Hiv
Conditions
Keywords
Stigma, Intervention, HIV, Dominican Republic, Spanish
Brief summary
This research has the potential to make important contributions toward HIV and intersectional stigma reduction across the Spanish-speaking Caribbean. It will do so by adapting and testing a patient-provider, clinic-based intersectional stigma-reduction intervention -- Finding Respect and Ending Stigma around HIV (FRESH) -- for the Dominican Republic. Preliminary results from this R21 study (e.g. workshop satisfaction, stigma outcomes, HIV continuum of care outcomes, etc.) will inform the development of an investigator-initiated R01 proposal to conduct a full scale randomized controlled trial of the adapted FRESH intervention.
Detailed description
The proposed study addresses the high level of stigma against people living with HIV (PLWH), particularly gender and sexual minorities, that is embedded in the Dominican Republic's HIV treatment system through the adaptation and testing of a patient-provider intervention -- Finding Respect and Ending Stigma around HIV (FRESH). The Dominican Republic is a high priority setting with an increasing need for HIV stigma reduction studies. The Caribbean holds the second highest regional burden of HIV in the world, yet receives insufficient HIV-related stigma research funding. The Dominican Republic is 1 of 5 countries that accounts for over 95% of all Caribbean HIV infections; it also has a significant concentrated HIV epidemic, a deeply conservative society in which PLWH are stigmatized, and an exceptionally low national viral load suppression rate. To accomplish this pilot study, three Specific Aims are proposed. Aim 1 is to explore sources, characteristics, and consequences of HIV-related and intersectional stigmas experienced in healthcare settings to inform the adaptation of FRESH. To accomplish Aim 1, we will conduct qualitative in-depth interviews with healthcare workers who provide HIV care, focus groups with MSM, and in-depth interviews with trans- women. Aim 2 is to adapt FRESH to address stigmas experienced these individuals in the Dominican Republic. We will apply the Aim 1 findings using the ADAPT-ITT framework to systematically adapt FRESH, an intervention that has been employed to reduce stigma in healthcare settings in Africa and the United States. Through an iterative process, each revision of FRESH will be shared with both PLWH and healthcare workers to solicit and incorporate their feedback about each version of the adapted intervention. Aim 3 will pilot-test the adapted intervention to obtain estimates of its ability to reduce stigmatizing attitudes and behaviors from HWs and experiences of stigma reported by sexual and gender minorities (SGM) and non-SGM clients living with HIV (primary); while exploring if FRESH has the potential to influence clinic-level outcomes. By adapting and testing the FRESH intervention for the Spanish-speaking Caribbean, FRESH could become a validated, multi-region HIV and intersectional stigma reduction intervention designed specifically for healthcare settings in high-stigma, culturally conservative, resource-constrained communities; such a scientific development would be a significant contribution to HIV stigma reduction efforts in the Caribbean and globally.
Interventions
The Finding Respect and Ending Stigma around HIV (FRESH) intervention is theoretically informed by Social Cognitive Theory (SCT) and Interpersonal Contact theory (ICT) and was specifically designed for delivery in high-stigma settings, such as Dominican Republic. FRESH was originally developed in Africa to address HIV-related stigma, and later was adapted to address intersectional stigmas experienced by sexual and gender minorities (SGM) living with HIV in the United States Deep South. To our knowledge, FRESH will be the first intervention to address intersectional stigmas experienced by men who have sex with men, transgender women, and people living with HIV in clinical settings in the Spanish-speaking Caribbean.
Sponsors
Fogarty International Center of the National Institute of Health
Florida State University
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
No masking.
Intervention model description
Pre- and post- intervention participation assessment; arms represent participant types, either healthcare worker or person with HIV (PWH) client.
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
for health worker participants: * Minimally 18 years and 0 months of age * Works at one of the three study sites * Interacts with people living with HIV * Spanish speaking * Can read Spanish text * Able and willing to provide informed consent Inclusion Criteria for people living with HIV participants: * Minimally 16 years and 0 months of age * Is HIV-positive * Spanish speaking * Receives treatment at one of the three study sites * Identifies as an SGM * Able and willing to provide informed consent
Exclusion criteria
• Does not meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HIV-related Stigma | Year 2 | For providers, the results are reported for the Opinions about People with HIV sub-scale from the HIV-related stigma among health facility staff scale, 6 questions. Response options are Strongly Agree, Agree, Disagree, and Strongly Disagree. This scale does not include reverse coding. Higher scores indicate higher levels of stigma. The score can range from 5 (min) to 20 (max). For clients, the results are reported for the Experiencing HIV-related Stigma in Healthcare Settings scale, 5 questions. Response options are Never, Rarely, Sometimes, Usually, and Always. This scale does not include reverse coding. Higher scores indicate higher levels of stigma. The score can range from 0 (min) to 20 (max). |
| HIV Knowledge Index | Year 2 | Results are reported for the HIV Knowledge Index from providers only. This is not a validated scale but was being tested in the context of this study. It included 13 homegrown questions. Range was 0 (min) to 13 (max), with higher scores indicating greater knowledge. |
