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

项目总结/摘要 本研究的目标是调整和试点一个有效的卫生设施艾滋病毒的耻辱减少干预， * 解决坦桑尼亚艾滋病毒护理和治疗诊所中的吸毒污名问题，这是联系的一个障碍， 继续为吸毒的艾滋病毒感染者提供艾滋病毒护理。在坦桑尼亚， 30万人使用毒品（PWUD），主要是海洛因。虽然大多数海洛因是吸入或摄入， 估计10%（30，000）的PWUD注射。不注射的艾滋病毒感染者中的艾滋病毒流行率（18-25%）， 注射者（35%）比一般人口（5%）高4-7倍。PWUD面临高水平的 污名化，包括当他们试图在艾滋病毒治疗中心寻求艾滋病毒治疗时，这对联系构成了障碍， 继续为这一艾滋病毒高度脆弱群体提供艾滋病毒治疗。因此，减少艾滋病毒感染者的吸毒污名， 社区治疗中心对于改善残疾人获得和保留艾滋病毒治疗服务至关重要。针对这一 需要，我们将： 1.调整保健设施减少艾滋病毒污名的参与性培训干预措施， 在艾滋病毒CTC中使用羞辱（目标1）。 2.试点测试经调整的减少吸毒污名干预措施的可接受性， 适当性和可行性。(Aim 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， 与使用药物的艾滋病毒携带者和CTC工作人员进行深入访谈， 健康政策附加（HP+）干预。利益攸关方，包括使用阿片类药物的艾滋病毒携带者和艾滋病中心工作人员，将 通过参与性讲习班提供对初步材料的反馈意见，从而编写培训手册， 将由专题专家审查，然后定稿。经验丰富的坦桑尼亚减少艾滋病毒污名培训员， 包括有阿片类药物使用经验的人，将接受培训，向反恐中心工作人员提供干预措施。 试点测试将包括达累斯萨拉姆七个社区治疗中心的150名卫生工作者。混合方法 评估将包括培训前调查、培训观察和培训后重点小组讨论 与干预参与者和培训师。2004年至2005年，反恐委员会工作人员在耻辱量表上的平均得分 将评估干预后的效果，沿着评估干预的可接受性、适当性和 可行性焦点小组将围绕参与阿片类药物使用污名的经历探讨主题- 减少训练。

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.