HIV-Related Stigma Intervention for Malaysian Clinicians

Implementing Stigma Reduction Tools Via a Popular Teletraining Platform to Reduce Clinician Stigma and Disparities in HIV Testing, Prevention, and Linkage to Care in Malaysia

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT05597787

Enrollment

Registered

2022-10-28

Start date

2022-07-26

Completion date

2023-05-11

Last updated

2024-12-11

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hiv

Brief summary

Key populations at risk of HIV (including men who have sex with men, people who inject drugs, transgender women, and female sex workers) are more likely to be infected with HIV but less likely than members of the general population to know of their HIV status, receive HIV prevention counseling, or be linked to HIV care services. Clinician stigma towards these groups remains a potent and persistent driver of these HIV disparities in many places of the world. The investigators propose to incorporate evidence-based stigma reduction tools into a popular teletraining platform for clinicians and pilot test the resulting intervention (Project ECHO® for HIV Prevention and Stigma Reduction) with clinicians in Malaysia, a context wherein clinician stigma and HIV disparities are substantial.

Interventions

BEHAVIORALHIV Connect

online education and clinical skills

BEHAVIORALProject ECHO for HIV Prevention

education and clinical skills

BEHAVIORALProject ECHO for HIV Prevention and Stigma Reduction

education, clinical skills and contact

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

SCREENING

Masking

DOUBLE (Subject, Caregiver)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* practicing general practitioner or family medicine specialist in Malaysia

Exclusion criteria

Design outcomes

Primary

Measure	Time frame	Description
Feasibility of Intervention	Month 9 Assessment	Measured with Feasibility of Intervention Measure. Theoretical or possible range of scores is 1-5, and actual range was 3.25-5. Higher scores indicate greater feasibility.
Stigma Reduction: Stereotypes	Month 9 Assessment	Measured with subscale of Multidimensional HIV-Related Stigma Scale. Theoretical or possible range of scores is 1-5, and actual range was 1-3.44. Higher scores indicate greater stereotypes.
Stigma Reduction: Discrimination	Month 9 Assessment	Measured with subscale of Multidimensional HIV-Related Stigma Scale. Theoretical or possible range of scores is 1-5, and actual range was 1-5. Higher scores indicate greater discrimination.
Acceptability of Intervention	Month 9 Assessment	Measured with Acceptability of Intervention Measure. Theoretical or possible range of scores is 1-5, and actual range was 3.50-5. Higher scores indicate greater acceptability.
Stigma Reduction: Prejudice	Month 9 Assessment	Measured with Feelings Thermometers. Positive/Negative affect is measured on 0-100 point scale, with higher scores indicating more prejudice.

Secondary

Measure	Time frame	Description
HIV Prevention Procedures: PrEP Prescriptions	Cumulative over 9 month intervention	Measured with weekly diary of PrEP prescriptions. Number of PrEP prescriptions will be summed over duration of intervention.
HIV Prevention Procedures: HIV Testing	Cumulative over 9 month intervention	Measured with weekly diary of HIV tests performed. Number of HIV tests will be summed over duration of intervention.

Countries

Malaysia

Participant flow

Recruitment details

Advertisements were posted to Malaysian medical groups (i.e., Family Medicine Association, Malaysian Medicine Association, Malaysian Primary Care Network, Doctors Only Bulletin Board System) between May and July 2022.

Pre-assignment details

n=411 individuals accessed the registration link. Of these, n=257 were excluded because they declined to participate in the study, were withdrawn because they provided incomplete registration data or their identity could not be verified, or were waitlisted. Of the remaining individuals, n=26 were allocated to an intervention condition. Individuals who did not receive an intervention withdrew, became non-responsive to communication from the project coordinator, or were waitlisted.

Participants by arm

Arm	Count
HIV Connect Participants randomized to this condition will complete HIV Connect, which is an online course developed by the Malaysian Society of HIV Medicine designed to educate primary care physicians in Malaysia about HIV. It consists of a series of modules featuring HIV infectious disease experts who instruct on topics including epidemiology and natural history of HIV, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), sexual history taking and STI testing, and others. HIV Connect: online education and clinical skills	26
Project ECHO for HIV Prevention Participants randomized to this condition will receive Project ECHO for HIV Prevention, without added evidence-based stigma reduction tools. Participants will meet with the Project ECHO Hub specialists and their learning community on a bi-weekly basis for 60 minutes over the course of 9 months. Each session will feature a didactic training incorporating standardized procedures for HIV testing, prevention, and/or linkage to care, and patient-case presentation and discussion. Project ECHO for HIV Prevention: education and clinical skills	26
Project ECHO for HIV Prevention + Stigma Reduction Participants randomized to this condition will receive the Project ECHO for HIV Prevention intervention with added evidence-based stigma reduction tools. Participants will meet with the Project ECHO Hub specialists and their learning community on a bi-weekly basis for 60 minutes over the course of 9 months. Each session will feature a didactic training incorporating standardized procedures for HIV testing, prevention, and/or linkage to care, and patient-case presentation and discussion. Project ECHO for HIV Prevention and Stigma Reduction: education, clinical skills and contact	26
Total	78

Withdrawals & dropouts

Period	Reason	FG000	FG001	FG002
Overall Study	Withdrawal by Subject	0	0	1

Baseline characteristics

Characteristic	HIV Connect	Project ECHO for HIV Prevention	Project ECHO for HIV Prevention + Stigma Reduction	Total
Age, Continuous	37.42 years STANDARD_DEVIATION 6.37	36.50 years STANDARD_DEVIATION 4.05	38.23 years STANDARD_DEVIATION 7.28	37.38 years STANDARD_DEVIATION 6.02
Race/Ethnicity, Customized Chinese	16 Participants	6 Participants	13 Participants	35 Participants
Race/Ethnicity, Customized Indian	5 Participants	6 Participants	13 Participants	24 Participants
Race/Ethnicity, Customized Malay	4 Participants	14 Participants	10 Participants	28 Participants
Race/Ethnicity, Customized Other	1 Participants	0 Participants	0 Participants	1 Participants
Region of Enrollment Malaysia	26 participants	26 participants	26 participants	78 participants
Sex: Female, Male Female	13 Participants	9 Participants	10 Participants	32 Participants
Sex: Female, Male Male	13 Participants	17 Participants	16 Participants	46 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk
deaths Total, all-cause mortality	0 / 26	0 / 26	0 / 26
other Total, other adverse events	0 / 26	0 / 26	0 / 26
serious Total, serious adverse events	0 / 26	0 / 26	0 / 26

Outcome results

Primary

Acceptability of Intervention

Measured with Acceptability of Intervention Measure. Theoretical or possible range of scores is 1-5, and actual range was 3.50-5. Higher scores indicate greater acceptability.