Improving HIV treatment outcomes for people who use drugs: adapting and piloting a drug-use use stigma-reduction intervention in HIV care and treatment clinics in Tanzania

项目摘要/摘要 这项研究的目标是调整和试点一种有效的卫生机构减少艾滋病毒污名的干预措施，以 解决坦桑尼亚艾滋病毒护理和治疗诊所(CTC)的药物使用污名，这是联系和 为使用毒品的艾滋病毒携带者(PLWH)保留艾滋病毒护理。在坦桑尼亚，估计有 30万人吸毒(PWUD)，主要是海洛因。尽管大多数海洛因是被吸入或摄入的，但 估计有10%(30,000)的PWUD注射。未注射的PWUD人群中艾滋病毒感染率(18%-25%)和 那些注射的人(35%)是普通人群(5%)的4-7倍。PWUD面临高水平的 耻辱，包括当他们试图在艾滋病毒控制和预防中心寻求艾滋病毒治疗时，对联系和 为这一艾滋病毒高度脆弱群体保留艾滋病毒治疗。因此，减少艾滋病毒中使用药物的耻辱 CTC对于改善获得和保留残疾患者的艾滋病毒治疗服务至关重要。作为对此的回应 需要，我们将： 1.调整一个保健机构--减少艾滋病毒污名的参与性培训干预措施，以解决毒品问题 在艾滋病毒CTC中使用污名(目标1)。 2.对适应的药物使用污名减少干预措施进行可接受性的试点测试， 适当性和可行性。(目标2)。 我们将通过一个系统的、多阶段的适应过程来实现目标1，其中将包括一个形成性的 与使用药物的公共卫生部门和四氯化碳工作人员进行深入访谈阶段，以告知初步适应情况 健康政策加(HP+)干预。利益攸关方，包括使用阿片类药物的PLWH和CTC工作人员，将 通过参与性研讨会提供对初始材料的反馈，从而编写培训手册， 将由专题专家进行审查，然后最后敲定。经验丰富的坦桑尼亚艾滋病毒污名减轻培训师， 包括有阿片类药物使用经验的人将接受培训，以便向CTC工作人员提供干预。 试点测试将包括驻在达累斯萨拉姆七个社区卫生中心的150名卫生工作者。一种混合的方法 评价将包括岗前调查、培训观察和培训后重点小组讨论。 与干预参与者和训练员一起进行。反恐中心工作人员污名量表平均分与治疗前的变化 将评估干预后，以及干预的可接受性、适当性和 可行性。焦点小组将围绕参与阿片类药物使用耻辱的经历探讨主题- 还原训练。

PROJECT SUMMARY/ABSTRACT The goal of this study is to adapt and pilot an effective health facility HIV stigma-reduction intervention to address drug use stigma in HIV care and treatment clinics (CTCs) in Tanzania, a barrier to linkage and retention in HIV care for people living with HIV (PLWH) who use drugs. In Tanzania, there are an estimated 300,000 people who use drugs (PWUD), primarily heroin. Although most heroin is inhaled or ingested, an estimated 10% (30,000) of PWUD inject. HIV prevalence among PWUD who do not inject (18–25%) and those who do inject (35%) is 4–7 times higher than in the general population (5%). PWUD face high levels of stigma, including when they try to seek HIV treatment at HIV CTCs, presenting a barrier to linkage and retention in HIV treatment for this highly HIV vulnerable group. Therefore, reducing drug use stigma in HIV CTCs is critical to improving access to and retention in HIV treatment services for PWUD. In response to this need, we will: 1. Adapt a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV CTCs (Aim 1). 2. Pilot test the adapted drug use stigma-reduction intervention for acceptability, appropriateness, and feasibility. (Aim 2). We will achieve Aim 1 through a systematic, multi-stage adaptation process that will include a formative phase of in-depth interviews with PLWH who use drugs and CTC staff to inform initial adaptation of the Health Policy Plus (HP+) intervention. Stakeholders, including PLWH who use opioids and CTC staff, will provide feedback on the initial materials through a participatory workshop, leading to a training manual that will be reviewed by topic experts and then finalized. Experienced Tanzanian HIV stigma-reduction trainers, including people with lived experience of opioid use, will be trained to deliver the intervention to CTC staff. The pilot test will include 150 health workers based in seven CTCs in Dar-es-Salaam. A mixed methods evaluation will comprise pre-post surveys, observation of trainings, and post-training focus group discussions with intervention participants and trainers. Changes in CTC staff's mean scores on stigma scales from pre- to post-intervention will be assessed, along with measures of intervention acceptability, appropriateness, and feasibility. Focus groups will explore themes around the experience of participating in the opioid use stigma- reduction training.