Adaptation and evaluation of an intervention to increase HIV care engagement among women who use drugs

PROJECT SUMMARY The goal of this R01 proposal is to adapt and pilot an intervention to reduce individual-level HIV/AIDS and drug use stigma and increase retention in HIV care among women living with HIV who use drugs (HIV+ WWUD) in Ukraine. The scientific evidence is consistent across populations and settings that stigma is associated with poor health outcomes. HIV stigma is associated with poor HIV medication adherence; worse health outcomes, lower health care utilization, and low self-reported health. Drug use stigma is associated with lower use of health care, suboptimal engagement in HIV care, increased injection risk behaviors, and decreased use of harm reduction and medical services. People may be part of multiple stigmatized groups and focusing on a single dimension of negative experiences (e.g., only HIV or only drug use) obscures the ways that these multiple experiences interact and are compounded to produce specific health outcomes. We will adapt a small group, multi-session intervention that targets the psychological, interpersonal, and other mechanisms. The goals of the adapted intervention are 1) train participants in cognitive and behavioral skills to improve adaptive coping and reduce internalized and anticipated HIV and drug use stigma, 2) develop communication skills to respond to enacted stigma and enlist social support, and 3) address context factors that decrease the ability to receive ART. A social worker co-facilitator will facilitate linkage to HIV and substance use providers through referrals and appointment-making.22 The Specific Aims of this study are: 1) To adapt the Workshop intervention for HIV+ WWUD using the ADAPT-ITT model; 2) To assess the preliminary efficacy of the adapted intervention on primary clinical outcomes of HIV care engagement and ART adherence and secondary outcome of drug treatment engagement; 3) To assess acceptability, feasibility, cost, and implementation-related processes and outcomes of the intervention using the PRISM (Practical, Robust Implementation & Sustainability) Model. We will enroll n=100 HIV+ WWUD who will be randomized to the intervention or control arm. Participants will complete baseline and 3- and 6-month post intervention assessments to measure HIV care engagement outcomes and changes in stigma mechanisms. We will also obtain medical records to validate HIV care engagement and ART medication adherence.