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Kleinman MB, Anvari MS, Felton JW, Bradley VD, Belcher AM, Abidogun TM, Hines AC, Dean D, Greenblatt AD, Wagner M, Earnshaw VA, Magidson JF. Reduction in substance use stigma following a peer-recovery specialist behavioral activation intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104511. [PMID: 39003894 PMCID: PMC11347115 DOI: 10.1016/j.drugpo.2024.104511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Patients' perceptions and experiences of stigma related to substance use and methadone treatment are barriers to successful treatment of opioid use disorder, particularly among low-income and medically underserved populations. Interventions led by peer recovery specialists (PRSs) may shift stigma-related barriers. This study sought to evaluate shifts in substance use and methadone treatment stigma in the context of an evidence-based behavioral intervention adapted for PRS delivery to support methadone treatment outcomes. METHODS We recruited patients who had recently started methadone treatment or demonstrated difficulty with adherence from a community-based program (N = 37) for an open-label pilot study of a 12-session behavioral activation intervention led by a PRS interventionist. Participants completed substance use and methadone treatment stigma assessments and the SIP-R, a brief measure of problems related to substance use, at baseline, mid-point (approximately six weeks), and post-treatment (approximately 12 weeks). Generalized estimating equations assessed change in total stigma scores between baseline and post-treatment as well as change in stigma scores associated with change in SIP-R responses. RESULTS There was a statistically significant decrease in substance use stigma (b(SE)=-0.0304 (0.0149); p = 0.042) from baseline to post-treatment, but not methadone treatment stigma (b(SE)=-0.00531 (0.0131); p = 0.68). Decreases in both substance use stigma (b(SE)=0.5564 (0.0842); p < 0.001) and methadone treatment stigma (b(SE)=0.3744 (0.1098); p < 0.001) were associated with a decrease in SIP-R scores. CONCLUSIONS PRS-led interventions have potential to shift substance use stigma, which may be associated with decrease in problems related to substance use, and therefore merit further testing in the context of randomized controlled trials.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Julia W Felton
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Valerie D Bradley
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Annabelle M Belcher
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tolulope M Abidogun
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Abigail C Hines
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Dwayne Dean
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Aaron D Greenblatt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Wagner
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland School of Medicine, College Park, MD, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland School of Medicine, College Park, MD, USA
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Myers B, Regenauer KS, Johnson K, Brown I, Rose A, Ciya N, Ndamase S, Jacobs Y, Anvari M, Hines A, Dean D, Baskar R, Magidson J. A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa. RESEARCH SQUARE 2024:rs.3.rs-4566640. [PMID: 39070655 PMCID: PMC11275972 DOI: 10.21203/rs.3.rs-4566640/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Introduction In South Africa (SA), community-oriented primary care (COPC) teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches (PRCs) into COPC teams could shift SU stigma and improve patients' engagement in care. The PRC role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a PRC role for COPC team integration. Methods We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (HCW, n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with HCW (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with HCW (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into COPC teams. Results Although all stakeholders viewed the PRC role as acceptable, patients and HCWs identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. HCWs prioritized clarification of the PRC role, working conditions, and processes to limit any impact on the COPC team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for PRC session structure, location, and content and expanded proposed components of PRC training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of PRC integration training for COPCs and PRC mentoring to address community and COPC dynamics. Conclusion Stakeholder engagement in an iterative HCD process has been integral to co-designing a PRC role that multiple stakeholder groups consider acceptable and that COPC teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.
