The goal of this study is to adapt and pilot an effective health facility HIV stigma-reduction intervention to address drug use stigma in HIV care and treatment clinics (CTCs) in Tanzania, a barrier to linkage and retention in HIV care for people living with HIV (PLWH) who use drugs. In Tanzania, there are an estimated 300,000 people who use drugs (PWUD), primarily heroin. Although most heroin is inhaled or ingested, an estimated 10% (30,000) of PWUD inject. HIV prevalence among PWUD who do not inject (18?25%) and those who do inject (35%) is 4?7 times higher than in the general population (5%). PWUD face high levels of stigma, including when they try to seek HIV treatment at HIV CTCs, presenting a barrier to linkage and retention in HIV treatment for this highly HIV vulnerable group. Therefore, reducing drug use stigma in HIV CTCs is critical to improving access to and retention in HIV treatment services for PWUD. In response to this need, we will: 1. Adapt a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV CTCs (Aim 1). 2. Pilot test the adapted drug use stigma-reduction intervention for acceptability, appropriateness, and feasibility.
(Aim 2). We will achieve Aim 1 through a systematic, multi-stage adaptation process that will include a formative phase of in-depth interviews with PLWH who use drugs and CTC staff to inform initial adaptation of the Health Policy Plus (HP+) intervention. Stakeholders, including PLWH who use opioids and CTC staff, will provide feedback on the initial materials through a participatory workshop, leading to a training manual that will be reviewed by topic experts and then finalized. Experienced Tanzanian HIV stigma-reduction trainers, including people with lived experience of opioid use, will be trained to deliver the intervention to CTC staff. The pilot test will include 150 health workers based in seven CTCs in Dar-es-Salaam. A mixed methods evaluation will comprise pre-post surveys, observation of trainings, and post-training focus group discussions with intervention participants and trainers. Changes in CTC staff's mean scores on stigma scales from pre- to post-intervention will be assessed, along with measures of intervention acceptability, appropriateness, and feasibility. Focus groups will explore themes around the experience of participating in the opioid use stigma- reduction training.
Drug use stigma in HIV care and treatment clinics is a barrier to HIV treatment linkage and retention for people who use drugs, a population highly vulnerable to HIV. This study will advance HIV science by adapting an HIV stigma-reduction intervention to address drug use stigma in HIV clinics and testing it for acceptability, adaptability, and feasibility.
