Controlled Trial of Game Changers: A Group Intervention to Train HIV Clients to be Change Agents for HIV Prevention in Uganda

项目总结 在乌干达，15岁--的艾滋病毒感染率估计为6.2%，坎帕拉更高(6.9%)， 建议的研究环境。政治和文化障碍，包括政府资金有限和艾滋病毒污名， 阻碍艾滋病毒预防，并导致艾滋病毒发病率迅速上升的预测。拟议的研究 将是一项针对游戏规则改变者的随机对照试验(RCT)，这是一项为期6次的同行领导的团体干预，旨在 增强和动员艾滋病毒携带者(PLWH)在其社交网络中成为艾滋病毒预防的代理人。 通过减少妇幼保健院及其社交网络成员的耻辱，并培训妇幼保健院采取以下策略 让社交网络成员参与有关艾滋病毒的讨论，游戏规则改变者为PLWH提供了以下工具 做好预防宣传。游戏改变器是通过NIMH R34开发的，它发现了高度的可行性和 可接受性和初步干预效果在公共卫生部门和公共卫生部门之间增加艾滋病毒预防宣传 他们的社交网络成员，减少了内在化的耻辱，并增加了对社会的艾滋病毒血清状态披露 在公共卫生部门的网络成员中，避孕套的使用和艾滋病毒检测的增加有中等到很大的影响 网络成员的子样本。具体目标是：(1)对游戏规则改变者进行RCT，同行- 在乌干达对PLWH进行领导小组干预，以测试干预对减少的主要结果的影响 无公寓性行为，增加艾滋病毒检测，减少社交网络成员对艾滋病毒的污名；(2) 为了测试干预对减少内在化艾滋病毒污名、增加艾滋病毒的次要结果的影响 血清状态披露，PLWH中病毒载量抑制增加，社会中PrEP摄入量增加 网络成员；(3)审查公共卫生署增加艾滋病毒预防宣传是否有助于干预 对社交网络成员增加避孕套使用和艾滋病毒检测的影响，以及是否增加了艾滋病毒 PLWH的披露中介了对社交网络成员减少实施的艾滋病毒污名的干预效果； (4)进行干预的成本-效果分析。我们将招募210名PLWH，随机选择105名 对干预组和对注意力控制组。每个PLWH将被要求招募社交网络成员 完成评估(总计736项，368项/ARM)，以测试干预对社交网络的影响。所有参与者将 在基线和基线后6个月、12个月和18个月完成调查；PLWH还将完成社交网络 评估。成本效益分析将让政策制定者了解游戏规则改变者是否是一个 可投资的可行干预措施。在生物医学干预的时代，我们的方法特别及时， 这需要将有效的艾滋病毒预防信息广泛渗透到社区中。定位 PLWH作为控制(与引起)艾滋病毒流行的解决方案的核心，具有减少艾滋病毒的潜力 在个人、家庭和网络层面上消除耻辱并改善预防效果。

PROJECT SUMMARY In Uganda, HIV prevalence is estimated to be 6.2% among those aged 15-64, and is higher (6.9%) in Kampala, the proposed study setting. Political and cultural barriers, including limited government funding and HIV stigma, impede HIV prevention and have led to projections of rapid increases in HIV incidence. The proposed research will be a randomized controlled trial (RCT) of Game Changers, a 6-session peer-led group intervention that aims to empower and mobilize people living with HIV (PLWH) to be agents for HIV prevention in their social networks. By decreasing stigma among PLWH and their social network members, and training PLWH on strategies to engage social network members in discussions around HIV, Game Changers provides PLWH with the tools to do prevention advocacy. Game Changers was developed through an NIMH R34 that found high feasibility and acceptability, and preliminary intervention effects on increased HIV prevention advocacy between PLWH and their social network members, reduced internalized stigma, and increased HIV-serostatus disclosure to social network members among PLWH, and medium to large effects on increased condom use and HIV testing among a subsample of network members. The Specific Aims are: (1) To conduct an RCT of Game Changers, a peer- led group intervention for PLWH in Uganda, to test intervention effects on the primary outcomes of reduced condomless sex, increased HIV testing, and decreased enacted HIV stigma among social network members; (2) To test intervention effects on the secondary outcomes of reduced internalized HIV stigma, increased HIV serostatus disclosure, and increased viral load suppression among PLWH, and PrEP uptake among social network members; (3) To examine whether increased HIV prevention advocacy by PLWH mediates intervention effects on social network members’ increased condom use and HIV testing, and whether increased HIV disclosure by PLWH mediates intervention effects on social network members’ reduced enacted HIV stigma; and (4) To conduct a cost-effectiveness analysis of the intervention. We will recruit 210 PLWH, randomizing 105 to the intervention and 105 to an attention control. Each PLWH will be asked to recruit social network members to complete assessments (736 total, 368/arm), to test intervention effects on social networks. All participants will complete surveys at baseline and 6-, 12-, and 18-months post-baseline; PLWH will also complete social network assessments. The cost-effectiveness analysis will inform policymakers about whether Game Changers is a feasible intervention in which to invest. Our approach is particularly timely in the era of biomedical interventions, which require widespread penetration of effective HIV prevention messaging into communities. Positioning PLWH as central to the solution for controlling (vs. causing) the HIV epidemic has the potential to reduce HIV stigma and improve prevention outcomes at the individual, household, and network levels.