HIV Infections, Stigma, Social
Conditions
Keywords
Stigma, HIV, Training, Iran, Student, Nursing
Brief summary
In this study, the investigators will assess the feasibility, acceptability, and preliminary efficacy of online HIV stigma training in reducing stigmatizing attitudes and behaviors of nursing students in simulated clinical visits of patients living with HIV compared to an online HIV epidemiology training with no specific content on stigma.
Detailed description
Iran has the highest burden of HIV in the Middle East. However, only 42% of Iranians living with HIV are diagnosed and 28% on antiretroviral therapy. The largest gap in the continuum of HIV care is diagnosis. Due to sociocultural and religious beliefs, HIV- associated stigma and drug use stigma are exceedingly high, and sex outside of marriage, or sex of man with another man are considered to be "sinful" behaviors. These intersectional stigmas (stigma towards drug use, sexism, and homophobia) in addition to HIV stigma are major barriers for many people at risk for or living with HIV to engage in HIV testing or treatment. Our prior studies found that health providers have limited clinical encounters with people living with HIV (PLWH) and have no HIV stigma training. This lack of training can lead to stigmatizing attitudes and behaviors towards people at risk for HIV or PLWH. The highest HIV stigmatizing behaviors was reported in nurses and physician assistants. These data, coupled with the extreme marginalization of key populations at high risk for HIV in Iran, call for the development of new ways to train nurses to reduce HIV-related stigma in clinical settings. The investigators propose to develop, and field test an HIV stigma online training including simulated patients living with HIV for nursing school students. In a randomized controlled trial, the investigators will assess the feasibility, acceptability, and preliminary efficacy of the online HIV stigma training in reducing stigmatizing attitudes and behaviors of nursing students in simulated clinical visits of patients living with HIV compared to an online HIV epidemiology training with no specific content on stigma. Successful development of the HIV stigma training and simulated patients at risk for or living with HIV will set the stage for developing a larger trial of nurses and other health providers which can lead to an effective and scalable training program to reduce HIV-related stigma in clinical settings and improve engagement in HIV testing and care services. The investigators from the University of California San Francisco (UCSF), will lead and co-investigate the project, respectively. They will collaborate with teams from Kerman University of Medical Sciences (KMU), Iran, and Ponce Health Sciences University (PHSU) in the USA.
Interventions
BEHAVIORALThe online HIV-related stigma training
The intervention is an online HIV-related stigma training that takes 6 hours in 4 weeks to be completed.
BEHAVIORALThe online HIV epidemiology training with no specific content on stigma
Nursing students will be trained in an online HIV epidemiology training with no specific content on stigma. It will take 6 hours in 4 weeks to complete the training.
Sponsors
University of California, San Francisco
Ponce Health Sciences University
Kerman University of Medical Sciences
Fogarty International Center of the National Institute of Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Masking description
To avoid potential bias based on the timing of enrollment, The investigators will use "block randomization" with randomly permuted block sizes to avoid identification of the allocation of the last participant in a block. Once a nursing student completes their baseline stigma and empathy survey, participants will be assigned the next masked envelope from the randomization list by a research staff, which in turn assign the person to one of the two study arms. The research staff and participants are masked to study arm assignment prior to opening the envelopes. The person analyzing the data will be masked to study arm assignment.
Intervention model description
The investigators will develop a 4-module online HIV stigma reduction training with simulated patients for nursing students in the intervention arm. This training includes three case scenarios: a male who injects drugs, a male who has sex with men, and a female sex worker, all with HIV. Interviews with people living with HIV (PLWH) and focus groups with nursing students and faculty will refine the content. The control group will receive a course on HIV epidemiology without stigma-specific content. To assess efficacy, 70 nursing students will initially have a clinical encounter with a simulated patient on a non-HIV topic. A week later, they will have an HIV visit and complete stigma and empathy scales. Participants will then be randomized into two groups: one receiving stigma training and the other, HIV epidemiology training. Afterward, they will have another HIV-related clinical encounter and complete the scales again.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Currently nursing students in their year 3 or 4 of training * Kerman Medical University (KMU) nursing schools
Exclusion criteria
* Nursing student in their year 1 and 2 * Students of other fields and other universities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stigma score | Up to 4 weeks before and after intervention | All nursing students will complete a validated stigma scale before and after the training interventions. |
| Behavioral manifestations of HIV stigma | Up to 4 weeks before and after intervention | Before and after the training interventions, all nursing students will meet with a randomly selected simulated patient for an HIV visit. These visits will be video recorded and will be coded and scored for stigmatizing behaviors. |
| Empathy score | Up to 4 weeks before and after intervention | All nursing students will complete a validated empathy scale before and after the training interventions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The attitudes and behaviors of nursing students after the online HIV stigma training | Three months after the intervention | We will qualitatively examine study participants' real-world behaviors with HIV and at-risk patients to (1) explore if behaviors learned during the intervention carry on in real-world settings, (2) better understand how behaviors are manifested in natural settings, and (3) explore best methods to assess behaviors in real-world scenarios |
Countries
Iran
Contacts
PRINCIPAL_INVESTIGATORAli Mirzazadeh, PhD
University of California, San Francisco
Outcome results
None listed