Adapting evidence-based stigma reduction interventions to address HIV and drug use stigma among family members of people who use drugs - PROJECT SUMMARY
The burden of HIV among people who use drugs (PWUD) is high in Tanzania. No current national data are
available in Tanzania on the burden of drug use and HIV among all PWUD. A study conducted in 2017 in Dar
es Salaam, a business capital of Tanzania, indicated HIV prevalence of 8.7% among a sample of people who
inject drugs (PWID) which is roughly twice as high as HIV prevalence in the general population (4.7%). One of
the challenges of the efforts to control HIV among PWUD globally including Tanzania is HIV and drug use
stigma.
PWUD face different kinds of HIV and drug use stigma globally and in Tanzania. These stigmas have
negative physical and mental health outcomes for PWUD and are a barrier to general health care and HIV
prevention, care and treatment. There is growing recognition of the need to address HIV and drug use stigma
faced by PWUD--yet research and interventions to do so are limited. Interventions to address HIV and drug
use stigma from health care workers towards patients exist but not with families. A family is critical to support
PWUD to enter and remain in HIV and drug prevention and treatment pathways. Also reducing family stigma is
crucial to improve quality of life of patients. In spite of this, globally there are no interventions to address HIV
and drug use stigma from family members towards PWUD. To address this gap, I propose to adapt existing
evidence-based health facility HIV and drug use stigma reduction interventions and create a stigma-reduction
intervention for family members of PWUD that will address both HIV and drug use stigma coming from family
members going towards PWUD. Therefore, the specific aims of this study are to:
1. Adapt existing health facility HIV and drug use stigma reduction interventions to address HIV
and drug use stigma among family members of PWUD in Tanzania.
2. Assess the acceptability, feasibility, appropriateness, adoption, and fidelity of the adapted
family HIV and drug use stigma reduction intervention among family members of PWUD in Tanzania.
3. Determine psychometric properties of developed HIV and drug use stigma measures.
Methods: We will achieve Specific Aim 1 through a step-wise adaptation process starting with the formative
assessment. We will conduct in-depth interviews with 36 PWUD who are about to start methadone treatment
and those who are on MAT in the first six month and 36 family members of PWUD to determine the
relationships, types and manifestations of HIV and drug use stigma that PWUD face from family members to
inform what and how to adapt the intervention and implementation. Principal Investigator (PI) and stigma
experts will use the results of the formative assessment to create draft 1 curriculum of the intervention. PWUD,
their family members, key stakeholders and topical experts will be involved to review draft 1. Stigma experts
and the PI will integrate feedback to create draft 2 of the intervention curriculum. We will achieve Specific Aim
2 by implementing the intervention among 151 family members of PWUD using draft 2 of the intervention
curriculum. After the implementation, we will measure the implementation outcomes namely acceptability,
feasibility, appropriateness, adoption, and fidelity using mixed methods. One focus group discussion (FGD) will
be done from each of the ten groups of family members that received the intervention. All Participants will be
surveys and 6-8 participants selected randomly for FGDs. To address Specific Aim 3, we will use secondary
data available from our previous grant (1R21TW011786) to determine the psychometric properties (validity and
reliability) of experienced, anticipated, perceived, and internalized HIV and drug use stigma measures. We will
conduct exploratory and confirmatory factor analyses, and known-group validity analyses.
