Reducing HIV Stigma for African American Women
2017년 5월 3일 업데이트: 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.
연구 개요
연구 유형
중재적
등록 (실제)
240
단계
- 해당 없음
연락처 및 위치
이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.
연구 장소
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Alabama
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Birmingham, Alabama, 미국, 35233
- University of Alabama Birmingham
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Illinois
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Chicago, Illinois, 미국, 60611
- Northwestern University (NU)
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참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
18년 이상 (성인, 고령자)
건강한 자원 봉사자를 받아들입니다
아니
연구 대상 성별
여성
설명
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.
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 지지 요법
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: 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
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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).
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다른: 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.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Change in stigma scores from baseline to 12 months.
기간: baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
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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.
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baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Location as a moderator variable
기간: baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
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This is a multi-site study (Chicago and Birmingham) and we are interested in seeing if location is a moderating variable
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baseline, after intervervention, 4 months, 6 months, 8 months, 12 months
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Post-Traumatic Stress Disorder Checklist
기간: baseline, 12 months
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baseline, 12 months
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Adherence to HIV Medication
기간: baseline, after intervention, 4 months, 6 months, 8 months, 12 months
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Adherence to HIV medication will be measured by participants self report of adherence using commonly used set of questions.
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baseline, after intervention, 4 months, 6 months, 8 months, 12 months
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Patient Health Questionnaire (PHQ-9)
기간: baseline, after intervention, 4 months, 6 months, 8 months, 12 months
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We will look at the correlation between stigma scores and depression scores over time.
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baseline, after intervention, 4 months, 6 months, 8 months, 12 months
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Medical Outcomes Study Social Support Scale
기간: Study duration
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We are going to use a validated social support scale, and analyze social support as a correlate.
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Study duration
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substance abuse
기간: baseline, 12 months
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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)
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baseline, 12 months
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Engagement in Care (from patient record)
기간: baseline, 4 months, 8 months, 12 months
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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.
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baseline, 4 months, 8 months, 12 months
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HIV viral load (from medical chart) over 1 year study duration
기간: baseline, 4 months, 8 months, 12 months
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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).
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baseline, 4 months, 8 months, 12 months
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Change in CD4 count
기간: baseline, 4 months, 8 months, 12 months
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We want to see wither stigma reduction from the intervention associated with improved physical health bio-markers such as CD4+ T cell count.
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baseline, 4 months, 8 months, 12 months
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공동 작업자 및 조사자
여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.
협력자
수사관
- 수석 연구원: Deepa Rao, PhD, MA, University of Washington
간행물 및 유용한 링크
연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.
일반 간행물
- 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.
연구 기록 날짜
이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.
연구 주요 날짜
연구 시작
2013년 6월 1일
기본 완료 (실제)
2016년 11월 1일
연구 완료 (실제)
2017년 2월 1일
연구 등록 날짜
최초 제출
2013년 2월 11일
QC 기준을 충족하는 최초 제출
2013년 7월 1일
처음 게시됨 (추정)
2013년 7월 8일
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
2017년 5월 8일
QC 기준을 충족하는 마지막 업데이트 제출
2017년 5월 3일
마지막으로 확인됨
2017년 5월 1일
추가 정보
이 연구와 관련된 용어
기타 연구 ID 번호
- 43970
- R01MH098675 (미국 NIH 보조금/계약)
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