Reducing HIV Stigma for African American Women
2017年5月3日 更新者：Deepa Rao、University of Washington
Reducing HIV Stigma to Improve Health Outcomes for African-American Women
African American women account for 66% of HIV infections in women in the U.S., AIDS is a leading cause of death for African American women, and African Americans have the lowest medication adherence rates compared to other groups in the U.S. One of the reasons for low medication adherence among African Americans is fear of stigma. HIV stigma has been linked to depression, psychological distress, poor quality of life, poor medication adherence and service utilization contributing to morbidity and mortality. Research has found that stigma is a moderator to poor adherence via depressive symptoms.
The current study is a randomized control trial with a time and attention control group to test the effectiveness of a stigma reduction intervention adapted for use with African American women. A total of 224 African American women will be recruited to participate in the study. Half of the women will be from Chicago, Illinois (112) and the other half will be from Birmingham, Alabama (112). A workshop will be held once a study site has recruited 28 women, half of the women will be in the intervention group (14) and the other half will be in the control group (14). Each study site will have 4 cohorts of 28 women.
The main aims of the current study are:
- to determine the long-term effectiveness of the intervention to reduce stigma for African American women living with HIV in Chicago Illinois and Birmingham, Alabama
- to examine whether stigma reduction due to the intervention is associated with improved physical health biomarkers (CD4+ T cell count, viral load), mediated by reduced psychological symptoms (depressive symptoms), improved engagement to care, and improved medication adherence
- to explore whether stigma reduction due to the intervention is moderated by location (Chicago vs. Birmingham), transmission risk factor, time since diagnosis, and perceived social support
We expect that the multimedia workshop intervention will demonstrate effectiveness in reducing internalized stigma through an easily-disseminated method, and that it will have a positive impact on medication adherence and engagement in care for African American women living with HIV.
調査の概要
研究の種類
介入
入学 (実際)
240
段階
- 適用できない
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
-
-
Alabama
-
Birmingham、Alabama、アメリカ、35233
- University of Alabama Birmingham
-
-
Illinois
-
Chicago、Illinois、アメリカ、60611
- Northwestern University (NU)
-
-
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年歳以上 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
女性
説明
Inclusion Criteria:
- they are women who identify as having an African American racial/ethnic background
- born in the U.S. (including women of Caribbean origin if born in the U.S.
- speak and understand English as their primary language of communication outside the home
- they are 18 years of age or older
- have a documented HIV positive status (women are on antiretroviral treatment and women who are not on antiretroviral are eligible)
- able to see and interact with a touchscreen computer in English.
Exclusion Criteria:
- women who not self-identify as African American
- women who are African born or born outside the United States
- younger than 18 years of age
- unable to provide informed consent
- life expectancy less than 1 year per physician report
- unable to see and interact with a touchscreen computer in English.
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：支持療法
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的：Unity Workshop
The intervention is a workshop facilitated by a peer advocate (an African American woman who is also HIV positive) and a social worker.
It has exercises, videos and group discussions intended to equip participants with coping skills to overcome HIV related stigma and the negative outcomes related to stigma.
The workshop will last about 8 hours total across 2 two days (4 hours per day).
The researcher in the current study has done a lot of work in adapting this intervention for African American women.
The workshop has been piloted in Seattle and had promising results.
Based on results in the pilot study, a 2 hour booster session has been added 6 months after the initial workshop
|
The intervention is based on other stigma reduction programs that are being used internationally (HIV Stigma Toolkit developed by the International Center for Research on Women and trigger videos developed by International Training & Education Center for health).
|
|
他の：Breast Cancer Screening
The time and attention control group workshop will be facilitated by a research coordinator.
The control group program is based on another program that is designed explore issues related to breast cancer screening among African American women.
The program has the same format as the Unity Workshop, with video and group discussion.
Although breast cancer may be associated with stigma, we anticipated that breast cancer stigmas would not be related to HIV-associated stigma, which is our primary outcome of interest.
The control groups will be held during the same week as the Unity Workshops, and control group participants will complete assessments on the same schedule as the Unity Workshop participants.
|
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Change in stigma scores from baseline to 12 months.
時間枠：baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
|
We will see if the intervention/workshop reduces HIV related stigma after 1 year in the study.
