October 11, 2021

New project aims to battle the stigma of substance use disorder in patients seeking care for HIV

An interdisciplinary and interprofessional team of faculty from three departments at the Wayne State University School of Medicine have launched a three-year project to plan a multi-level intervention to reduce substance use disorder stigma for patients in HIV care.

Erin Fanning Madden, Ph.D., M.P.H., is the lead principal investigator on “Planning a Multi-Level Intervention to Reduce Substance Use Stigma in HIV Prevention and Care,” funded by a three-year, $684,027 grant launched Sept. 30 from the National Institute on Drug Abuse.

Erin Madden, Ph.D., M.P.H.

She is an assistant professor in the Department of Family Medicine and Public Health Sciences. The study’s co-principal investigator is Mark Greenwald, Ph.D., the Gertrude Levin Endowed Chair in Addiction and Pain Biology and a professor of Psychiatry and Behavioral Neurosciences. Dr. Greenwald also directs the department’s Substance Abuse Research Division.

Co-investigators include Department of Internal Medicine Division of Infectious Diseases Professor Jonathan Cohn, M.D., a renowned expert on HIV care; and Fares Qeadan, M.S., an associate professor of Biostatistics at Loyola University in Chicago.

The project will use a community-engaged research approach for planning a trial with federally-qualified health centers.

“While it is well known that people with HIV and people who use substances are stigmatized and this stigma negatively affects health care access and quality, research on how to reduce stigma is extremely limited,” Dr. Madden said. “Most studies of interventions trying to reduce stigma among health care providers focus exclusively on training and only measure short-term attitude changes. Our team will use this planning grant to work with professionals providing care in metropolitan Detroit communities to plan a feasible and rigorous test of an intervention that combines education and changes to organizational factors that may promote stigma in health care settings.”

The planning process will allow the researchers to design a trial that measures attitude change among providers and clinic staff, as well as changes to patient outcomes and objective measures of service provision.

“Our goal is to adapt and refine a multi-level substance use stigma intervention that leverages education and organizational policy to address structural drivers of stigma and the stigmatizing professional attitudes and behaviors that affect patients,” Dr. Madden said. “The subsequent results of the trial research are expected to provide scientific evidence demonstrating how health care organizations can address substance use stigma that influences HIV prevention and care outcomes among people who use drugs.”

The study team aims to identify eight primary care sites in metropolitan Detroit that agree to collaborate in planning an intervention trial. They also will pilot test stigma training for clinical and administrative staff; identify site policy changes that may reduce organizational drivers of substance use stigma; and collaboratively plan a trial study that would test the effect of the training and policy changes on stigma among primary care professionals and other clinic staff.

At the end of the three-year planning grant, the team will apply for additional funding to conduct the stigma intervention trial with the eight sites.

The grant number for this National Institutes of Health study is R34DA053758.

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