[R01] Developing and testing a digital health tool for INterseCtional stigma assessment and reduction at multiple Levels and mUltiple DimEnsions (INCLUDE) to improve HIV care in ART centers in Nepal
Ente: John E. Fogarty International Center for Advanced Study in the Health Sciences
Scadenza: 2027-07-31
Importo max: 114.326 EUR
Paese: US
Descrizione
Project Abstract
People living with HIV (PLWH) have poor clinical outcomes when they are excluded from care due to
intersectional stigma related to HIV, mental health (MH), and other dimensions. In the United States,
intersectional stigma is a documented driver of disparities in HIV care engagement and viral suppression.
Recent studies highlight three major challenges in identifying and addressing intersectional stigma: a lack of
multi-dimensional stigma assessment strategies that can be incorporated into routine clinical care, a lack of
tailored stigma-reduction activities, and a lack of implementation of multi-level interventions. These gaps make
it difficult to recognize and address intersectional stigma, leading to poor HIV care outcomes globally, including
the United States. Digital health tools, co-designed with PLWH and healthcare workers (HCWs), have the
potential to assist in addressing these challenges. Guided by the principles of human-centered design, which
our team utilized in a recent R34 study on HIV care adherence, we now propose to develop and pilot test a
digital tool with three components: 1) a dynamic assessment strategy that can be used during a clinic visit to
collect PLWH-reported quantitative and qualitative data on stigma; 2) a dashboard integrating stigma
assessment data alongside routine clinical data so HCWs can directly link stigma with care engagement and
identify relevant stigma-reduction activities; and 3) a repository of evidence-based, culturally appropriate
activities that can reduce stigma at the intrapersonal-, interpersonal-, and clinic-levels. The three components
are theoretically grounded and based on prior studies.
The study’s Aim 1 is: To iteratively develop the digital health tool, INterseCtional stigma assessment and
reduction at multiple Levels and mUltiple DimEnsions (INCLUDE), for routine use in healthcare settings,
through a co-design process involving PLWH, HCWs and researchers, followed by pre-piloting at a single
clinic. Aim 2 is: To assess the acceptability and feasibility of INCLUDE among clients, HCWs, and center leads
of four healthcare centers in Nepal. The work will be conducted in Nepal because doing so in the US will result
in immense challenges beyond the grant’s resources: Nepal offers (1) a higher prevalence of intersectional
stigma burden (~32%, compared to <20% in the US); (2) centralized, government-managed HIV care with
cases concentrated in close proximity, compared to the diffuse cases managed by numerous payors and
delivery systems in the US; and (3) the team’s prior work in Nepal in HIV care providing rapid and trusted
access to clients with multiple dimensions of stigma. which often also results in less likelihood of enrollment in
clinical trials. Findings will directly inform a planned cluster randomized trial in the US, Nepal, and other regions
facing similar challenges. By producing a transportable, evidence-based intervention that closes a persistent
gap in HIV care deliv
Istituzione: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
PI: Bibhav Acharya, Sabitri Sapkota
Progetto: 5R01TW012682-03
Settori: John E. Fogarty International Center for Advanced Study in the Health Sciences
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