Strengthening HIV Activism Among Clinicians in Malaysia: A Randomised Controlled Trial.

Abstract

HIV continues to disproportionately affect key populations in Malaysia, compared to the general population. Lessons learned from decades of research and programmatic experience suggest that HIV activism can be a driver for change. We pilot-tested a tele-training platform, Project ECHO^® for Stigma Reduction (PE-SR), in a randomised controlled trial from July 2022 to March 2023, alongside two comparator groups, i.e., Project ECHO^®-Standard (PE-S) and the conventional HIV training program for clinicians, HIV Connect (HC). We randomised 78 primary care physicians and general practitioners across Malaysia into the three study arms (n = 26 each). We evaluated changes in HIV activist identity and commitment, and orientation towards day-to-day HIV activism and structural HIV activism. Repeated measure analysis of covariance (ANCOVA), controlling for age, years of practice, and contact with key populations as covariates, compared changes in HIV activism constructs across time and groups. The randomised controlled trial yielded mixed results. We observed statistically significant changes in HIV activist identity and commitment, as well as changes in orientation towards structural activism in all groups. We also found statistically significant mean differences between PE-S and HC in terms of HIV activist identity and commitment, and between PE-SR and HC in terms of orientation towards structural activism. Results suggest that stigma reduction tools embedded in a tele-training platform had a preliminary impact on HIV activism and could be scaled up and tailored to train clinician-activists.Trial Registration NCT05597787.