An HIV care provider training on addressing intersectional stigma and medical mistrust: A pilot randomized controlled trial

BACKGROUND: Intersectional stigma and medical mistrust in healthcare are associated with worse HIV care outcomes among marginalized populations, such as Black and Latine communities. We developed and conducted a pilot randomized controlled trial (RCT) of an online provider training intervention designed to address medical mistrust stemming from intersectional stigma among HIV patients. METHODS: Participants were fifty-nine HIV care providers (e.g., physicians, physician assistants, and nurse practitioners) from across the United States, with 29 randomized to the training group and 30 to the no-training control group. Training-group providers underwent training incorporating evidence-based principles of validation and motivational interviewing to acknowledge patients' intersectional stigma experiences and recognize and address medical mistrust in healthcare interactions. Provider outcomes were assessed using surveys and role-play simulations that measured the use of training-consistent skills in responses to hypothetical patient scenarios involving intersectional stigma and medical mistrust. Surveys and qualitative interviews were used to assess feasibility and acceptability of the training. RESULTS: In survey assessments, training participants, relative to controls, demonstrated a moderate improvement in skills addressing medical mistrust from baseline to post-training (d = 0.54), although this effect was not sustained at 6-month follow-up (d = -0.14). In role-play simulations, training participants also showed a small improvement in training-consistent communication strategies from baseline to post-training (d = 0.35), with notable improvements in supporting autonomy (d = 1.26) and checking understanding (d = 0.66). Providers rated the training highly for acceptability, feasibility, and appropriateness. Qualitative feedback emphasized the value of structured role-play exercises and effective facilitation, despite reported challenges related to time constraints and institutional barriers. DISCUSSION: The training was feasible and well-received, demonstrating promise for improving provider-patient communication about medical mistrust, though booster sessions may be needed to sustain these skills. This training has potential to reduce health disparities across patient populations, including patients with HIV. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05803720.