Feasibility and Effectiveness of Digital Peer-support-based Anti-HIV Stigma Intervention in Improving Clinical Outcomes Among Adolescents Living With HIV in Ethiopia
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 282
- 试验地点
- 5
- 主要终点
- HIV-related stigma: internalised and anticipated
研究概览
简要总结
Advances in HIV care and treatment turned a once deadly disease into a chronic condition where people living with HIV, including perinatally HIV acquired children, can now lead a healthy life and live longer with their highly effective antiretroviral therapy. Despite the advancements and successes in HIV care and treatment, HIV-related stigma remained a challenge to people living with HIV and for the provision of the available successful treatment and support. Stigma and discrimination related to HIV infection inhibit health-seeking behaviour, clinical outcomes, physical and psychosocial wellbeing and is a major obstacle for timely diagnosis.
Peer support programs to people living with HIV appeared to have improved self-confidence of members and consequently reduced self-stigma and improved their coping ability against external stigma. However, these services are limited in terms of geography owing to lack of adequate financing to cover operational costs for adolescents coming from rural areas and space and facility limitation to accommodate large groups.
The eHealth services have potential to provide some of the services offered in the in-person sessions of the peer support group. Despite this important potential of eHealth services, they are underutilized and are not often used to target HIV-related stigma in adolescents living with HIV. The present study will investigate whether the digital peer-support anti-HIV stigma reduces internalized and anticipated stigma among adolescents living with HIV (ALHIV) in South Ethiopia. Further, we will explore the health-related outcomes including adolescent's psychological wellbeing, retention in care and sustained viral load suppression.
详细描述
Introduction The advent of the antiretroviral therapy (ART) and its widespread use have turned HIV/AIDS, a condition once considered as a death sentence, into a chronic disease with perinatally HIV infected children are now living longer and transition into adulthood. Despite this clinical success story, psychological wellbeing of adolescents is overlooked, mainly due to HIV-related stigma, as interventions to reduce stigma did not often target children.
Stigma and discrimination related to HIV infection inhibit health-seeking behavior, clinical outcomes, physical and psychosocial wellbeing and is a major obstacle for timely diagnosis and linkage to care, including adherence to antiretroviral therapy. As a counter to negative experiences, peer-support group by people living with HIV improved self-confidence of members and consequently reduced self-stigma and improved their coping ability against external stigma.
The eHealth, which comprise a range of information and communication resources and tools including text messaging, videos and social media, is uniquely positioned to share interactive health information pseudonymously. However, there is a lack of digital peer-support group interventions for adolescents with a focus on HIV stigma reduction. While different eHealth services provide social support and have the potential to target interventions delivered in the traditional methods, only a few have used it, mostly for ART adherence interventions.
A recent review of stigma reduction interventions in people living with HIV reported a lack of well-designed intervention studies investigating stigma reduction to wither the challenge of HIV-related stigma in HIV care and support. Thus, there is a need for anti-stigma interventions and the effect on health-related outcomes among adolescents living with HIV.
The in-person in-clinic psychosocial peer-support is widely implemented, but this important program had shortfalls with operational logistics. The program, for example, has been severely interrupted during the high picks of covid-19 restrictions, there were also issues of accessibility and the need to travel long distance, unintended disclosure, and funding availability to run programs.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 14 Years 至 22 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adolescents who have been disclosed of their HIV status
- •adolescents and young people between the age of 15 and 22 years old
- •receiving antiretroviral medications; and
- •completed at least first cycle primary school education (i.e. grade 4).
排除标准
- •Participants with known diagnosed mental health condition
- •Participants with hearing loss or loss of vision
研究组 & 干预措施
Digital peer support
In the digital peer support arm, adolescents and youth living with HIV will be networked digitally to share their experiences and receive a structured educational message designed based on literature review and also referring the national psychosocial support guidelines. Adolescents and youth who don't have smartphones will be offered with one to enable them connect digitally. Brief orientation about the Telegram messaging app will be provided to all participants in the intervention arm to close any digital divide. Two modules (individual life skills module and the social mastery skills module) in 12 sessions (module 1: introduction, goal-setting, decision-making, myths and misconceptions about HIV, self-acceptance, self-care, resilience; module 2: coping skills, communication skills, onward disclosure of HIV status, understanding stigma language, and building relationship) will be offered over 16 weeks.
干预措施: Peer support based digital anti-HIV stigma intervention (Behavioral)
Digital peer support
In the digital peer support arm, adolescents and youth living with HIV will be networked digitally to share their experiences and receive a structured educational message designed based on literature review and also referring the national psychosocial support guidelines. Adolescents and youth who don't have smartphones will be offered with one to enable them connect digitally. Brief orientation about the Telegram messaging app will be provided to all participants in the intervention arm to close any digital divide. Two modules (individual life skills module and the social mastery skills module) in 12 sessions (module 1: introduction, goal-setting, decision-making, myths and misconceptions about HIV, self-acceptance, self-care, resilience; module 2: coping skills, communication skills, onward disclosure of HIV status, understanding stigma language, and building relationship) will be offered over 16 weeks.
干预措施: A standard in-clinic in-person psychosocial support (Behavioral)
In-person peer support
In the in-clinic in-person peer support, adolescents and youth living with HIV meet in-person fortnightly and share experiences and receive peer led lessons based on the national psychosocial support module. They also had time to spend together playing and eating lunch. Furthermore, they receive a small amount of fee to cover transport.
干预措施: A standard in-clinic in-person psychosocial support (Behavioral)
结局指标
主要结局
HIV-related stigma: internalised and anticipated
时间窗: From enrollment at baseline to the end of intervention at 16 weeks.
The Brief HIV Stigma Scale-12, translated into Amharic and validated for use in the Ethiopian context, will be employed to assess HIV-related stigma among adolescents living with HIV. The tool comprises 12 items measuring four constructs, each represented by three items. Responses are rated on a four-point Likert scale ranging from 1 ("strongly disagree") to 4 ("strongly agree"). Total scores range from 12 to 48, with higher scores indicating greater levels of stigma (i.e., worse outcomes).
次要结局
- Psychological well-being(From enrollment at baseline to the end of intervention at 16 weeks.)
- Retention in care(From enrollment at baseline to the end of intervention at 16 weeks.)