Implementing Stigma Reduction Tools via a Popular Teletraining Platform to Reduce Clinician Stigma and Disparities in HIV Testing, Prevention, and Linkage to Care in Malaysia

通过流行的远程培训平台实施减少耻辱工具，以减少马来西亚临床医生在艾滋病毒检测、预防和护理方面的耻辱和差异

• 批准号: 10618548
• 负责人: Valerie Ann Earnshaw
• 金额: $ 5.75万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10618548
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Applications Grants; Award; Caring; Clinic; Communities; Community Healthcare; Counseling; Country; Criminal Law; Data; Diagnosis; Discrimination; Disease; Education; Elements; Family Practice; Focus Groups; Funding; General Population; General Practitioners; Goals; Guidelines; HIV; Health Services; Hepatitis C virus; Human immunodeficiency virus test; Hybrids; Individual; Injecting drug user; Intervention; Intervention Studies; Interview; Learning; Link; Malaysia; Malaysian; Medical Students; Modeling; Outcome; Palliative Care; Participant; Perception; Persons; Phase; Population; Populations at Risk; Prejudice; Prevention; Promoting Action on Research Implementation in Health Services framework; Protocols documentation; Randomized; Religion and Spirituality; Research; Research Personnel; Same-sex; Social Environment; Specialist; Stereotyping; Technology; Test Result; Testing; Training Support; Universities; Videoconferencing; Work; acceptability and feasibility; addiction; care outcomes; care systems; community setting; efficacy trial; empowered; evidence base; experience; female sex worker; gender expression; illicit drug use; implementation science; implementation trial; insight; intervention refinement; medical specialties; member; men who have sex with men; pilot test; recruit; social norm; social stigma; success; three-arm study; tool; transgender; transgender women; voucher

ABSTRACT A scalable intervention is needed to remove one of the most potent and persistent drivers of disparities in HIV testing, prevention, and linkage to care globally: clinician stigma toward key populations. Key populations at risk of HIV who experience and/or anticipate stigma from clinicians are less likely to initiate, engage in, and adhere to care, including HIV testing, prevention, and linkage to care services. Researchers have uncovered evidence-based stigma reduction tools that hold promise to reduce stigma among clinicians and narrow HIV disparities globally. Yet, a vehicle to deliver these tools to clinicians at large scale (i.e., beyond single clinics) is currently lacking. The long-term goal of this work is to address clinician stigma globally via the widespread implementation of evidence-based stigma reduction tools via a popular teletraining platform. Project ECHO® (Extension for Community Healthcare Outcomes) trains, supports, and empowers clinicians to provide a wide range of specialty care services globally, including HIV testing, prevention, and linkage to care. It uses a “hub and spoke” model, wherein non-specialists in community setting “spokes” learn from and collaborate with specialists at academic “hubs” via videoconferencing technology. The objective of this R34 project is to incorporate evidence-based stigma reduction tools into Project ECHO® and pilot test the resulting intervention with clinicians in Malaysia. Malaysia is an optimal testing ground for this project because it exemplifies many social contexts globally, and in the U.S., wherein clinician stigma and HIV disparities are substantial; and the University of Malaya is already a Project ECHO® hub for several diseases. The first aim of this project is to evaluate key elements that will influence the implementation of evidence-based stigma reduction tools via Project ECHO®, including evidence, context, and facilitation, and is guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. In Phase 1 of this aim, Photovoice will be used to collect evidence regarding experiences of clinician stigma among 30-35 key stakeholders, including key populations at risk of HIV and PLWH. In Phase 2, additional evidence will be collected regarding Malaysian clinician perspectives and the intervention context will be assessed via online focus groups with 30-40 general practitioners and family medicine clinicians. In Phase 3, factors related to facilitation will be assessed by pre-testing the intervention protocol with 5 clinicians. The second aim is to pilot test Project ECHO® for HIV Prevention and Stigma Reduction among Malaysian clinicians and evaluate its acceptability, feasibility, and preliminary impact on clinician stigma and HIV testing, prevention, and linkage to care services among key populations. General practitioner and family medicine clinicians (n=78) will be randomized to one of 3 study arms: (1) Project ECHO® for HIV Prevention and Stigma Reduction, (2) Project ECHO® for HIV Prevention only, or (3) control. Following guidelines for Hybrid Type 1 Implementation Trials, the acceptability and feasibility of the intervention will be assessed as well as its preliminary impact. If results support the feasibility, acceptability, and preliminary impact of the intervention, funding will be sought to conduct a large-scale efficacy trial. This line of research will ultimately yield a highly scalable intervention that can be disseminated to practicing clinicians in Malaysia and other countries via an existing, popular teletraining platform to address clinician stigma toward key populations and reduce HIV disparities globally.

