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.
