JMIR Publications

ABSTRACT

Background:

Racialized immigrant and refugee communities are disproportionately impacted by HIV in Canada, with stigma and discrimination reinforcing HIV vulnerability in the population. Yet gaps on effective and sustainable stigma reduction strategies and programs continue to exist.

Objective:

We aim to use the RE-AIM framework to guide the contextual adaptation, implementation, and evaluation of the evidence-based Acceptance and Commitment to Empowerment (ACE) intervention to reduce HIV related stigma in six Canadian sites: Calgary and Edmonton in Alberta, and London, Ottawa, Niagara, and the Greater Toronto Area in Ontario.

Methods:

This multi-phase implementation study is underpinned by the principles of critical public health, social justice and health equity. We will apply community-centred, meaningful engagement and collective empowerment approaches in all research activities. In Phase One, we will engage 30 service providers, 60 community members, and 12 organizations to assess the local contexts of stigma to inform the adaptation of the ACE intervention for local use. We will also explore the acceptability, feasibility, and adoption of the ACE intervention to reduce HIV stigma in the local communities. In Phase Two, we will apply a Train-the-Trainer (TTT) capacity building approach to engage 48 service providers and community leaders in the ACE training. Upon completion of the ACE TTT program, they will be mentored to become ACE Community Champion Facilitators. In Phase Three, we will support the 48 ACE Community Champion Facilitators to work in a small team to co-facilitate the ACE intervention and engage 288 participants in their local communities. We will apply the RE-AIM framework throughout the study to assess the reach, adoption, implementation, effectiveness, maintenance and sustainability of the intervention. Data analysis will draw on a multiple-case study design examining the contextual factors of the intervention effectiveness. inferential statistics (regression, path analysis and hierarchical structural equation modelling) and analyses of variance will be conducted to determine the effectiveness of the interventions over time while controlling for the effects of mediating and moderating impact of other variables (e.g. sociodemographic). Thematic analysis will be applied to qualitative data.

Results:

This implementation study is underway. We have established a project advisory committee, engaged 18 community-based health and social care organizations in providing baseline information on stigma reduction programs or services. We have also completed data collection for Phase One and data analysis is underway. Over the course of the project, we will apply integrated knowledge translation to provide project updates, disseminate study results and engage affected communities, collaborators and relevant interest-holders through various strategies (e.g., semi-annual dialogical sessions, triannual newsletter, posting on websites, conference presentations, etc.). We anticipate that ACE graduates from Phase Two and Phase Three will engage in community stigma reduction activities and reach over 3000 people. Conclusion: This study protocol offers a detailed outline with key steps, drawing on the RE-AIM framework to contextualize, implement, and evaluate our community-centered ACE stigma reduction intervention. Our expected outcomes include: (i) reduced internalized and enacted stigma among our project populations; (ii) increased community capacity to address HIV stigma; (iii) critical knowledge on contextual factors that influence the effective implementation, uptake, and sustainability of evidence-based interventions; and (iv) contribution to intervention and implementation science.