HIV-Related Stigma Intervention for Malaysian Clinicians

Study Overview
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Brief Summary
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Key populations at risk of HIV (including men who have sex with men, people who inject drugs, transgender women, and female sex workers) are more likely to be infected with HIV but less likely than members of the general population to know of their HIV status, receive HIV prevention counseling, or be linked to HIV care services. Clinician stigma towards these groups remains a potent and persistent driver of these HIV disparities in many places of the world. The investigators propose to incorporate evidence-based stigma reduction tools into a popular teletraining platform for clinicians and pilot test the resulting intervention (Project ECHO® for HIV Prevention and Stigma Reduction) with clinicians in Malaysia, a context wherein clinician stigma and HIV disparities are substantial.

Official Title
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Implementing Stigma Reduction Tools Via a Popular Teletraining Platform to Reduce Clinician Stigma and Disparities in HIV Testing, Prevention, and Linkage to Care in Malaysia

Conditions
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Hiv

Intervention / Treatment
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* Behavioral: Stigma Reduction Tools
* Behavioral: Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: practicing general practitioner or family medicine specialist in Malaysia Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: HIV Connect<br>Participants randomized to this condition will complete HIV Connect, which is an online course developed by the Malaysian Society of HIV Medicine designed to educate primary care physicians in Malaysia about HIV. It consists of a series of modules featuring HIV infectious disease experts who instruct on topics including epidemiology and natural history of HIV, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), sexual history taking and STI testing, and others. | Behavioral: Education<br>* education and clinical skills<br>|
| Active Comparator: Project ECHO for HIV Prevention<br>Participants randomized to this condition will receive Project ECHO for HIV Prevention, without added evidence-based stigma reduction tools. Participants will meet with the Project ECHO Hub specialists and their learning community on a bi-weekly basis for 60 minutes over the course of 9 months. Each session will feature a didactic training incorporating standardized procedures for HIV testing, prevention, and/or linkage to care, and patient-case presentation and discussion. | Behavioral: Education<br>* education and clinical skills<br>|
| Experimental: Project ECHO for HIV Prevention + Stigma Reduction<br>Participants randomized to this condition will receive the Project ECHO for HIV Prevention intervention with added evidence-based stigma reduction tools. Participants will meet with the Project ECHO Hub specialists and their learning community on a bi-weekly basis for 60 minutes over the course of 9 months. Each session will feature a didactic training incorporating standardized procedures for HIV testing, prevention, and/or linkage to care, and patient-case presentation and discussion. | Behavioral: Stigma Reduction Tools<br>* behavioral design, contact, and social norms<br>Behavioral: Education<br>* education and clinical skills<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability of Intervention | Measured with Acceptability of Intervention Measure (adapted from Weiner et al., 2017). Items are measured on 5-point, Likert-type scale and will be averaged for analysis. | Month 9 Assessment | 
| Feasibility of Intervention | Measured with Feasibility of Intervention Measure (adapted from Weiner et al., 2017). Items are measured on 5-point, Likert-type scale and will be averaged for analysis. | Month 9 Assessment | 
| Stigma Reduction: Prejudice | Measured with Feelings Thermometers (adapted from Alwin, 1997). Positive/Negative affect is measured on 0-100 point scale. | Month 9 Assessment | 
| Stigma Reduction: Stereotypes | Measured with subscale of Multidimensional HIV-Related Stigma Scale (adapted from Stein & Li, 2007). Items are measured on 5-point, Likert-type scale and will be averaged for analysis. | Month 9 Assessment | 
| Stigma Reduction: Discrimination | Measured with subscale of Multidimensional HIV-Related Stigma Scale (adapted from Stein & Li, 2007). Items are measured on 5-point, Likert-type scale and will be averaged for analysis. | Month 9 Assessment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| HIV Prevention Procedures: HIV Testing | Measured with weekly diary of HIV tests performed. Number of HIV tests will be summed over duration of intervention. | Cumulative over 9 month intervention | 
| HIV Prevention Procedures: PrEP Prescriptions | Measured with weekly diary of PrEP prescriptions. Number of PrEP prescriptions will be summed over duration of intervention. | Cumulative over 9 month intervention |