Development of an Online Provider Intervention to Address Intersectional Stigma and Medical Mistrust in People Living with HIV

制定在线提供者干预措施，以解决艾滋病毒感染者的跨部门耻辱和医疗不信任问题

• 批准号: 10584495
• 负责人: Lu Dong
• 金额: $ 23.74万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10584495
• 关键词: AIDS prevention; Address; Adherence; American; Black race; Caring; Clinical; Code; Cognitive Therapy; Communities; Competence; Control Groups; Counseling; Development; Discrimination; Dissemination and Implementation; Feedback; Funding; HIV; HIV Infections; HIV disparities; HIV/AIDS; Health; Health Personnel; Health behavior and outcomes; Healthcare; Incidence; Individual; Intervention; Knowledge; Latinx; Learning Skill; Mediating; Medical; Mental disorders; Methods; Outcome; Patient Care; Patients; Persons; Physicians; Pilot Projects; Provider; Randomized; Randomized, Controlled Trials; Reduce health disparities; Reporting; Research; Research Priority; Risk; Science; Scientific Advances and Accomplishments; Sexism; Structure; Testing; Training; Treatment outcome; Trust; United States National Institutes of Health; Viral Load result; Work; acceptability and feasibility; antiretroviral therapy; behavior change; black patient; care delivery; care providers; care systems; clinical practice; community engagement; ethnic health disparity; ethnic minority; evidence base; experience; explicit bias; feasibility testing; follow-up; health disparity; implementation efforts; implicit bias; improved; intersectionality; intervention refinement; meetings; men; motivational enhancement therapy; online intervention; patient level intervention; perceived discrimination; poor health outcome; post intervention; prevention service; process evaluation; provider intervention; psychoeducation; psychoeducational; racial health disparity; racial minority; racism; recruit; response; service delivery; sexual minority; sexual minority men; skills; skills training; social stigma; substance use; therapy adherence; treatment adherence; treatment as usual; usability

PROJECT SUMMARY/ABSTRACT Intersectional stigma and discrimination are key contributors to health disparities, including in HIV care, in Black and Latinx communities. As a result of historical and ongoing stigma and discrimination in the U.S., medical mistrust is highly prevalent in Black and Latinx communities, including those living with HIV, and contributes to low care engagement, treatment nonadherence, and poor health outcomes. However, no evidence-based provider intervention is available for providers to gain knowledge and skills to address intersectional stigma and medical mistrust with patients. This study responds to the call in RFA-DA-21-001 to “reduce the impact of intersectional stigma and strengthen the provision and utilization of HIV prevention or care services,” by developing an intervention for HIV care providers working with individuals who experience intersectional stigma and discrimination. The proposed intervention has the potential to improve providers’ competence to address the impact of intersectional stigma and medical mistrust with patients, which may in turn improve patient’s healthcare engagement, treatment adherence, and health outcomes. Aim 1 involves developing an online provider intervention for HIV care providers to gain knowledge and skills to address the impact of experiencing intersectional stigma and discrimination, with particular focus on medical mistrust, using input from key community stakeholders, including HIV providers and patients from Black and Latinx communities. The intervention will include psychoeducation on the impact of intersectionality and medical mistrust on patients as well as skills training to address these issues based on principles of motivational interviewing (MI), cognitive behavior therapy (CBT), and the science of behavior change. We will engage community stakeholders to provide feedback on the intervention content. The context of the intervention will be online, and we will work with a provider training center partner to develop the online platform and conduct a usability test in 10 HIV care physicians. Aim 2 involves conducting a pilot randomized controlled trial in 80 physicians providing care for patients at risk or living with HIV to test the intervention (n = 40) against a no- treatment control group (n = 40). Provider training outcomes will include providers’ use of skills learned in the intervention (e.g., MI-consistent statements) to address intersectional stigma and medical mistrust using hypothetical patient scenarios, and provider-reported HIV service delivery outcomes. Outcomes will be assessed at baseline, immediately post-intervention, and at 12-month follow-up. A mixed-method process evaluation will be conducted at post-intervention to assess acceptability, feasibility, and appropriateness of the online intervention. Results from this study have the potential to significantly advance scientific knowledge and clinical practice regarding addressing intersectional stigma and medical mistrust at the provider-level with patients from Black and Latinx communities as a way to reduce HIV-related disparities.

项目总结/摘要 交叉羞辱和歧视是造成健康差距的主要因素，包括艾滋病毒护理， 黑人和拉丁裔社区。由于美国历史上和目前的耻辱和歧视， 医疗不信任在黑人和拉丁裔社区，包括艾滋病毒感染者中非常普遍， 导致护理参与度低、治疗不依从和健康结果差。但没有 基于证据的提供者干预可供提供者获得知识和技能， 交叉的耻辱和对病人的医疗不信任。本研究响应了RFA-DA-21-001中的要求， “减少交叉污名化的影响，加强艾滋病毒预防措施的提供和利用， 护理服务，”通过为艾滋病毒护理提供者制定干预措施， 相互交织的耻辱和歧视。拟议的干预措施有可能改善供应商的 有能力解决交叉污名化和对患者的医疗不信任的影响，这可能会 从而提高患者的医疗保健参与度、治疗依从性和健康结果。目标1涉及 为艾滋病毒护理提供者制定在线提供者干预措施，以获得知识和技能， 经历交叉羞辱和歧视的影响，特别关注医疗不信任， 关键社区利益攸关方的投入，包括来自黑人和拉丁裔的艾滋病毒提供者和患者 社区.干预措施将包括关于交叉性和医疗影响的心理教育。 对病人的不信任，以及技能培训，以解决这些问题的基础上的原则，激励 访谈（MI）、认知行为疗法（CBT）和行为改变科学。我们会委聘 社区利益相关者就干预内容提供反馈。干预的背景将是 在线，我们将与供应商培训中心合作伙伴合作开发在线平台，并进行 在10名HIV护理医生中进行可用性测试。目标2涉及在80名受试者中进行一项初步随机对照试验。 为高危患者或艾滋病毒感染者提供护理的医生（n = 40）， 治疗对照组（n = 40）。提供者培训成果将包括提供者对在培训中学到的技能的使用。 干预（例如，MI一致的声明），以解决交叉污名和医疗不信任， 假设的患者情景和提供者报告的艾滋病毒服务提供结果。成果将 在基线、干预后即刻和12个月随访时进行评估。混合方法工艺 将在干预后进行评估，以评估 在线干预。这项研究的结果有可能显着推进科学知识， 关于解决交叉污名和医疗不信任的临床实践， 来自黑人和拉丁裔社区的患者作为减少艾滋病毒相关差异的一种方式。