Project Summary/Abstract
Youth living with HIV (YLHIV) are at the forefront of the HIV epidemic globally, as more perinatally infected
children increasingly survive into adulthood, and more youth become infected worldwide. HIV-related stigma is
a critical challenge to antiretroviral therapy (ART) adherence and retention in care of YLHIV and is associated
with mental health issues such as depression and anxiety. Few stigma-reduction strategies exist for youth,
however, particularly in low and middle income countries (LMICs). The overall goals of the proposed research
are to deepen understanding of the spectrum of stigma experienced by YLHIV in Vietnam and to identify relevant
mediation strategies. Our Specific Aims (SA) are to 1) adapt a psychosocial stigma-reduction intervention for
YLHIV in Vietnam based on cognitive-behavioral therapy (CBT) principles and delivered by telephone, using
critical input from youth during intervention development; 2) assess the feasibility, acceptability and preliminary
efficacy of this innovative approach to reduce stigma, and improve psychosocial wellbeing and ART adherence
among YLHIV through a small pre-post study; 3) explore the multiple facets of stigma experienced by YLHIV in
Vietnam and their relationships with ART adherence and psychosocial wellbeing via quantitative surveys and
electronic adherence monitoring; and 4) strengthen our team's capacity to conduct future research on stigma
and stigma-reduction interventions. The research will be conducted over two years in three phases. Phase 1 will
comprise intervention development including initial interviews with YLHIV and pilot testing to meet SA1. In Phase
2, the intervention will be provided remotely to 40 YLHIV accessing HIV care at outpatient clinics in Hanoi;
sociodemographic, psychosocial, and clinical data will be collected at baseline and endline, and adherence will
be monitored continuously via wireless pill containers. Phase 3 will involve data analysis and dissemination
activities. Our proposed intervention will target multiple levels of stigma experienced by YLHIV using supportive
self-management skills; it is grounded in CBT principles and in previous research which has documented
interrelationships among stigma, psychosocial wellbeing, and ART adherence. The core psychosocial treatment
plan will comprise four months of weekly coaching sessions by phone, followed by two monthly “booster”
sessions, and will be tailored to the situation of each participant. Analysis of baseline, endline, and the continuous
adherence data will enable the achievement of SA2 and SA3 and thereby contribute to the scientific evidence
base on low-cost strategies to reduce stigma and improve psychosocial wellbeing and ART adherence for YLHIV
in LMICs. The study's team of experienced multi-disciplinary Vietnamese and American researchers has
exceptional capacity to conduct the study; our close collaboration supplemented by skill-specific training
throughout the project will help us to strengthen our capacity to conduct future work on stigma and psychosocial
interventions, thus addressing SA4. With strong support from Vietnamese officials and clinicians, as well as
international experts, our results have high potential for policy and program impact.
