Assessing outcomes of a stigma-reduction intervention with venue-based analysis

Abstract

Purpose: A randomized controlled trial with a matched design was conducted during October 2008 and February 2010, aiming at reducing HIV-related stigma in healthcare settings.

Methods: Forty county hospitals in Fujian and Yunnan provinces of China were matched into pairs and randomized to either an intervention condition or a control condition. Forty-four service providers were randomly selected from each hospital, yielding a sample of 1,760. Intervention outcomes were assessed at baseline, 6 and 12 months based on venue-based pair comparisons. We identified and trained 30 popular opinion leaders in each intervention hospital among service providers to disseminate stigma-reduction messages to their peer providers.

Results: Hospital and participant characteristics were comparable between the intervention and control conditions. Thirteen out of twenty pairs of hospitals showed significant reduction in the stigma outcome measure at the 6-month follow-up assessment. For most hospitals, the intervention effects were maintained at the 12-month follow-up assessment. Among the 13 pair of hospitals, which showed intervention effects at 6 months, eight were in Fujian and five were in Yunnan. The non-significant hospitals at 6 months had more beds than significant hospitals. However, the difference did not reach statistical significance.

Conclusions: A matched design and venue-based analysis provide more insight in assessing intervention effects for facility-based intervention trials. The identification of venue-based or hospital characteristics that are associated with intervention efficacy provides additional implications for the adaptation and implementation of future interventions.

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Figure 1

Flow of the participants and venues used in the study.

Figure 2

Estimated difference in stigma reduction (with 95% CI) at 6-month (left) and 12-month (right) follow-up assessments. The solid circle and the circle with plus symbol represent the estimated difference in stigma reduction for the intervention versus the control condition. The horizontal bar represents the 95% CI and the significance is indicated by one star (P < 0.05) or two stars (P < 0.0001).