| Empathy and Avoidance in Treating Patients Living With HIV/AIDS | Year 2 | For providers, the results are reported for empathy and avoidance in treating patients living with HIV/AIDS, 11 questions. Response options are Strongly Agree, Agree, Neutral, Disagree, and Strongly Disagree. This scale includes reverse coding. Higher scores indicate higher levels of stigma. The score can range from 11 (min) to 55 (max). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Multiple Discrimination Scale - Orientation | Year 2 | For clients, the results are reported for experiences of discrimination related to sexual orientation, 10 questions. Response options are Yes and No. Higher scores indicate higher levels of stigma. The score can range from 0 (min) to 10 (max). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Providers Healthcare providers from both clinics that received the FRESH intervention. | 20 |
| Clients People with HIV clients from both clinics that received the FRESH intervention. | 16 |
| Total | 36 |
Baseline characteristics
| Characteristic | Providers | Clients | Total |
|---|---|---|---|
| Age, Customized | 40.40 years STANDARD_DEVIATION 10.33 | 32.47 years STANDARD_DEVIATION 6.78 | 36.88 years STANDARD_DEVIATION 5.61 |
| Race/Ethnicity, Customized Black | 4 participants | 6 participants | 10 participants |
| Race/Ethnicity, Customized Multiracial | 14 participants | 8 participants | 22 participants |
| Race/Ethnicity, Customized Other or Not Reported | 0 participants | 2 participants | 3 participants |
| Race/Ethnicity, Customized White | 2 participants | 0 participants | 2 participants |
| Region of Enrollment Dominican Republic | 20 participants | 16 participants | 36 participants |
| Sex/Gender, Customized Female | 16 participants | 0 participants | 16 participants |
| Sex/Gender, Customized Male | 4 participants | 13 participants | 17 participants |
| Sex/Gender, Customized Not Reported or Other | 0 participants | 3 participants | 3 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 20 | 0 / 16 |
| other Total, other adverse events | 0 / 20 | 0 / 16 |
| serious Total, serious adverse events | 0 / 20 | 0 / 16 |
Outcome results
Primary
Empathy and Avoidance in Treating Patients Living With HIV/AIDS
For providers, the results are reported for empathy and avoidance in treating patients living with HIV/AIDS, 11 questions. Response options are Strongly Agree, Agree, Neutral, Disagree, and Strongly Disagree. This scale includes reverse coding. Higher scores indicate higher levels of stigma. The score can range from 11 (min) to 55 (max).
Time frame: Year 2
Population: Pre -and post- survey measures were then compared to assess the change after the FRESH workshop intervention using paired t-tests if the normality was confirmed. The significance level was identified as p\<0.05. All analyses were performed with SAS (Version 9.4, Cray, North Carolina, USA).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Providers | Empathy and Avoidance in Treating Patients Living With HIV/AIDS | Pre-Intervention | 37.10 units on a scale | Standard Deviation 4.64 |
| Providers | Empathy and Avoidance in Treating Patients Living With HIV/AIDS | Post-Intervention | 38.00 units on a scale | Standard Deviation 5.7 |
Primary
HIV Knowledge Index
Results are reported for the HIV Knowledge Index from providers only. This is not a validated scale but was being tested in the context of this study. It included 13 homegrown questions. Range was 0 (min) to 13 (max), with higher scores indicating greater knowledge.
Time frame: Year 2
Population: Pre -and post- survey measures were then compared to assess the change after the FRESH workshop intervention using paired t-tests if the normality was confirmed. The significance level was identified as p\<0.05. All analyses were performed with SAS (Version 9.4, Cray, North Carolina, USA).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Providers | HIV Knowledge Index | Pre-Intervention | 7.00 units on a scale | Standard Deviation 0.58 |
| Providers | HIV Knowledge Index | Post-Intervention | 6.63 units on a scale | Standard Deviation 0.76 |
Primary
HIV-related Stigma
For providers, the results are reported for the Opinions about People with HIV sub-scale from the HIV-related stigma among health facility staff scale, 6 questions. Response options are Strongly Agree, Agree, Disagree, and Strongly Disagree. This scale does not include reverse coding. Higher scores indicate higher levels of stigma. The score can range from 5 (min) to 20 (max). For clients, the results are reported for the Experiencing HIV-related Stigma in Healthcare Settings scale, 5 questions. Response options are Never, Rarely, Sometimes, Usually, and Always. This scale does not include reverse coding. Higher scores indicate higher levels of stigma. The score can range from 0 (min) to 20 (max).
Time frame: Year 2
Population: Pre -and post- survey measures were then compared to assess the change after the FRESH workshop intervention using paired t-tests if the normality was confirmed. The significance level was identified as p\<0.05. All analyses were performed with SAS (Version 9.4, Cray, North Carolina, USA).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Providers | HIV-related Stigma | Pre-Intervention | 8.74 units on a scale | Standard Deviation 3.12 |
| Providers | HIV-related Stigma | Post-Intervention | 7.16 units on a scale | Standard Deviation 2.4 |
| Clients | HIV-related Stigma | Pre-Intervention | 10.25 units on a scale | Standard Deviation 3.91 |
| Clients | HIV-related Stigma | Post-Intervention | 8.42 units on a scale | Standard Deviation 4.03 |
Secondary
Multiple Discrimination Scale - Orientation
For clients, the results are reported for experiences of discrimination related to sexual orientation, 10 questions. Response options are Yes and No. Higher scores indicate higher levels of stigma. The score can range from 0 (min) to 10 (max).
Time frame: Year 2
Population: Pre -and post- survey measures were then compared to assess the change after the FRESH workshop intervention using paired t-tests if the normality was confirmed. The significance level was identified as p\<0.05. All analyses were performed with SAS (Version 9.4, Cray, North Carolina, USA).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Clients | Multiple Discrimination Scale - Orientation | Pre-Intervention | 0.83 units on a scale | Standard Deviation 2.29 |
| Clients | Multiple Discrimination Scale - Orientation | Post-Intervention | 1.45 units on a scale | Standard Deviation 2.42 |