Department of Psychology.
Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
AIDS. 2020 Sep 1;34 Suppl 1(Suppl 1):S73-S82. doi: 10.1097/QAD.0000000000002566.
Considering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The 'integrating ENGagement and Adherence Goals upon Entry' (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles.
The iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm.
Baseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined.
The decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame.
The multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.
考虑到内化的 HIV 相关耻辱感与治疗依从性之间的关联，解决 HIV 治疗依从性问题的干预措施可能具有减少内化耻辱感的额外益处。“整合 HIV 治疗开始时的参与和目标”（iENGAGE）干预措施旨在促进新接受 HIV 护理的个体适应 HIV 生活。我们评估了该干预措施对内化耻辱感的影响，并检验了这种影响是否受到抑郁症状和应对方式的调节。
该 iENGAGE 干预措施根据个体情况进行定制，以改善信息、动机和行为技能，促进治疗依从性和病毒抑制。371 名在美国四个地点开始接受 HIV 护理的参与者被随机分配到接受四个面对面疗程的干预组或标准护理对照组。
进行基线和 48 周随访评估，包括经过验证的内化 HIV 相关耻辱感、抑郁症状和应对机制（行为脱离和自责）的测量，作为次要结果。重复测量方差分析评估了干预对内化 HIV 耻辱感变化的影响。此外，还检验了抑郁症状和应对机制对内化耻辱感降低的调节作用。
与对照组相比，干预组从基线到 48 周时内化耻辱感的下降幅度显著更大。这种效果显著受到基线抑郁症状和自责水平的调节。
多方面的 iENGAGE 干预措施对于新接受 HIV 护理的个体有效减少内化耻辱感，特别是对于抑郁症状较高或使用更高水平自责应对的个体。
