Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

项目摘要 南非（SA）是世界上艾滋病毒感染者（PLWH）人数最多的国家， 未经治疗的物质使用障碍（SUD），这导致了艾滋病毒护理和艾滋病毒感染的参与不足 传输内化的物质使用（SU）耻辱是PLWH参与艾滋病毒护理和治疗的障碍。 治疗将同伴恢复教练（PRC）-或具有生活SUD经验的人-整合到现有的 旨在让艾滋病毒感染者重新参与艾滋病毒护理的团队可能是减少艾滋病毒感染者中内化的SU耻辱感的一种有希望的方法。 艾滋病毒/艾滋病感染者和艾滋病毒/艾滋病患者中的艾滋病毒携带者和艾滋病毒携带者的比例增加，从而增加了艾滋病毒护理和SUD治疗的保留率。然而， 尽管人们普遍假设，中国减少了内化的SU污名，但很少有研究对此进行检验 定量地，没有人在艾滋病毒护理的背景下研究过这一点。此外，尽管PRC模型具有 尽管中国模式在美国迅速扩大，但很少有研究探讨中国模式在低收入和中等收入国家的应用。 在一项正在进行的研究（R21 DA 053212）中，我们的团队正在评价PRC模型的可行性和可接受性 纳入现有的艾滋病毒保留团队，以及其在改变卫生工作者污名方面的初步成效 药物使用和改善患者艾滋病毒护理参与。在这项正在进行的研究中， 本提案的目的是评估这种PRC模式在将患者内化方面的初步有效性 SU污名，并检查患者内化的SU污名是否与SUD治疗的参与相关 沿着艾滋病毒护理，对脱离艾滋病毒护理的PLWH和SUD患者进行治疗（n=50）。我们的概念模型整合了 自我污名的阶段模型与情境信息动机的关怀启动行为技能模型 维护框架。我们提出了三个目标：（1）首先，我们将评估PRCs是否转移了内化的SU 通过比较内化的SU耻辱的变化，对脱离艾滋病毒护理的患有SUD的PLWH的耻辱 从中国综合再参与团队接受治疗的患者人数， 在基线和后续（基线后约六个月）评估之间的参与小组。(2)接下来我们 将评估内化SU污名的变化是否与HIV护理和SUD治疗参与相关 通过艾滋病毒诊所和SUD治疗出勤记录，(3)我们的最终目标是抓住病人 关于如何内化SU污名的观点 和其他交叉的柱头 与艾滋病毒/SUD护理参与有关， 以及这些可能与中国接触有关，通过定性访谈接受中国护理的患者 综合再接触小组。本研究将使用正在进行的研究R21 DA 053212的现有基础设施。 调查结果将为未来的努力提供信息，以评估可扩展的SU减少耻辱干预措施，以改善艾滋病毒和 为患有SUD的PLWH提供SUD护理服务。该项目还将使PI的追求成为一个 独立研究人员专注于设计和调整干预措施，以增加治疗参与 在资源有限的环境中，

Project Summary South Africa (SA) has the highest number of people living with HIV in the world (PLWH) and a high burden of untreated substance use disorder (SUD), which contributes both to poor engagement in HIV care and HIV transmission. Internalized substance use (SU) stigma is barrier to PLWH engaging in both HIV care and treatment. Integrating peer recovery coaches (PRCs)—or persons with lived SUD experience—into existing teams aiming to re-engage PLWH in HIV care may be a promising way to reduce internalized SU stigma among PLWH who have fallen out of care, and consequently, increase retention in HIV care and SUD treatment. Yet, despite the prevalent assumption that PRCs reduce internalized SU stigma, few studies have examined this quantitatively, and none have examined this in the context of HIV care. Further, although PRC models have been rapidly scaled in the US, little research has examined PRC models in low- and middle-income countries. In an ongoing study (R21DA053212), our team is evaluating the feasibility and acceptability of a PRC model integrated into existing HIV retention teams, and its preliminary effectiveness in shifting health worker stigma towards substance use and improving patient HIV care engagement. Adding to this ongoing study, the overall aim of this proposal is to evaluate the preliminary effectiveness of this PRC model in shifting patient internalized SU stigma and to examine if patient internalized SU stigma is associated with engagement in SUD treatment along with HIV care for PLWH and SUD who have fallen out of HIV care (n=50). Our conceptual model integrates the Stage Model of Self-Stigma and the situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance framework. We propose three aims: (1) First, we will evaluate if PRCs shift internalized SU stigma among PLWH with SUD who have fallen out of HIV care by comparing changes in internalized SU stigma scores of patients receiving care from the PRC integrated re-engagement team to a matched non-PRC re- engagement team between baseline and follow-up (about six-months post-baseline) assessments. (2) Next, we will evaluate if changes in internalized SU stigma are associated with HIV care and SUD treatment engagement over six-months via HIV clinic and SUD treatment attendance records. (3) Our final aim will be to capture patient perspectives on how internalized SU stigma and other intersecting stigmas relate to HIV/SUD care engagement, and how these may be related to PRC contact, by qualitatively interviewing patients receiving care from the PRC integrated re-engagement team. This study will use the existing infrastructure of ongoing study R21DA053212. Findings will inform future efforts to evaluate scalable SU stigma reduction interventions to improve HIV and SUD care engagement for PLWH with SUD. This project will additionally enable the PI’s pursuit of becoming an independent researcher focused on designing and adapting interventions to increase treatment engagement among people with SUD in resource-limited settings.