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

• 批准号: 10683694
• 负责人: Abigail Winston Batchelder
• 金额: $ 79.91万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683694
• 关键词: 2 arm randomized control trial; Address; Adherence; Adoption; Appointment; Area; Automobile Driving; Awareness; Behavior Therapy; Behavioral; Behavioral Sciences; Boston; Caring; Case Manager; Cognition; Communicable Diseases; Communities; Compassion; Data; Drug user; Educational process of instructing; Emotions; Epidemic; Feedback; Florida; Future; Goals; HIV; Health; Hybrids; Inequity; Intervention; Location; Maintenance; Massachusetts; Mediating; Mediator; National Institute of Drug Abuse; Outcome; Outcome Measure; Participant; Persons; Positioning Attribute; Public Health; Race; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Risk; San Francisco; Self Care; Self Efficacy; Severities; Shame; Site; Social Work; Substance Use Disorder; Telephone; Text; Text Messaging; Time; Treatment Efficacy; Viral; Viral Load result; Visit; acceptability and feasibility; arm; comparison control; cost effectiveness; effectiveness evaluation; efficacy evaluation; evidence base; experience; follow-up; gender minority; gender minority group; housing instability; hybrid type 1 study; hybrid type 2 trial; implementation design; implementation strategy; implementation study; improved; informant; innovation; internalized stigma; men; men who have sex with men; prevent; service engagement; sex; skills; social; social stigma; substance use; substance use treatment; therapy design; transmission process; viral rebound; virtual delivery; virtual therapy

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.

抽象的 与男人发生性关系的男性（MSM）占美国艾滋病毒感染者的69％。在MSM和 与患有艾滋病毒的男性发生性关系的性别少数族裔，药物使用障碍（SUD）是 与参与艾滋病毒护理的不足有关，通常导致情节不受抑制的病毒载荷 （VL）或病毒反弹，因此通过艾滋病毒传播风险升高，使流行病驱动。行为 科学识别出经验丰富的污名和结构不平等现象的内在污名， 影响艾滋病毒护理中的次优参与，导致的未受抑制的VL以及传播 MSM带泡沫。污名和相关情绪（例如，羞耻）都会直接损害健康结果 （例如，通过次优的遵守和任命出席）和间接（例如，作为社会的障碍 服务参与）。需要干预措施来解决污名和羞耻作为病毒的障碍 MSM和性别少数族裔抑制艾滋病毒和泡沫的人。为了满足这种需求， 我们开发，完善并进行了一个飞行员RCT（K23DA043418），以评估可行性和 此事干预的可接受性，一种证据和社区知情的心理行为 干预措施通过减少内在污名和羞耻对抑制病毒抑制 与SUDS的MSM参与艾滋病毒护理。此事干预旨在减轻 内部污名和羞耻对病毒抑制的负面行为后果） 行为自我保健目标设定技能和相关的自我效能感，b）提高元认知意识 （即，对认知和情感的非判断性意识），以及c）富有同情心的自我毁灭性 （即自我同情）。它涉及5-一对一的虚拟疗法课程和双向个性化 文本消息传递以扩大干预措施的影响，同时使用较少的干预主义时间和电话 - 基于资源导航。拟议的1型混合动力效率实践研究将使用重新 评估的目标框架：1）在最终 与使用完全动力随机的时间匹配的控制臂相比，12个月的随访访问 对照试验（RCT; n = 256），2）提议的事项干预措施，以告知未来 减轻污名影响的干预措施，以及3）促进者和障碍，采用，采用， 实施和维护要在两个优先位置进行的事项干预措施 有关键差异：波士顿，马萨诸塞州和佛罗里达都会区迈阿密。应该干预 有效，并确认创新的内在化污名方法，我们将是很好的 定位以利用已确定的促进者和障碍来实施这种干预 MSM和性别少数人与随后的艾滋病毒和泡沫的男人发生性关系 混合2型试验以评估可伸缩性，包括全面的成本效益评估。