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

项目摘要 在乌干达，15-64岁人群中艾滋病毒感染率估计为6.2%，坎帕拉的感染率更高（6.9%）， 建议的研究设置。政治和文化障碍，包括政府资金有限和艾滋病毒污名化， 阻碍了艾滋病毒的预防，并导致预测艾滋病毒发病率迅速上升。拟议研究 将是一项关于游戏改变者的随机对照试验（RCT），这是一项6次会议的同行领导的小组干预，旨在 增强艾滋病毒感染者的权能并动员他们在其社交网络中成为艾滋病毒预防工作的推动者。 通过减少艾滋病毒携带者及其社会网络成员的耻辱感，并对艾滋病毒携带者进行战略培训， 让社交网络成员参与有关艾滋病毒的讨论，游戏规则改变者为艾滋病毒携带者提供工具， 做好预防宣传。游戏规则改变者是通过NIMH R34开发的，该R34具有很高的可行性， 艾滋病毒感染者和艾滋病患者之间的艾滋病毒预防宣传的可接受性和初步干预效果 他们的社会网络成员，减少内化的耻辱，并增加艾滋病毒血清状态披露给社会 艾滋病毒/艾滋病感染者网络成员之间的影响，以及对增加安全套使用和艾滋病毒检测的中到大的影响， 网络成员的子样本。具体目标是：（1）进行游戏改变者RCT，同行- 在乌干达，领导对艾滋病毒携带者进行小组干预，以测试干预对减少艾滋病毒携带者的主要结局的影响。 无安全套性行为，增加艾滋病毒检测，并减少社会网络成员之间的艾滋病毒污名化;（2） 为了测试干预对次要结果的影响，即减少内化的艾滋病毒污名，增加艾滋病毒 血清状态披露，并增加病毒载量抑制PLWH，和PrEP摄取社会 （3）研究艾滋病毒感染者和艾滋病网络成员对艾滋病毒预防宣传的增加是否介导了干预 对社会网络成员增加安全套使用和艾滋病毒检测的影响，以及是否增加艾滋病毒 艾滋病毒感染者披露信息对社会网络成员减少艾滋病毒污名化的干预效果起中介作用; （4）对干预措施进行成本-效果分析。我们将招募210名PLWH，随机抽取105名 105人注意力控制。每个艾滋病毒携带者将被要求招募社交网络成员 完成评估（共736项，每组368项），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。成本效益分析将告知政策制定者游戏改变者是否是一个 可行的投资方式。我们的方法在生物医学干预的时代特别及时， 这就需要将有效的艾滋病毒预防信息广泛渗透到社区。定位 艾滋病毒感染者作为控制（而不是引起）艾滋病毒流行的解决方案的核心，有可能减少艾滋病毒 在个人、家庭和网络层面，消除污名并改善预防成果。

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.