Kudos to Michael Relf, associate dean for Global and Community Health Affairs, and Julie Barroso with the Medical University South Carolina and their entire team for the resubmission of their NIH R01 application entitled "Improving Outcomes through a Stigma Reduction Intervention for African American Women Living with HIV." This proposal requesting funding for a five-year period with a start date of July 1, 2020.

Project Summary/Abstract

Stigma as it is experienced by women living with HIV infection creates a cascade of adverse outcomes and impairs effective HIV prevention behavior, ART adherence, retention in care, and disease outcomes. As a mechanism of action, stigma is a social determinant impacting transmission and treatment. Stigma is persistent, and efforts to ameliorate it among the general public have been largely ineffective. In our previous

work, we implemented a feasible, acceptable, and effective video-based intervention, Maybe Someday, aimed at reducing internalized stigma and improving self-esteem and coping self-efficacy in women living with HIV. The success of this project led to the current proposal to test the efficacy of the intervention in a fully powered RCT, in sites noted to be high-HIV burden counties and high-HIV burden rural states, with African American

women, who bear a disproportionate burden of HIV/AIDS in the US. We propose to use a multi-site, 2x4 repeated measures RCT to compare those receiving the Maybe Someday video intervention to a written version of the script developed for the video, to determine the intervention’s ability to reduce internalized stigma, improve coping self-efficacy and self-esteem; and improve effective HIV prevention behaviors, antiretroviral adherence, retention in care, and disease outcomes. Using the President’s strategy to end the HIV epidemic, we will recruit 300 women living with HIV infection in high-HIV burden counties in NC (Mecklenburg county) and GA (Cobb, DeKalb, Fulton and Gwinnett counties), and high-HIV burden rural

states, specifically AL and SC. The intervention will be delivered via smartphone, allowing intervention privacy and portability.

The specific aims of the proposed study are to:

Aim 1: Use a multisite, 2x4 repeated measures randomized controlled trial (2 treatments x 4 time points [baseline, 3, 6, and 12 months]) to determine if the Maybe Someday video intervention results in:

a) reduced internalized stigma; improved self-esteem and coping self-efficacy (proximal targets)

b) increased effective HIV prevention behaviors and improved ART adherence (distal targets)

c) increased retention in care and reduced HIV viral loads (distal targets).

Aim 2: Examine the hypothesis that internalized stigma, self-esteem, and coping self-efficacy will mediate the

relation between the intervention condition and distal patient outcomes.

Exploratory Aim 3: Explore the effect of the intervention among women recruited from 5 high-HIV burden

counties versus those from 2 states with a substantial rural HIV burden.