Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South Africa

项目摘要 南非(SA)是世界上艾滋病毒携带者人数最多的国家， 未经治疗的物质使用障碍(SUD)，导致对艾滋病毒护理和艾滋病毒的参与程度较低 变速箱。内在化物质使用(SU)耻辱是PLWH参与HIV护理和 治疗。将同伴恢复教练(PR)-或有过SUD经验的人-整合到现有的 旨在让PLWH重新参与HIV护理的团队可能是一种有希望的方式，可以减少在 失去护理的PLWH，因此增加了艾滋病毒护理和SUD治疗的留存率。然而， 尽管普遍假设原癌基因可以减少内在化的SU污名，但很少有研究检验这一点 从数量上讲，没有人在艾滋病毒护理的背景下审查过这一点。此外，尽管中国的车型有 虽然在美国迅速扩大了规模，但很少有研究考察中国在低收入和中等收入国家的模式。 在一项正在进行的研究(R21DA053212)中，我们的团队正在评估PRC模式的可行性和可接受性 整合到现有的艾滋病毒保留团队，以及其在改变卫生工作者污名方面的初步有效性 针对物质使用和改善患者艾滋病毒护理参与度。除了这项正在进行的研究外，总体上 这项建议的目的是评估这种PRC模式在转移患者内化方面的初步效果。 SU耻辱和检查患者内在化SU耻辱是否与参与SUD治疗有关 以及对已退出艾滋病毒护理的PLWH和SUD的艾滋病毒护理(n=50)。我们的概念模型集成了 自我污名的阶段模型和情境信息动机行为技能的关爱启动模型 和维护框架。我们提出了三个目标：(1)首先，我们将评估PRC是否内部化SU 通过比较内化SU耻辱的变化，研究脱离HIV护理的PLWH和SUD患者的耻辱 接受从中国综合再介入团队到匹配的非中国再介入团队的数十名患者的护理 在基线和后续(基线后约六个月)评估之间的参与度团队。(2)接下来，我们 将评估内在化SU污名的变化是否与HIV护理和SUD治疗参与度相关 通过HIV诊所和SUD治疗出勤记录超过6个月。(3)我们的最终目标是抓住病人 关于苏式污名内化的几点思考 和其他相交的柱头 与HIV/SUD护理接触有关， 通过定性地采访接受中国护理的患者，这些可能与中国的接触有何关系？ 整合的再交战团队。本研究将使用正在进行的研究R21DA053212的现有基础设施。 这些发现将为未来评估可扩展的SU耻辱减少干预措施以改善艾滋病毒和 PLWH与SUD的SUD护理接洽。这个项目还将使PI成为一名 独立研究人员专注于设计和调整干预措施，以增加治疗参与度 在资源有限的情况下患有SUD的人。

Project Summary South Africa (SA) has the highest number of people living with HIV in the world (PLWH) and a high burden of untreated substance use disorder (SUD), which contributes both to poor engagement in HIV care and HIV transmission. Internalized substance use (SU) stigma is barrier to PLWH engaging in both HIV care and treatment. Integrating peer recovery coaches (PRCs)—or persons with lived SUD experience—into existing teams aiming to re-engage PLWH in HIV care may be a promising way to reduce internalized SU stigma among PLWH who have fallen out of care, and consequently, increase retention in HIV care and SUD treatment. Yet, despite the prevalent assumption that PRCs reduce internalized SU stigma, few studies have examined this quantitatively, and none have examined this in the context of HIV care. Further, although PRC models have been rapidly scaled in the US, little research has examined PRC models in low- and middle-income countries. In an ongoing study (R21DA053212), our team is evaluating the feasibility and acceptability of a PRC model integrated into existing HIV retention teams, and its preliminary effectiveness in shifting health worker stigma towards substance use and improving patient HIV care engagement. Adding to this ongoing study, the overall aim of this proposal is to evaluate the preliminary effectiveness of this PRC model in shifting patient internalized SU stigma and to examine if patient internalized SU stigma is associated with engagement in SUD treatment along with HIV care for PLWH and SUD who have fallen out of HIV care (n=50). Our conceptual model integrates the Stage Model of Self-Stigma and the situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance framework. We propose three aims: (1) First, we will evaluate if PRCs shift internalized SU stigma among PLWH with SUD who have fallen out of HIV care by comparing changes in internalized SU stigma scores of patients receiving care from the PRC integrated re-engagement team to a matched non-PRC re- engagement team between baseline and follow-up (about six-months post-baseline) assessments. (2) Next, we will evaluate if changes in internalized SU stigma are associated with HIV care and SUD treatment engagement over six-months via HIV clinic and SUD treatment attendance records. (3) Our final aim will be to capture patient perspectives on how internalized SU stigma and other intersecting stigmas relate to HIV/SUD care engagement, and how these may be related to PRC contact, by qualitatively interviewing patients receiving care from the PRC integrated re-engagement team. This study will use the existing infrastructure of ongoing study R21DA053212. Findings will inform future efforts to evaluate scalable SU stigma reduction interventions to improve HIV and SUD care engagement for PLWH with SUD. This project will additionally enable the PI’s pursuit of becoming an independent researcher focused on designing and adapting interventions to increase treatment engagement among people with SUD in resource-limited settings.