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Affiliation(s)
| | | | - Kim Johnson
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Imani Brown
- Department of Psychology, University of Maryland
| | | | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Yuche Jacobs
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | | | | | - Dwayne Dean
- Department of Psychology, University of Maryland
| | | | - Jessica Magidson
- Center for Substance Use, Addiction & Health Research, University of Maryland
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Regenauer KS, Rose AL, Belus JM, Johnson K, Ciya N, Ndamase S, Jacobs Y, Staniland L, Sibeko G, Bassett IV, Joska J, Myers B, Magidson JF. Piloting Siyakhana: A community health worker training to reduce substance use and depression stigma in South African HIV and TB care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002657. [PMID: 38713695 DOI: 10.1371/journal.pgph.0002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/03/2023] [Indexed: 05/09/2024]
Abstract
South Africa has one of the highest rates of HIV/tuberculosis (TB) co-infection, and poor engagement in HIV/TB care contributes to morbidity and mortality. In South Africa, community health workers (CHWs) are tasked with re-engaging patients who have dropped out of HIV/TB care. CHWs have described substantial challenges with substance use (SU) and depression among their patients, while patients have described CHW stigma towards SU and depression as barriers to re-engagement in care. Yet, CHWs receive little-to-no training on SU or depression. Therefore, we piloted Siyakhana, a brief CHW training to reduce stigma related to SU and depression while improving skills for re-engaging these patients in HIV and/or TB care. This study evaluated the preliminary effectiveness (stigma towards SU and depression; clinical competence assessed via roleplay) and implementation (quantitative ratings of feasibility, acceptability, appropriateness, adoption; semi-structured written qualitative feedback) of Siyakhana among CHWs and supervisors (N = 17) at pre- and post-training assessments. SU stigma significantly decreased (F(1,16) = 18.94, p < 0.001, ηp2 = 0.54). Depression stigma was lower than SU stigma at both timepoints and did not significantly decrease after training. CHW clinical competency towards patients with SU/depression significantly improved (t(11) = -3.35, p = 0.007, d = 1.00). The training was rated as feasible, acceptable, appropriate, and likely to be adopted by CHWs and their supervisors. Nonjudgmental communication was commonly described as the most useful training component. Based on this pilot, the training is being refined and evaluated in a larger randomized stepped-wedge clinical trial.
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Affiliation(s)
- Kristen S Regenauer
- Department of Psychology, University of Maryland, College Park, College Park, Maryland, United States of America
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, College Park, Maryland, United States of America
| | - Jennifer M Belus
- University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Kim Johnson
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
| | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
| | - Yuche Jacobs
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
- People Development Centre: Corporate Wellness, Western Cape Department of Health & Wellness, Plumstead, Cape Town, South Africa
| | - Lexy Staniland
- EnAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
| | - John Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
- EnAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, College Park, Maryland, United States of America
- Center for Substance Use, Health & Addiction Research (CESAR), University of Maryland, College Park, College Park, Maryland, United States of America
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Giusto A, Jack HE, Magidson JF, Ayuku D, Johnson S, Lovero K, Hankerson SH, Sweetland AC, Myers B, Fortunato Dos Santos P, Puffer ES, Wainberg ML. Global Is Local: Leveraging Global Mental-Health Methods to Promote Equity and Address Disparities in the United States. Clin Psychol Sci 2024; 12:270-289. [PMID: 38529071 PMCID: PMC10962902 DOI: 10.1177/21677026221125715] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Structural barriers perpetuate mental health disparities for minoritized US populations; global mental health (GMH) takes an interdisciplinary approach to increasing mental health care access and relevance. Mutual capacity building partnerships between low and middle-income countries and high-income countries are beginning to use GMH strategies to address disparities across contexts. We highlight these partnerships and shared GMH strategies through a case series of said partnerships between Kenya-North Carolina, South Africa-Maryland, and Mozambique-New York. We analyzed case materials and narrative descriptions using document review. Shared strategies across cases included: qualitative formative work and partnership-building; selecting and adapting evidence-based interventions; prioritizing accessible, feasible delivery; task-sharing; tailoring training and supervision; and mixed-method, hybrid designs. Bidirectional learning between partners improved the use of strategies in both settings. Integrating GMH strategies into clinical science-and facilitating learning across settings-can improve efforts to expand care in ways that consider culture, context, and systems in low-resource settings.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, 1147B Biology-Psychology Building College Park, MD 20742
| | - David Ayuku
- Department of Mental Health and Behavioural Sciences, College of Health Sciences Moi University, P. O. Box 4606-30100, Eldoret, Kenya
| | - Savannah Johnson
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
| | - Kathryn Lovero
- Department of Clinical Sociomedical Sciences in Psychiatry, Columbia Mailman School of Public Health, New York, NY, USA
| | - Sidney H Hankerson
- Department of Population Health Sciences & Policy, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Annika C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, New York, NY 10032
