Smith M Kumi, Luo Danyang, Meng Siyan, Fei Yunqing, Zhang Wei, Tucker Joseph, Wei Chongyi, Tang Weiming, Yang Ligang, Joyner Benny L, Huang Shujie, Wang Cheng, Yang Bin, Sylvia Sean Y
Division of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis, MN.
Zhitong Guangzhou LGBT Center, Guangzhou, China.
J Acquir Immune Defic Syndr. 2025 Mar 1;98(3):224-233. doi: 10.1097/QAI.0000000000003565. Epub 2025 Feb 5.
Consistent evidence shows stigma impedes healthcare access in people living with HIV (PLWH) and men who have sex with men (MSM). We evaluated the impact of stigma reduction training for providers whose design was informed by direct observation of their clinical behaviors obtained through visits by incognito standardized patients (SPs).
We conducted this study in sexually transmitted disease clinics in Guangzhou, China.
This pilot cluster randomized control trial assessed the feasibility, acceptability, and preliminary efficacy of an intervention whose design was informed by a baseline round of incognito visits in which SPs presented standardized cases to consenting doctors. By randomly varying the HIV status and sexual orientation of each case, we could quantify stigma as differences in care quality across scenarios. We then conducted a follow-up round of SP visits and assessed the impact using linear fixed effects regression.
Feasibility and acceptability among the 55 provider participants were high, with no adverse visit events. The provider training improved the offering of testing to HIV-negative MSM (0.05 percentage points, 95% confidence interval, -0.24 to 0.33) and diagnostic effort for HIV-positive MSM (0.23 SD improvement, 95% CI: -0.92 to 1.37). Patient-centered care only improved for HIV-positive straight cases (SD, 0.57; 95% CI: -0.39 to 1.53). All estimates lacked statistical precision, an expected outcome of a pilot randomized control trial.
Our training reduced stigma in several domains of care, but least of all for PLWH, suggesting that future trainings should include more clinical content to strengthen clinical skills in PLWH management.
一致的证据表明，耻辱感阻碍了艾滋病毒感染者（PLWH）和男男性行为者（MSM）获得医疗保健。我们评估了针对提供者的减少耻辱感培训的影响，该培训的设计基于通过匿名标准化患者（SP）就诊直接观察其临床行为而获得的信息。
我们在中国广州的性传播疾病诊所进行了这项研究。
这项试点整群随机对照试验评估了一种干预措施的可行性、可接受性和初步疗效，该干预措施的设计基于第一轮匿名就诊，在就诊中，SP向同意参与的医生呈现标准化病例。通过随机改变每个病例的艾滋病毒感染状况和性取向，我们可以将耻辱感量化为不同情景下护理质量的差异。然后，我们进行了第二轮SP就诊，并使用线性固定效应回归评估其影响。
55名提供者参与者的可行性和可接受性很高，没有不良就诊事件。提供者培训改善了对艾滋病毒阴性MSM的检测提供（0.05个百分点，95%置信区间，-0.24至0.33）以及对艾滋病毒阳性MSM的诊断努力（标准差提高0.23，95%置信区间：-0.92至1.37）。以患者为中心的护理仅在艾滋病毒阳性异性恋病例中有所改善（标准差，0.57；95%置信区间：-0.39至1.53）。所有估计值都缺乏统计精度，这是试点随机对照试验的预期结果。
我们的培训减少了护理几个领域的耻辱感，但对艾滋病毒感染者的效果最差，这表明未来的培训应包括更多临床内容，以加强艾滋病毒感染者管理方面的临床技能。
