebound, thus driving the epidemic through elevated HIV transmission risk. Behavioral science identifies that internalized stigmas perpetuated by experienced stigma and structural inequities, influences sub-optimal engagement in HIV care, resultant unsuppressed VL, and transmission among MSM with SUDs. Stigma and related emotions (e.g., shame) compromise health outcomes both directly (e.g., via sub-optimal adherence and appointment attendance) and indirectly (e.g., as barriers to social services engagement). Interventions are needed to address stigma and shame as barriers to viral suppression among MSM and gender minority individuals living with HIV and SUDs. To meet this need, we developed, refined, and conducted a pilot RCT (K23DA043418) to assess the feasibility and acceptability of the MATTER intervention, an evidence- and community- informed psychobehavioral intervention to facilitate viral suppression by reducing the impact of internalized stigma and shame on engagement in HIV care among MSM with SUDs. The MATTER intervention aims to mitigate the negative behavioral consequences of internalized stigma and shame on viral suppression by a) behavioral self-care goal setting skills and related self-efficacy, b) increasing metacognitive awareness (i.e., non-judgmental awareness of cognitions and emotions), and c) compassionate self-restructuring (i.e., self- compassion). It involves 5- one-on-one virtual therapy sessions and bidirectional personalized text messaging to extend the impact of the intervention while using less interventionist time and phone- based resource navigation. The proposed hybrid type 1 efficacy-implementation study will use the RE- AIM framework to assess: 1) the efficacy of the MATTER intervention on viral suppression at the final 12-month follow up visit compared to a time-matched control arm using a fully powered randomized controlled trial (RCT; N=256), 2) the proposed mechanisms of the MATTER intervention to inform future interventions to mitigate the impact of stigma, and 3) facilitators and barriers to the reach, adoption, implementation, and maintenance of the MATTER intervention to be conducted in two priority locations with key differences: the Boston, Massachusetts and Miami, Florida metro areas. Should the intervention be efficacious, and the innovative internalized stigma mitigation approach be confirmed, we will be well- positioned to leverage the identified facilitators and barriers to implementing this intervention among MSM and gender minority people who have sex with men living with HIV and SUDs in a subsequent hybrid type 2 trial to assess the scalability, including a full cost-effectiveness assessment.
摘要 男男性行为者(MSM)占美国艾滋病毒感染者的69%。在男男性行为者中, 与艾滋病毒感染者发生性关系的性别少数个体,物质使用障碍(SUD), 与艾滋病毒护理参与不足相关,通常导致偶发性未抑制的病毒载量 (VL)或病毒反弹,从而通过提高艾滋病毒传播风险推动流行病。行为 科学发现,由于经历过的耻辱和结构性不平等, 影响艾滋病毒护理的次优参与,导致未受抑制的VL,以及 有SUD的MSM污名和相关情绪(例如,羞耻)直接损害健康结果, (e.g.,经由次优遵守和预约出席)和间接地(例如,作为社会 服务业)。需要采取干预措施,以解决耻辱和羞耻作为病毒感染的障碍。 在男男性行为者和少数性别艾滋病毒感染者和SUD患者中进行抑制。为了满足这一需求, 我们开发、完善并进行了一项试点RCT(K23 DA 043418),以评估其可行性, 物质干预的可接受性,一个证据和社区知情的心理行为 通过减少内化的耻辱感和羞耻感的影响, 在患有SUD的MSM中参与艾滋病毒护理。干预措施旨在减轻 内化的耻辱感和羞耻感对病毒抑制的负面行为后果a) 行为自我护理目标设定技能和相关的自我效能,B)增加元认知意识 (i.e.,对认知和情感的非判断性意识),以及c)富有同情心的自我重建 (i.e.,自我同情)。它涉及5个一对一的虚拟治疗会话和双向个性化 短信,以扩大干预的影响,同时使用更少的干预时间和电话- 资源导航。拟议的混合1型有效性-实施研究将使用RE- AIM框架,以评估:1)最后阶段MATTER干预对病毒抑制的有效性 12-使用全把握度随机化方法,与时间匹配的对照组相比, 对照试验(RCT; N=256),2)建议的机制,物质干预,以告知未来 干预措施,以减轻耻辱的影响,和3)促进者和障碍的接触,采用, 在两个优先地点实施和维护MATTER干预措施 主要区别在于:波士顿,马萨诸塞州和迈阿密,佛罗里达大都市区。如果干预 有效,创新的内化污名缓解方法得到确认,我们将很好地- 能够利用已确定的促进者和障碍,在下列群体中实施这一干预措施: 男男性行为者和性别少数人群与感染艾滋病毒和SUD的男性发生性关系, 混合2型试验,以评估可扩展性,包括全面的成本效益评估。

项目成果

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Abigail Winston Batchelder其他文献

Abigail Winston Batchelder的其他文献

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{{ truncateString('Abigail Winston Batchelder', 18)}}的其他基金

Stigma-Treatment Enhanced Incentivized Directly Observed Therapy for People with HIV who Inject Drugs
针对注射吸毒艾滋病毒感染者的耻辱治疗强化激励直接观察治疗
  • 批准号:
    10472519
  • 财政年份:
    2021
  • 资助金额:
    $ 79.91万
  • 项目类别:
Stigma-Treatment Enhanced Incentivized Directly Observed Therapy for People with HIV who Inject Drugs
针对注射吸毒艾滋病毒感染者的耻辱治疗强化激励直接观察治疗
  • 批准号:
    10668323
  • 财政年份:
    2021
  • 资助金额:
    $ 79.91万
  • 项目类别:
Stigma-Treatment Enhanced Incentivized Directly Observed Therapy for People with HIV who Inject Drugs
针对注射吸毒艾滋病毒感染者的耻辱治疗强化激励直接观察治疗
  • 批准号:
    10227320
  • 财政年份:
    2021
  • 资助金额:
    $ 79.91万
  • 项目类别:
Understanding and Addressing Internalized Stigma and Shame as Barriers to Engagement in HIV Care among Men who Have Sex with Men who Use Substances.
了解并解决与使用药物的男性发生性关系的男性参与艾滋病毒护理的障碍的内在耻辱和羞耻感。
  • 批准号:
    10166815
  • 财政年份:
    2017
  • 资助金额:
    $ 79.91万
  • 项目类别:

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