Health Care Worker’s HIV Stigma Reduction Interventions: A Systematic Review
Creators: name: Endo, Yutaka
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2017

description: Introduction HIV/AID has been still epidemic across the world although the treatment and prevention strategy have enormously been developing so that the people living HIV/AIDS (PLWHA) can receive a quality and sustainable medical care, who would have otherwise struggled with their life. Stigma that is described as the experience of moving through life with an attribute that is deeply discrediting, and HIV-related stigma in health care settings can prevent PLWHA from getting access to medical care in a number of negative ways. Therefore, reducing the health care workers’ stigma is an urgent mission across the world. Even though there have been more and more interventions to reduce health care workers’ stigma toward PLWHA, it is required for the future study to identify theoretically successful and effective interventions for reducing the stigma as well as the powerful insights and technical brief obtained from them. Objectives The goals of this study are to systematically review as many related the peer-reviewed articles and grey literature to grasp a whole picture of the current progress of stigma-reduction interventions targeting health care workers and, based on those findings, to develop technical briefs that provide guidance and recommendations for the future research. Methods I conducted a systematic review of studies and reports that evaluated the effectiveness of HIV- related stigma-reduction interventions for health care workers, which is published in English from January 1, 1985 through June 1, 2017. For searching peer reviewed articles, Scopus, PubMed, PsychINFO were utilized and grey literature was obtained from Global Health, OpenGrey, ProQuest, The New York Academy of Medicine, Web of Science, UNAIDS, and WHO. I also conducted ancestry search for peer-reviewed articles and grey literature included during this review to maximize a capacity to capture as many pertinent studies. Study designs were only randomized control trial and quasi-experimental (one, only a study population, or two groups that include a control population, with pre- and/or post-intervention evaluation of stigma- level), and the primary or secondary objective was to reduce HIV-related stigma generated health care workers. Lastly, each of study quality was comprehensively assessed with a toolkit developed by the Effective Public Health Practice Project Quality (EPHPP) to evaluate the reliability and usefulness of those findings. Results Amongst 5167 peer-reviewed articles and grey literature identified through a systematic search, 30 articles were identified, which met my inclusion criteria. Those research were conducted in a total of 20 countries across the world, and the target population was a variety types of health care workers, mostly nurses and physicians. Many of them incorporated multiple strategies into the programs to reduce HIV-related stigma and measured multiple types of stigma (i.e., perceived, enacted, and/or internalized stigma) as the outcome variables. Some research targeted multiple socio-ecological factors, most frequently individual and organizational level. Almost of all of the studies reported that the intervention was effective for health care worker’s HIV stigma reduction at all or to some extent. However, measures of stigma widely varied in studies and many of them lacked validity so that it was difficult to compare the effectiveness and identify the unbiased findings. Also, few studies employed objective data correction manners other than self- administered survey distributed to the participants and none evaluated their behavioral change and biomedical outcomes, as a measure of consequences of stigma-reduction. Study quality evaluation also showed there were still various risks of biases across the studies and assigned most (23 studies) “weak,” while only six studies and one study were “moderate” and “strong,” respectively, which is mainly due to lack of randomization, blinding, and validated and/or reliable stigma scales. Conclusion This review focused on the interventions for health care worker’s HIV-related stigma-reduction and identified significant characteristics of each study. Even though I compared the effectiveness for reducing stigma and revealed considerable amounts of those findings, there have been still enormous challenges to identify promising and effective HIV-related stigma-reduction strategies that can be implemented in a larger scale for the future. Developing standardized measures of stigma and the consistent use is one of the critical next steps for the future research in this field. Studies with quality and robust designs that include objective data collection method and health care workers’ behavioral changes and biomedical outcomes of PLWHA as consequences of the stigma-reduction are also urgently required to enhance the ultimate goal of PLWHA’s health and life quality.