Status-neutral community-based multilevel intervention to address intersectional stigma and discrimination, and increase HIV testing, PrEP, and ART uptake among YGBMSM in Ghanaian Slums

项目摘要 年轻的男同性恋者、双性恋者和其他男男性行为者(YGBMSM)占艾滋病毒流行率的63% (18%)在加纳的GBMSM中。我们以前的研究表明，交叉性污名和歧视(ISD) (围绕艾滋病毒、性和性别表达)和艾滋病毒知识不足阻碍艾滋病毒检测、PrEP和ART (HPART)在GBMSM之间的坚持。那些住在贫民窟的人面临着与他们所在社区相关的额外耻辱； 因此，贫民窟社区的社会和经济障碍可能与ISD交织在一起，从而加剧 艾滋病毒感染并阻止YGBMSM遵守HPART，因为它们将耻辱内化并避免了HCF。 地位中立的HIV护理方法可以减少YGBMSM和HCFS中的ISD，并改善HPART YGBMSM。然而，加纳目前的艾滋病毒干预和方案侧重于单独的服务和 主要解决仅测试问题。为此，我们建议采用多级干预(Lafiya， 在加纳语中，使用YGBMSM和HCF之间的地位中立来解决ISD和HPART问题 贫民窟。Lafiya在增加HIV阴性或未知人群中的HIV检测/自我检测方面显示出早期的有效性 加纳贫民窟的YGBMSM现状。适应状态中立的干预措施将扩大其对艾滋病毒的效用 利用关于交叉污名、HIVST、PrEP和连锁的科学进步进行预防和护理 去关心。拉菲亚还主要关注GBMSM，并涉及两个获得ISD的设施的提供者 还原训练。拟议的Lafiya将包括整个人道主义援助框架的培训、PrEP和ART部分。引导式 通过ADAPTT-IT模式的八个步骤，我们将实现这两个目标。1)采用多层次干预 使用YGBMSM中的状态中立性解决ISD和HPART。我们将开展FGDS和深入研究 与YGBMSM(n=70)、GBMSM提供者(n=20)和护士/医务工作者(n=80)进行访谈(IDI)以加深 了解YGBMSM遵守HPART的ISD、障碍和促进者。在总结性分析中， 我们将结合提供商和YGBMSM的实际情况，优化干预潜力，以解决ISD和 增加HPART。2)检验解决ISD和增加HPART干预的初步效果 坚持使用CRT设计。我们将YGBMSM(n=240)个朋友群分配给对照组或干预组 对照组和干预组(n=3)。干预部门将接待拉菲亚。我们会收集 青年男性接触者(240人)和医务人员(300人)干预后3、6、9个月的数据。测量HPART的步骤 坚持(主要结果)、减少ISD、艾滋病毒和地位中立知识(次要结果)以及 干预措施的可接受性、适当性和可行性(实施结果)。我们将进行 在实施者和参与者中进行干预后的其他焦点小组和访谈(样本量 与AIM1相同)，以评估他们的干预经验。这一发现将为跨部门耻辱提供信息 在YGBMSM、贫民窟、SSA和其他高危人群中实施减少和艾滋病毒状况中立的战略 不同环境中的人口。

Project Summary Young gay, bisexual, and other men who have sex with men (YGBMSM) make up 63% of the HIV prevalence (18%) among GBMSM in Ghana. Our previous studies show that intersectional stigma and discrimination (ISD) (around HIV, sex, and gender expression) and insufficient HIV knowledge impede HIV testing, PrEP, and ART (HPART) adherence among GBMSM. Those in slums face additional stigma associated with their communities; hence the social and economic barriers in slum communities can intertwine with ISD to exacerbate the risk of HIV infections and discourage HPART adherence among YGBMSM as they internalized stigma and avoid HCF. A status-neutral approach to HIV care can reduce ISD among YGBMSM and HCFs and improve HPART among YGBMSM. Yet, current HIV interventions and programs in Ghana have focused on separate services and predominantly address only testing. To this effect, we propose to adapt a multilevel intervention (LAFIYA, meaning wellness) to address ISD and HPART using status neutrality among YGBMSM and HCF in Ghanaian slums. LAFIYA showed early efficacy in increasing HIV testing/self-testing among HIV-negative or unknown- status YGBMSM in Ghanaian slums. Adaptation to a status-neutral intervention will extend its utility for HIV prevention and care by utilizing scientific advancements around intersectional stigma, HIVST, PrEP, and linkage to care. LAFIYA also mainly focused on GBMSM and involved providers from two facilities who received ISD reduction training. The proposed LAFIYA will include HCF-wide training, PrEP, and ART components. Guided by the eight steps of the ADAPTT-IT model, we will implement the two aims. 1) Adapt a multilevel intervention to address ISD and HPART using status neutrality among YGBMSM. We will conduct FGDs and in-depth interviews (IDI) with YGBMSM (n=70), GBMSM providers (n=20), and NURSES/HCWs (n=80) to deepen understanding of ISD, barriers, and facilitators of HPART adherence among YGBMSM. In a summative analysis, we will integrate realities from providers and YGBMSM to optimize the intervention potential to address ISD and increase HPART. 2) Test the preliminary efficacy of the intervention to address ISD and increase HPART adherence using CRT Design. We will assign YGBMSM (n=240) friend groups to control or intervention groups (n=120) and HCF(n=6) to control or intervention (n=3). The intervention arm will receive LAFIYA. We will collect 3, 6, and 9 months post-intervention data among YGBMSM (n=240) and HCWs(n=300). to measure HPART adherence (primary outcomes), ISD reduction, HIV and status-neutral knowledge (secondary outcomes), and acceptability, appropriateness, and feasibility of the intervention (implementation outcomes). We will conduct additional focus groups and interviews post-intervention among implementers and participants (sample sizes same as in AIM1) to evaluate their experiences with the intervention. The findings will inform intersectional stigma reduction and HIV status-neutral implementation strategies among YGBMSM, slums, SSA, and other high-risk populations in different settings.