1 - (SYM 57) a Randomized Clinical Trial of Acceptance and Commitment Therapy for People with HIV Who Inject Drugs in St. Petersburg, Russia; Cultural Adaptation, Processes of Change, and Outcomes

Stigma surrounding HIV and substance use among people who inject drugs (PWID) can act as a barrier to accessing care and have a negative impact on their health. Despite this, there are limited interventions to address this issue. The aim of the SCRIPT trial, conducted in St. Petersburg, Russia, was to empower 108 HIV-positive PWID to cope with both forms of stigma. This paper describes the development, cultural adaptation process, outcomes, and processes of change in this study. An Acceptance and Commitment Training (ACT) manual was created to guide three two-hour group sessions, which were designed to help participants cope with both HIV and substance use stigma and reduce stigma's impact on their health and care. Researchers and practitioners from both the US and Russia were involved in culturally adapting the intervention. Interventionists were trained in the ACT stigma intervention, and their adherence to the study protocol and intervention manual was assessed through session debrief summaries and fidelity monitoring. Adherence to the intervention was assessed by two independent coders, and challenges to implementation were identified. The culturally adapted stigma coping intervention was implemented with good fidelity to the study protocol and intervention manual. In the resulting study, participants were randomized to either a six-hour, 3-session group intervention based on ACT or usual care. At 1 month, HIV and substance use stigma changes did not differ between groups. At six months, participants in the intervention group were more likely to initiate anti-retroviral therapy (20% vs. 3%) and to engage in substance use care (23% vs. 7%) than controls. Intervention participants also had less frequent injections in the previous 30 days at six months. There were no significant between-group differences on change in substance-use related psychological flexibility or stigma avoidance at any time point. Change on a measure of stigma-related values disengagement was higher in the active treatment arm compared to controls at one month, but not at six months. Additional contextual information will be reported in an attempt to understand these results.