School of Nursing, Yale University, New Haven, CT, United States of America.
Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, United States of America.
PLoS One. 2021 Nov 29;16(11):e0259324. doi: 10.1371/journal.pone.0259324. eCollection 2021.
BACKGROUND: Men with have sex with men (MSM) in Africa face high levels of stigma due to elevated HIV exposure (actual or perceived), same-sex practices, and gender non-conformity. These stigmas are documented barriers to HIV prevention and treatment. Most stigma-reduction interventions have focused on single-level targets (e.g., health care facility level [HCF]) and addressed one type of stigma (e.g., HIV), without engaging the multiple intersecting stigmas that MSM encounter. Determining the feasibility and acceptability of multi-level intervention of reducing intersectional stigma and estimating its efficacy on increasing HIV testing are needed. METHODS: We proposed a mixed method study among MSM in Ghana. First, we will develop the intervention protocol using the Convergence Framework, which combines three interventions that were previously implemented separately in Ghana for reducing stigma at the HCF-level, increasing HIV testing at the peer group-level, and increasing peer social support at the individual-level. Then, we will conduct a cluster randomized controlled trial with four pairs of HCFs matched on staff size. HCFs within each pair are randomized to the HCF-level stigma-reduction intervention or control arm. MSM (n = 216) will be randomized to receive the group-level and individual-level interventions or standard of care control arm. MSM will be assigned to receive HIV testing at one of the HCFs that match their study assignment (intervention or control facility). The frequency of HIV testing between MSM in the study arms at 3 and 6 months will be compared, and the predictors of HIV testing uptake at the HCF, peer group and individual-levels will be assessed using multi-level regression models. DISCUSSION: These findings from this study will provide important evidence to inform a hybrid implementation-effectiveness trial of a public health intervention strategy for increasing HIV case detection among key populations in sub-Saharan African communities. Accurate information on HIV prevalence can facilitate epidemic control through more precise deployment of public health measures aimed at HIV treatment and viral load suppression, which eliminates risk of transmission. TRIAL REGISTRATION: This study was prospectively registered on ClinicalTrials.gov, Identifier: NCT04108078, on September 27, 2019.
背景:非洲的男男性行为者(MSM)由于艾滋病病毒暴露(实际或感知)、同性性行为和性别不一致,面临着高水平的耻辱感。这些耻辱感是艾滋病预防和治疗的障碍。大多数减少耻辱感的干预措施都集中在单一层次的目标(例如,医疗保健机构层面[HCF])上,并解决了一种耻辱感(例如,艾滋病毒),而没有涉及 MSM 所面临的多种交叉耻辱感。需要确定减少交叉耻辱感的多层次干预措施的可行性和可接受性,并评估其增加艾滋病毒检测的效果。
方法:我们在加纳的 MSM 中提出了一项混合方法研究。首先,我们将使用融合框架制定干预方案,该框架结合了在加纳以前分别实施的三项干预措施,以减少 HCF 层面的耻辱感、增加同伴群体层面的艾滋病毒检测率和增加个人层面的同伴社会支持。然后,我们将在四对匹配工作人员规模的 HCF 中进行一项集群随机对照试验。每对 HCF 内部随机分配到 HCF 层面的耻辱感减少干预或对照组。MSM(n=216)将随机接受群体层面和个人层面的干预或标准护理对照组。MSM 将被分配到与他们的研究分配(干预或对照设施)相匹配的 HCF 之一进行艾滋病毒检测。将比较研究臂中的 MSM 在 3 个月和 6 个月时的艾滋病毒检测频率,并使用多水平回归模型评估 HCF、同伴群体和个人层面上艾滋病毒检测的预测因素。
讨论:这项研究的结果将为一项公共卫生干预策略的混合实施效果试验提供重要证据,该策略旨在增加撒哈拉以南非洲社区关键人群的艾滋病毒病例发现。关于艾滋病毒流行率的准确信息可以通过更精确地部署旨在治疗和抑制艾滋病毒载量的公共卫生措施来促进疫情控制,从而消除传播风险。
试验注册:这项研究于 2019 年 9 月 27 日在 ClinicalTrials.gov 上进行了前瞻性注册,标识符为 NCT04108078。
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