Planning a Multi-Level Intervention to Reduce Substance Use Stigma in HIV Prevention and Care

规划多层次干预措施以减少艾滋病毒预防和护理中的药物使用耻辱

• 批准号: 10669764
• 负责人: Mark K Greenwald
• 金额: $ 22.22万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10669764
• 关键词: AIDS prevention; Address; Adherence; Administrator; Affect; Anti-Retroviral Agents; Area; Attitude; Behavior; Biometry; Buprenorphine; Caring; Clinical; Collaborations; Communicable Diseases; Contracts; Data; Decision Making; Discrimination; Drug user; Education; Educational Curriculum; Educational Intervention; Exhibits; Federally Qualified Health Center; Future; Goals; HCV screening; HIV; HIV Infections; Harm Reduction; Health; Health Professional; Health Services; Health Services Research; Health care facility; Healthcare; Human Resources; Individual; Intervention; Intervention Studies; Interview; Knowledge; Lead; Literature; Medical; Medical Students; Mental Health; Methadone; Methodology; Needle-Exchange Programs; Organizational Policy; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Prejudice; Prevention; Process; Professional Education; Professional Organizations; Protocols documentation; Provider; Public Health; Research; Research Methodology; Risk; Role; Services; Social Sciences; Source; Stigmatization; Substance Use Disorder; Syringes; Techniques; Testing; Work; antiretroviral therapy; barrier to care; care outcomes; community engaged research; design; effective intervention; experience; falls; health care quality; health care service organization; health care service utilization; improved; opioid overdose; physical conditioning; pilot test; practical application; pre-exposure prophylaxis; programs; randomized trial; reduced substance use; social; social stigma; substance use; treatment services; trial design

SUMMARY ABSTRACT Both substance use disorders (SUDs) and HIV are subject to stigma, namely, the process by which an attribute is deemed deeply discrediting and prone to prejudice and discrimination. Stigma toward SUDs and HIV arises from multiple sources, including policies or individuals who carry out policies (“structural stigma”) and health professionals (“provider-based stigma”). Stigma from health professionals experienced or anticipated by people with SUDs can create barriers to accessing high-quality health services. For people with SUDs who need HIV prevention or care, the added stigma of HIV may compound substance use-related stigma to enhance social barriers to healthcare. However, few studies have examined the role of substance use stigma in HIV healthcare contexts, or how to intervene on substance use stigma in this doubly-sensitive area of healthcare. Extant studies on substance use stigma in other healthcare contexts found that educational interventions incorporating critical reflection techniques and opportunities for contact with people who use drugs may significantly reduce provider- based stigma. An even greater limitation is that provider-based stigma intervention studies fall short of practical application: they largely focus on attitudinal outcomes among professionals, but do not measure the effects of policies or how stigma interventions affect healthcare utilization or patient health outcomes. For HIV prevention and care contexts to improve healthcare quality and outcomes among people with SUDs, interventions are needed to reduce provider-based and structural stigma perennially attached to substance use. Our goal is to adapt and refine a multi-level stigma intervention that leverages professional education and organizational policy to address structural drivers of stigma and the stigmatizing professional attitudes and behaviors that determine patient care and health. To achieve this goal, this planning project will work with federally qualified health centers (FQHCs) to address three Specific Aims: 1) Create a substance use curriculum for HIV prevention and care contexts that pilot testing demonstrates significantly improves knowledge, attitudes, and planned actions related to professional stigma towards people who use drugs; 2) Use qualitative interviews with FQHC administrators and personnel to identify organizational policies that improve conditions of professional decision-making and may enhance the effects of professional education on stigma reduction; and 3) Develop, optimize, and finalize a trial design and protocol that is intended to test how the multi-level SUD stigma intervention influences intermediate outcomes related to SUDs and professional and patient stigma, as well as principal HIV outcomes related to prevention and care. This project will use community-engaged research methods with FQHCs to develop a multi-level stigma intervention and trial protocol that seeks to test whether combining educational and organizational policy interventions addresses substance use stigma in HIV prevention and care contexts, and ultimately affects patient outcomes. The subsequent results of the trial research are expected to inform future professional and organizational interventions seeking to improve HIV services for people with SUDs.

摘要 摘要 物质使用障碍 (SUD) 和艾滋病毒都受到耻辱，即一种属性 被认为是严重损害名誉并容易产生偏见和歧视。对 SUD 和 HIV 的污名化出现 来自多个来源，包括政策或执行政策的个人（“结构性耻辱”）和健康 专业人士（“基于提供商的耻辱”）。人们经历或预期的卫生专业人员的耻辱 SUD 可能会对获得高质量的医疗服务造成障碍。对于需要 HIV 的 SUD 患者 预防或护理方面，艾滋病毒的增加的耻辱可能会加剧与药物使用相关的耻辱，以增强社会 医疗保健的障碍。然而，很少有研究探讨物质使用耻辱在艾滋病毒医疗保健中的作用 背景，或如何干预这个双重敏感的医疗保健领域的药物使用耻辱。现有研究 关于其他医疗保健环境中药物使用耻辱的研究发现，教育干预措施纳入了关键的 反思技巧和与吸毒者接触的机会可能会显着减少提供者- 基于耻辱。更大的局限性是，基于提供者的耻辱干预研究缺乏实用性。 应用：它们主要关注专业人员的态度结果，但不衡量其影响 政策或耻辱干预措施如何影响医疗保健利用或患者健康结果。用于预防艾滋病毒 和护理环境，以提高 SUD 患者的医疗质量和结果，干预措施包括 需要减少长期与药物使用相关的基于提供者的和结构性的耻辱。我们的目标是 调整和完善利用专业教育和组织政策的多层次耻辱干预措施 解决污名化的结构性驱动因素以及决定污名化的职业态度和行为 患者护理和健康。为了实现这一目标，该规划项目将与联邦合格的健康中心合作 (FQHC) 旨在实现三个具体目标：1) 创建艾滋病毒预防和护理药物使用课程 试点测试显示的环境显着提高了相关知识、态度和计划行动 对吸毒者的职业耻辱； 2) 对 FQHC 管理员进行定性访谈 和人员确定改善专业决策条件的组织政策和 可以增强专业教育对减少耻辱的影响； 3) 开发、优化并最终确定 旨在测试多层次 SUD 耻辱干预如何影响的试验设计和方案 与 SUD 和专业人士和患者耻辱相关的中间结果，以及主要的艾滋病毒结果 与预防和护理有关。该项目将使用社区参与的研究方法和 FQHC 来 制定多层次的耻辱干预和试验方案，旨在测试是否将教育和 组织政策干预措施解决艾滋病毒预防和护理背景下的药物使用耻辱问题，以及 最终影响患者的治疗效果。试验研究的后续结果预计将为未来提供信息 寻求改善针对 SUD 患者的艾滋病毒服务的专业和组织干预措施。