Addressing Drug Use Stigma in Human Immunodeficiency Virus (HIV) Care and Treatment Clinics in Tanzania

Summary

The goal of this study is to adapt and pilot an effective health facility HIV stigma-reduction intervention to address drug use stigma in human immunodeficiency Virus (HIV) Care and Treatment clinics (CTCs) in Tanzania, a barrier to HIV care for People Living with HIV (PLWH) who use drugs. In Tanzania, there are an estimated 300,000 People Who use Drugs (PWUD), primarily heroin. HIV prevalence among PWUD who do not inject (18-25%) and those who do inject (35%) is 4-7 times higher than in the general population (5%). PWUD face high levels of stigma, including when they try to seek HIV treatment at HIV CTCs, presenting a barrier to linkage and retention in HIV treatment for this highly HIV vulnerable group. Reducing drug use stigma in HIV CTCs is critical to improving access to and retention in HIV treatment services for PWUD. In response to this need, the investigators will: 1) Adapt a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV CTCs (Aim 1). 2) Pilot test the adapted drug use stigma-reduction intervention for acceptability, appropriateness, and feasibility (Aim 2).

The investigators will achieve Aim 1 through a systematic, multi-stage adaptation process that will include a formative phase of in-depth interviews with PLWH who use drugs and CTC staff to inform initial adaptation of the Health Policy Plus (HP+) intervention. Stakeholders, including PLWH who use drugs and CTC staff, will provide feedback on the initial materials through a participatory workshop, leading to a training manual that will be reviewed by topic experts and then finalized. Experienced Tanzanian HIV stigma-reduction trainers will deliver the intervention to CTC staff. The pilot test will include 150 staff (the study participants) based in seven CTCs in Dar-es-Salaam. A mixed methods evaluation will comprise pre-post surveys, observation of trainings, and post-training focus group discussions with staff (study participants) who complete the intervention and trainers. Changes in CTC staff (study participants) mean scores on stigma scales from pre- to post-intervention will be assessed, along with measures of intervention acceptability, appropriateness, and feasibility (measured at end line only). Post-intervention focus group discussions will explore themes around the experience of participating in the drug use stigma-reduction training.

Conditions

• Drug Use Stigma in HIV Treatment Clinics

Interventions

BEHAVIORAL

Drug-use stigma reduction intervention for HIV care and treatment clinic staff

We will adapt the HP+ health facility HIV stigma-reduction intervention to focus on drug stigma in HIV CTCs. The intervention will address key stigma drivers, including fear, awareness of stigma, and stigmatizing attitudes and beliefs, through a participatory training approach that involves all levels of staff and is grounded in social cognitive theory principles. The approach seeks to reduce stigma through fostering empathy, interpersonal interactions (contact strategies) and building efficacy for stigma reduction through awareness, skills, and knowledge building. The intervention consists of five-2.5 hour participatory training sessions.

Sponsors & Collaborators

• Muhimbili University of Health and Allied Sciences

  collaborator OTHER

• Fogarty International Center of the National Institute of Health

  collaborator NIH

• RTI International

  lead OTHER

Principal Investigators

• Laura C Nyblade, PhD · RTI International

Study Design

Allocation

NA

Purpose

OTHER

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2021-02-17

Primary Completion

2022-07-01

Completion

2022-07-01

Countries

• Tanzania

Study Locations