We will use the Stigma Scale for Chronic Illness to measure stigma.
|
baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Location as a moderator variable
時間枠：baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
|
This is a multi-site study (Chicago and Birmingham) and we are interested in seeing if location is a moderating variable
|
baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
|
|
Post-Traumatic Stress Disorder Checklist
時間枠：baseline, 12 months
|
baseline, 12 months
|
|
|
Adherence to HIV Medication
時間枠：baseline, after intervention, 4 months, 6 months, 8 months, 12 months
|
Adherence to HIV medication will be measured by participants self report of adherence using commonly used set of questions.
|
baseline, after intervention, 4 months, 6 months, 8 months, 12 months
|
|
Patient Health Questionnaire (PHQ-9)
時間枠：baseline, after intervention, 4 months, 6 months, 8 months, 12 months
|
We will look at the correlation between stigma scores and depression scores over time.
|
baseline, after intervention, 4 months, 6 months, 8 months, 12 months
|
|
Medical Outcomes Study Social Support Scale
時間枠：Study duration
|
We are going to use a validated social support scale, and analyze social support as a correlate.
|
Study duration
|
|
substance abuse
時間枠：baseline, 12 months
|
substance use and stigma of substance use will be measured using: Alcohol Use disorders Identification Test (AUDIT) Severity of Dependence Scale (SDS) Substance Abuse Self Stigma (SASS)
|
baseline, 12 months
|
|
Engagement in Care (from patient record)
時間枠：baseline, 4 months, 8 months, 12 months
|
Research assistants will access participants' medical records to see if patients have missed any HIV related visits (i.e.
medical, counseling).
Engagement to care will be measured as a proportion (missed visits over total scheduled).
Rescheduled visits will not count as missed visits.
At baseline, we will look at visits for the past 12 months.
|
baseline, 4 months, 8 months, 12 months
|
|
HIV viral load (from medical chart) over 1 year study duration
時間枠：baseline, 4 months, 8 months, 12 months
|
We want to examine whether stigma reduction due to the intervention is associated with improved physical health bio-markers such as suppression in HIV viral load in the blood (taken from medical chart/previous clinical blood tests).
|
baseline, 4 months, 8 months, 12 months
|
|
Change in CD4 count
時間枠：baseline, 4 months, 8 months, 12 months
|
We want to see wither stigma reduction from the intervention associated with improved physical health bio-markers such as CD4+ T cell count.
|
baseline, 4 months, 8 months, 12 months
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
スポンサー
協力者
捜査官
- 主任研究者：Deepa Rao, PhD, MA、University of Washington
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007 Jan;19(1):28-33. doi: 10.1080/09540120600652303.
- Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDS. 2006 May;20(5):359-68. doi: 10.1089/apc.2006.20.359.
- CDC. HIV/AIDS Surveillance Report: Cases of HIV infection and AIDS in the United States. 2004.
- CDC. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Leading Cause of Death for Black Women 1999-2007. 2008; www.cdc.gov/ncipc/wisqars. Accessed December 4, 2011.
- Halkitis PN, Parsons JT, Wolitski RJ, Remien RH. Characteristics of HIV antiretroviral treatments, access and adherence in an ethnically diverse sample of men who have sex with men. AIDS Care. 2003 Feb;15(1):89-102. doi: 10.1080/095401221000039798.
- Palacio H, Kahn JG, Richards TA, Morin SF. Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature. Public Health Rep. 2002 May-Jun;117(3):233-51; discussion 231-2. doi: 10.1093/phr/117.3.233.
- Traeger L, O'Cleirigh C, Skeer MR, Mayer KH, Safren SA. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2012 Oct;35(5):548-56. doi: 10.1007/s10865-011-9383-z. Epub 2011 Nov 9.
- Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, Crane HM. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012 Apr;16(3):711-6. doi: 10.1007/s10461-011-9915-0.
- Rao D, Desmond M, Andrasik M, Rasberry T, Lambert N, Cohn SE, Simoni J. Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. AIDS Patient Care STDS. 2012 Oct;26(10):614-20. doi: 10.1089/apc.2012.0106. Epub 2012 Sep 17.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2013年6月1日
一次修了 (実際)
2016年11月1日
研究の完了 (実際)
2017年2月1日
試験登録日
最初に提出
2013年2月11日
QC基準を満たした最初の提出物
2013年7月1日
最初の投稿 (見積もり)
2013年7月8日
学習記録の更新
投稿された最後の更新 (実際)
2017年5月8日
QC基準を満たした最後の更新が送信されました
2017年5月3日
最終確認日
2017年5月1日
詳しくは
本研究に関する用語
その他の研究ID番号
- 43970
- R01MH098675 (米国 NIH グラント/契約)
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。