Reducing Stigma to Improve HIV/AIDS Prevention, Treatment, and Care among Adolescents Living with HIV in Botswana

减少耻辱感，改善博茨瓦纳艾滋病毒感染青少年的艾滋病毒/艾滋病预防、治疗和护理

• 批准号: 10265667
• 负责人: Bagele M Chilisa
• 金额: $ 10.78万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265667
• 关键词: 17 year old; AIDS prevention; Address; Adherence; Adolescent; Adverse effects; Affect; African; Age; Alcohol or Other Drugs use; Applications Grants; Botswana; Caregivers; Caring; Child; Communities; Conflict (Psychology); Consequences of HIV; Consult; Counseling; Country; Data Collection; Depression and Suicide; Development; Discrimination; Divorce; Drops; Educational workshop; Ensure; Focus Groups; Fright; Goals; HIV; HIV risk; Health; High Prevalence; Household; Husband; Impairment; Intervention; Intervention Studies; Knowledge; Learning; Malawi; Mental Depression; Outcome; Parents; Pennsylvania; Pharmaceutical Preparations; Population; Preparation; Prevalence; Prevention; Probability; Quality of life; Randomized Controlled Trials; Recording of previous events; Research; Research Methodology; Research Personnel; Risk; Risk Reduction; Safe Sex; Science; Series; Sexual Partners; Side; South Africa; Suicide; Surveys; Tanzania; Teenagers; Testing; Thailand; Treatment Efficacy; Uganda; United States; Universities; Vertical Disease Transmission; Viral Load result; Work; Zimbabwe; adolescent health; antiretroviral therapy; base; behavior change; clinical center; experience; improved; member; multidisciplinary; peer; programs; recruit; rural area; rural setting; self esteem; social cognitive theory; social stigma; theories; therapy adherence; transmission process; urban area; urban setting; willingness

PROJECT SUMMARY Considerable research has been conducted on HIV stigma, documenting its high prevalence worldwide. HIV stigma has been tied to adverse effects on HIV prevention, treatment engagement, adherence to antiretroviral therapy (ART). HIV stigma and its accompanying fear of discrimination also adversely affect viral load, depression, suicidality, self-esteem, quality of life, and HIV-transmission risk. Despite the progress in documenting the prevalence and negative consequences of HIV stigma, little is known about the best way to reduce stigma’s deleterious impact. Accordingly, the broad objective of this research is to identify interventions to reduce HIV stigma and its impact on HIV prevention, treatment, and care and health among adolescents living with HIV (ALWH) in Botswana, a sub-Saharan African nation with the third highest HIV prevalence in the world. Another important goal is to improve the capacity of researchers in Botswana to develop interventions to improve HIV prevention, treatment, and care. This project is a collaborative effort of a multidisciplinary team of researchers from the United States and the Republic of Botswana who have a history of collaborating and draws on a more than decade-long University of Botswana-University of Pennsylvania partnership. Members of the team have developed several efficacious HIV risk-reduction interventions for a variety of populations of adolescents. Specifically, the team will conduct preliminary exploratory research to develop a theory-based, developmentally and culturally appropriate HIV stigma-reduction intervention to improve ART adherence and reduce HIV stigma’s adverse impact on adolescents’ health. The intervention will be an adaptation of Teen Club, an intervention implemented with Batswana ALWH ages 13 to 17 years since 2005 that does not address HIV stigma. The bane of intervention research is that resulting efficacious interventions too often are not disseminated because they are not sustainable in the settings that need them. We seek to circumvent this problem by adapting an intervention employed for over 10 years in the proposed setting, resulting in an intervention with a high probability of sustainability. We will conduct focus groups with ALWH, peer educators who implement the existing program, and parents and other caregivers of ALWH, conduct a survey with ALWH to examine correlates of stigma, consult with a Community Advisory Board, and integrate what we learn with Social Cognitive Theory to adapt the intervention to address HIV stigma while ensuring that it is theory-based and developmentally and culturally appropriate. We will conduct a pilot feasibility randomized controlled trial (RCT) to determine the adapted intervention’s feasibility and acceptability. The proposed work includes a Science of Behavior Change Fellows Program with a series of workshops implemented in concert with the project’s activities to improve the capacity of researchers in Botswana to develop interventions to improve HIV prevention, treatment, and care. Based on the preliminary research, we will develop a grant application to test the stigma-reduction intervention’s efficacy in a full-scale RCT with ALWH.

项目摘要 对艾滋病毒污名化问题进行了大量研究，记录了艾滋病毒污名化在全世界的高流行率。艾滋病毒 耻辱感与艾滋病毒预防、治疗参与、坚持抗逆转录病毒治疗 治疗（ART）。艾滋病毒污名化及其伴随的对歧视的恐惧也对病毒载量产生不利影响， 抑郁、自杀、自尊、生活质量和艾滋病毒传播风险。尽管取得了进展， 虽然记录了艾滋病污名的流行和负面后果，但人们对艾滋病污名化的最佳途径知之甚少。 减少污名的有害影响。因此，本研究的广泛目标是确定干预措施 减少艾滋病毒污名化及其对青少年艾滋病毒预防、治疗、护理和健康的影响 博茨瓦纳是撒哈拉以南非洲国家，艾滋病毒感染率在非洲排名第三。 世界另一个重要目标是提高博茨瓦纳研究人员制定干预措施的能力， 改善艾滋病毒预防、治疗和护理。该项目是一个多学科团队的合作努力， 来自美国和博茨瓦纳共和国的研究人员，他们有合作的历史， 利用了长达十多年的博茨瓦纳大学-宾夕法尼亚大学的合作关系。成员 该小组已经为各种人群开发了几种有效的降低艾滋病毒风险的干预措施， 青少年。具体而言，该团队将进行初步探索性研究，以开发一种基于理论， 采取发展和文化上适当的减少艾滋病毒污名的干预措施，以提高抗逆转录病毒疗法的坚持率， 减少艾滋病毒污名化对青少年健康的不利影响。干预将是一个适应青少年 俱乐部，自2005年以来对13至17岁的BatterialALWH实施的干预措施， 解决艾滋病毒污名化问题。干预研究的祸根在于，所产生的有效干预往往是无效的。 没有传播，因为它们在需要它们的环境中不可持续。我们试图绕过这一点 通过调整在拟议环境中使用了10多年的干预措施， 具有高度可持续性的干预措施。我们将与ALWH、同伴教育者 实施现有计划的人，以及ALWH的父母和其他照顾者，与ALWH一起进行调查 检查耻辱的相关性，咨询社区咨询委员会，并将我们学到的与 社会认知理论，以调整干预措施，以解决艾滋病毒的耻辱，同时确保它是基于理论的 在发展和文化上都是合适的。我们将进行一项可行性随机对照试验 (RCT)以确定适应性干预的可行性和可接受性。拟议的工作包括 行为改变研究员计划的科学与一系列的研讨会在音乐会上实施， 提高博茨瓦纳研究人员制定干预措施以改善艾滋病毒状况的能力的项目活动 预防、治疗和护理。在初步研究的基础上，我们将开发一个赠款申请，以测试 减少污名干预在ALWH的全面RCT中的有效性。