Centering HIV Stigma in Clinical Conversations to increase Alcohol Treatment Uptake (CHAT)

People with HIV/AIDS (PWH) experience substantial harms from unhealthy alcohol use (UAU). Stigma – associated with both HIV and substance use– is a major driver of poor outcomes for PWH and worsens for PWH who experience multiple forms of stigma. Patient-reported outcomes (PROs) can de-stigmatize patient-provider communication about alcohol and enhance the patient-centeredness of HIV care delivery. The CFAR Network of Integrated Clinical Systems (CNICS) already captures a validated measure of patient-reported HIV stigma as part of their routine PRO capture, yet little is known about how this measure is used in practice to support decision-making about UAU care. Directly addressing stigma during clinical visits may therefore be an important but undercapitalized on pathway for increasing alcohol treatment uptake for PWH. This K01 career development proposal positions complementary training and research aims that seek to strengthen crucial skills in my path towards conducting high impact patient-centered research that reduces the burden of UAU for PWH. Specifically, this research aims to: 1) characterize patient and provider perspectives on lived experiences of stigma and preferences for the use of patient-reported stigma measures in clinical practice for PWH with UAU; 2) co-design a stigma-centered decision support tool for PWH with UAU using human-centered design methodology in partnership with a Lived Experience Advisory Board of patients and providers; and 3) evaluate the acceptability and effectiveness of the stigma-centered decision support tool on reducing UAU in a pilot clinical trial in three CNICS sites. This research will be complemented by structured training and ongoing mentorship that seeks to: 1) enhance knowledge of stigma and stigma reduction in HIV primary care; 2) develop skills in user-centered design; and 3) gain advanced skills in the design and conduct of experimental implementation trials. This proposed work - directly responsive to NIH’s and NIAAA’s strategic priorities to improve care outcomes for all people with HIV through enhanced delivery of effective alcohol-related care – will provide important foundational work to improve UAU care delivery in HIV care settings.