Pilot randomized controlled trial to reduce HIV-related stigma among clinicians in Malaysia via project ECHO®

HIV-related stigma from clinicians contributes to global disparities in HIV testing and prevention. Scalable interventions, particularly those reaching clinicians beyond individual healthcare facilities, are needed to reach clinicians worldwide. These interventions are especially important in places like Malaysia where substantial HIV-related structural stigma exists. We tested an intervention that incorporated evidence-based stigma reduction tools into a popular teletraining program for clinicians, Project ECHO for HIV Prevention and Stigma Reduction (PEHP-SR). We compared PEHP-SR to the same program but without stigma-reduction tools (PEHP) and with an existing HIV education course, HIV Connect (HC). We randomized n = 78 clinicians in Malaysia to the three intervention conditions for nine months. Participants completed surveys measuring implementation-, stigma-, and clinical-related outcomes before, mid-way, and after the interventions. A subgroup of participants engaged in qualitative focus groups after the interventions. Quantitative survey results suggested that participants found PEHP to be the most acceptable and appropriate condition, and that stigma- and clinical-related outcomes improved in all three conditions. Qualitative focus group results provided insights into components of PEHP-SR that may have been ineffective and identified potential benefits of PEHP-SR not measured by quantitative surveys. Future research should continue to explore scalable interventions to reduce HIV-related stigma worldwide.Clinical trial registration: This study is registered at ClinicalTrials.gov (NCT05597787), with materials submitted in March 2022.