摘要 需要一种可扩展的干预措施，以消除造成艾滋病毒检测差异的最有力和最持久的驱动因素之一， 预防，以及与全球护理的联系：临床医生对关键人群的污名。感染艾滋病毒的主要人群是谁 经历和/或预期来自临床医生的污名不太可能发起、参与和坚持护理，包括艾滋病毒 检测、预防和与护理服务的联系。研究人员发现了基于证据的减少耻辱的工具 承诺减少临床医生的耻辱，缩小全球艾滋病毒差距。然而，一辆运送这些工具的工具 目前缺乏大规模(即超越单一诊所)的临床医生。这项工作的长期目标是解决 通过广泛实施基于证据的减少耻辱工具，在全球范围内通过广受欢迎的 远程训练平台。Echo®项目(社区医疗保健成果扩展)培训、支持和支持 临床医生在全球范围内提供广泛的专业护理服务，包括艾滋病毒检测、预防和与护理的联系。它使用 “中心和分支”模式，在这种模式中，社区环境中的非专家“分支”向专家学习并与专家协作 通过视频会议技术建立学术“中心”。这个R34项目的目标是结合循证污名 将减少工具整合到Project ECHO®中，并与马来西亚的临床医生一起进行初步干预试验。马来西亚是最好的 这个项目的试验场，因为它体现了全球和美国的许多社会背景，其中临床医生的耻辱 艾滋病毒的差距很大；马来亚大学已经是几种疾病的Project ECHO®中心。这个 该项目的第一个目标是评估将影响循证减少污名的实施的关键因素 通过项目ECHO®提供的工具，包括证据、背景和促进，并由促进研究行动指导 在卫生服务中的实施(PARiHS)框架。在这个目标的第一阶段，将使用PhotoVoice来收集证据 关于30-35个关键利益攸关方的临床医生污名经历，包括艾滋病毒风险关键人群和 PLWH。在第二阶段，将收集关于马来西亚临床医生观点和干预的更多证据 将通过由30-40名全科医生和家庭医学临床医生组成的在线焦点小组评估背景。同相 3、通过与5名临床医生对干预方案进行预试，对易化相关因素进行评估。第二个目标是 在马来西亚临床医生中试行Echo®项目以预防艾滋病毒和减少耻辱，并对其进行评估 临床医生污名和艾滋病毒检测、预防以及与护理服务的联系的可接受性、可行性和初步影响 在关键人群中。全科医生和家庭医学临床医生(n=78)将随机参加3项研究之一 ARMS：(1)预防艾滋病毒和减少耻辱的ECHO®项目，(2)仅预防艾滋病毒的ECHO®项目，或(3) 控制力。遵循混合类型1实施试验的指导方针，干预的可接受性和可行性 将对其及其初步影响进行评估。如果结果支持的可行性、可接受性和初步影响 此次干预后，将寻求资金进行大规模疗效试验。这一系列研究最终将产生一种 高度可扩展的干预措施，可通过现有的、 广受欢迎的远程培训平台，以解决临床医生对关键人群的耻辱，并减少全球艾滋病毒差距。

项目成果

Acceptability and Feasibility of Online, Asynchronous Photovoice with Key Populations and People Living with HIV.

• DOI: 10.1007/s10461-022-03938-5
• 发表时间: 2023-07
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Earnshaw, Valerie A.;Cox, Jon;Wong, Pui Li;Saifi, Rumana;Walters, Suzan;Azwa, Iskandar;Omar, Sharifah Faridah Syed;Collier, Zachary K.;Hassan, Asfarina Amir;Lim, Sin How;Wickersham, Jeffrey;Haddad, Marwan S.;Kamarulzaman, Adeeba;Altice, Frederick L.
• 通讯作者: Altice, Frederick L.

"I want the doctors to know that I am as bright as a candle": : Experiences with and Hopes for Doctor Interactions Among Malaysian Key Populations and People Living with HIV.

• DOI: 10.1007/s10461-022-03942-9
• 发表时间: 2023-07
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Earnshaw, Valerie A.;Cox, Jon;Wong, Pui Li;Saifi, Rumana;Walters, Suzan;Azwa, Iskandar;Omar, Sharifah Faridah Syed;Collier, Zachary K.;Hassan, Asfarina Amir;Lim, Sin How;Wickersham, Jeffrey;Haddad, Marwan S.;Kamarulzaman, Adeeba
• 通讯作者: Kamarulzaman, Adeeba