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Acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs: an RCT in St. Petersburg, Russia

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BACKGROUND: People with HIV who inject drugs experience multiple, intersecting forms of stigma which adversely impact care utilization needed to ending the HIV epidemic. This RCT evaluated a behavioral stigma coping intervention's effects on stigma and care utilization.
METHODS: We randomized 100 adults with HIV and past 30 days injection drug use (IDU) at a harm reduction non-governmental organization (NGO) in St. Petersburg, Russia. The control group had access to usual services at the NGO. The intervention group received three weekly 2-hour group sessions of an adapted Acceptance and Commitment Therapy intervention, in addition to usual services at the NGO. Primary outcomes were changes in HIV and substance use stigma scores 1 month after randomization. Secondary outcomes were self-reported initiation of antiretroviral therapy (ART), engagement in substance use care (outpatient, inpatient, or 12-step program), and change in total number of injections in previous 30 days at 6 months post randomization. We used linear regressions and linear probability models with robust standard errors to estimate the effect of the intervention on continuous and binary outcomes, respectively. We adjusted primary outcomes for baseline stigma scores, injection frequency, history of ART, and depressive symptoms. We used unadjusted analysis for secondary outcomes except for a change in injecting frequency adjusted for baseline score.
RESULTS: There were no major imbalances across arms. Participants were 47% female with a mean age of 38 years ± 5.4 at baseline. At 1 month, HIV and substance use stigma changes did not differ between groups (p=0.141, and 0.112, respectively). At 6 months, participants in the intervention group were more likely to initiate ART (20% vs. 3%, OR=0.17, 95%CI [0.05, 0.29], p=0.005) and to engage in substance use care (23% vs. 7%, OR=0.17, 95%CI [0.03, 0.31], p=0.017) than control participants. Intervention participants had less frequent injections in the previous 30 days (adjusted mean frequency of injection -8.58, 95%CI [-17.15,-0.01], p=.0497).
CONCLUSIONS: This brief stigma-coping intervention did not change how stigma manifests in people with HIV and current substance use stigma. However, it reduced stigma's impact as a care barrier, improved HIV and substance use care, and decreased IDU, which warrants further investigation.