Enhancing HIV assisted contact tracing in Malawi through blended learning: an implementation science study

摘要 背景：协助接触者追踪（ACT）是一个自愿的过程，在这个过程中， 艾滋病毒，也称为索引病例，被确定和接触艾滋病毒检测。多项研究表明， 在撒哈拉以南非洲地区发现新的艾滋病毒病例的效率。尽管其功效已被证实，但有限的研究 已经做了显示如何耻辱可能具体影响ACT的摄取。这一点至关重要，因为 被定义为个人或一群人被认为具有不名誉的现象， 不可取的，或负面的属性，“别人”他们在自己的眼睛或别人的眼睛，一再被 显示对艾滋病毒结果和艾滋病毒感染者（PLWH）的生活质量产生负面影响。目标和 方法：在父组随机对照PRACTICE研究（R01MH124526）下， 正在评估实施方案的能力，以改善ACT的结果，卫生保健工作者的忠诚， ACT咨询和成本效益。混合式学习包括培训卫生工作者使用电子和 和面对面的方式。拟议的混合方法补充旨在评估成见的影响， 以及混合学习培训在减少污名方面的作用。这将是完成 通过三个目标。目标1审查混合学习方案是否减少了污名化态度 艾滋病毒携带者的健康状况。这一目标将使用定量和定性数据收集。通过 定量分析，我们将描述和比较研究组间随时间推移的卫生工作者污名评分 通过管理两个适应的耻辱量表。质量方面，我们将探讨卫生工作者的看法 以及他们对与指数客户及其联系人合作的态度和信念， 与卫生工作者进行深入访谈。目标2比较了增强型和标准型组的预期耻辱 在索引客户中。指数客户将参加离职面谈，其中包括9项威瑟耻辱量表 比较研究组之间的预期耻辱。团队：在艾滋病毒污名化和实施方面提供辅导 科学，定量和定性的研究方法，指导的受训者处于有利地位， 实现这些目标。此外，该团队多年的指导和指导学生的综合经验提供了一个 为学生实现拟议的学习目标提供丰富的支持。意义：本研究为 通过审查污名作为一个可能对真实的世界中ACT的使用产生负面影响的因素， 研究的进行也将导致成功完成 为这位有前途的实习生提供博士培训。

Summary Abstract Background: Assisted Contact Tracing (ACT) is a voluntary process in which the contacts of persons living with HIV, also called index cases, are identified and contacted for HIV testing. Multiple studies have shown ACT’s efficacy in identifying new HIV cases across sub-Saharan Africa. Despite its proven efficacy, limited research has been done showing how stigma may specifically impact ACT uptake. This is critical as stigma, a phenomenon defined as an individual or group of individuals being perceived as having a discrediting, undesirable, or negative attribute that ‘others’ them in their own eyes or the eyes of others, has repeatedly been shown to negatively impact HIV outcomes and the quality of life for people living with HIV (PLWH). Aims & Methods: Under the parent cluster randomized controlled PRACTICE study (R01MH124526) a blended learning implementation package is being assessed for its ability to improve ACT outcomes, health care worker fidelity to ACT counseling, and cost-effectiveness. Blended learning involves training health workers using both electronic and in-person modalities. The proposed mixed methods supplement aims to assess the impact that stigma has on ACT and the role that the blended learning training can have on stigma reduction. This will be accomplished through three aims. Aim 1 examines whether the blended learning package reduces stigmatizing attitudes towards PLWH held by health workers. This aim will use both quantitative and qualitative data collection. Through quantitative analysis we will characterize and compare health worker stigma scores across study arms over time through the administration of two adapted stigma scales. Qualitatively, we will explore health worker perceptions of PLWH, and their attitudes and beliefs about working with index clients and their contacts over time through in-depth interviews with health workers. Aim 2 compares enhanced and standard arms for anticipated stigma among index clients. Index clients will participate in exit interviews that include the 9-item Weiser stigma scale to compare anticipated stigma between study arms. Team: Offering mentorship in HIV stigma, implementation science, and quantitative and qualitative research methodologies, the mentored trainee is well positioned to address these aims. Further, the team’s years of combined experience mentoring and guiding students offers a wealth of support to the student carrying out the proposed study aims. Significance: This research makes a significant contribution by examining stigma as a factor that may negatively impact ACT uptake in real world settings and ultimately how to address it. Conduct of the research will also lead to successful completion of doctoral training for this promising trainee.