부산대학교 도서관

Background: Attempts to combat HIV stigma enacted in healthcare settings are often hampered by the inherent challenges of objective stigma measurement. We developed an experimental audit approach using unannounced standardized patient (SP) visits to observe provider behaviors in real clinical settings to inform a tailored, relevant, and culturally appropriate intervention for healthcare providers in a southern Chinese city. Our pilot cluster randomized control trial (RCT) assessed feasibility, acceptability, and preliminary effects of an intervention to reduce stigma towards men who have sex with men (MSM) and people living with HIV (PLWH). Methods: Design of the 2-day intervention was informed by results of a baseline round of clinic visits in which trained SPs presented standardized cases to consenting doctors. The HIV status and sexual orientation of each case was randomly varied in order to quantify stigma as differences in care across case scenarios. Measures of care quality were grouped into summary indices in the areas of diagnostic testing, sexual history taking, physical exam, and behavioral counseling. The stigma training consisted of didactic, experiential, and discussionbased modules delivered in an in-person and hybrid virtual format. Results of a follow-up round of SP visits were conducted to assess impact through linear fixed effects regression models. Results: Feasibility and acceptability for this novel study design were high. 87.3% of eligible providers enrolled in the study (N=55) and 74.5% of planned visits were completed (N=238). No adverse events were reported. All intervention participants reported that training content was "highly useful" or "useful" and that they would attend future sessions if offered. Preliminary effects suggest that the intervention may have improved care when SPs presented as MSM in terms of diagnostic testing (β=0.12; SE=0.19) and physical exams (β=0.69; SE=34**). For PLWH the intervention improved care in terms of counseling (β=0.43; SE=0.35) and sexual history taking (β=0.46; SE=0.41). Conclusion: Our pilot RCT demonstrated high feasibility, acceptability, and several areas of impact for an intervention to reduce enacted healthcare stigma in a low/middle-income setting. Preliminary effect estimates should be considered in light of the pilot nature of this study which was not powered to detect intervention effects. [ABSTRACT FROM AUTHOR]