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Science, Curtin University, Perth, Australia; Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, South Africa
| | - Palmira Fortunato Dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Eve S Puffer
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
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Myers B, Regenauer KS, Rose A, Johnson K, Ndamase S, Ciya N, Brown I, Joska J, Bassett IV, Belus JM, Ma TC, Sibeko G, Magidson JF. Community health worker training to reduce mental health and substance use stigma towards patients who have disengaged from HIV/TB care in South Africa: protocol for a stepped wedge hybrid type II pilot implementation trial. Implement Sci Commun 2024; 5:1. [PMID: 38167261 PMCID: PMC10759561 DOI: 10.1186/s43058-023-00537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND South Africa has deployed community health workers (CHWs) to support individuals to enter and stay in HIV/TB care. Although CHWs routinely encounter patients with mental health (particularly depression) and substance use (SU) conditions that impact their engagement in HIV/TB care, CHWs are rarely trained in how to work with these patients. This contributes to mental health and SU stigma among CHWs, a known barrier to patient engagement in care. Mental health and SU training interventions could reduce CHW stigma and potentially improve patient engagement in care, but evidence of the feasibility, acceptability, and preliminary effectiveness of these interventions is scarce. Therefore, we designed a hybrid type 2 effectiveness-implementation pilot trial to evaluate the implementation and preliminary effectiveness of a CHW training intervention for reducing depression and SU stigma in the Western Cape, South Africa. METHODS This stepped wedge pilot trial will engage CHWs from six primary care clinics offering HIV/TB care. Clinics will be block randomized into three-step cohorts that receive the intervention at varying time points. The Siyakhana intervention involves 3 days of training in depression and SU focused on psychoeducation, evidence-based skills for working with patients, and self-care strategies for promoting CHW wellness. The implementation strategy involves social contact with people with lived experience of depression/SU during training (via patient videos and a peer trainer) and clinical supervision to support CHWs to practice new skills. Both implementation outcomes (acceptability, feasibility, fidelity) and preliminary effectiveness of the intervention on CHW stigma will be assessed using mixed methods at 3- and 6-month follow-up assessments. DISCUSSION This trial will advance knowledge of the feasibility, acceptability, and preliminary effectiveness of a CHW training for reducing depression and SU stigma towards patients with HIV and/or TB. Study findings will inform a larger implementation trial to evaluate the longer-term implementation and effectiveness of this intervention for reducing CHW stigma towards patients with depression and SU and improving patient engagement in HIV/TB care. TRIAL REGISTRATION ClinicalTrials.gov NCT05282173. Registered on 7 March 2022.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Perth, WA, Australia.
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Kristen S Regenauer
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Alexandra Rose
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Kim Johnson
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
| | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
| | - Imani Brown
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - John Joska
- Department of Psychiatry and Mental Health, Division of Neuropsychiatry, University of Cape Town, HIV Mental Health Research Unit, Cape Town, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jennifer M Belus
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Tianzhou Charles Ma
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Lavoie MCC, Okui L, Blanco N, Stoebenau K, Magidson JF, Gokatweng G, Ikgopoleng K, Charurat ME, Ndwapi N. Feasibility and acceptability of peer-delivered interventions using mHealth for PrEP services among adolescent girls and young women in DREAMS program in Botswana. Glob Health Action 2023; 16:2231256. [PMID: 37462118 DOI: 10.1080/16549716.2023.2231256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Adolescent girls and young women accounted for 25% of all new HIV infections despite representing only 10% of the population in Sub Saharan Africa. PEPFAR has launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative, a comprehensive HIV prevention program including PrEP services. Among adolescent girls and young women, PrEP adherence is currently sub-optimal. Tailored strategies for adolescent girls and young women to improve access and use of PrEP delivery are urgently needed to maximise its potential. Recommended interventions include peer-delivered interventions using mobile technology. However, data on the feasibility and acceptability of this approach is limited for SSA. OBJECTIVES We assessed the feasibility and perceived acceptability of providing mHealth peer-delivered interventions to support PrEP services among adolescent girls and young women in Botswana. METHODS This cross-sectional study included HIV-negative women aged 18-24 years old seeking health services at DREAMS-supported facilities. Participants completed a survey assessing the feasibility and perceived acceptability of the mHealth peer-delivered interventions, which included the Acceptability of Intervention Measure (AIM). Descriptive analyses were performed. RESULTS A total of 131 participated in the study. Overall, 89% owned a mobile phone (feasibility). There was no difference in cell phone ownership between participants from rural and urban settings. Among participants, 85% reported interest in participating in a mHealth peer-delivered intervention if it was available to them. Regarding perceived acceptability for mHealthpeer support groups for PrEP, the average score on the AIM was 3.8 out of 5 (SD = 0.8). CONCLUSION mHealthpeer-delivered interventions appear to be feasible and perceived acceptable among adolescent girls and young women in Botswana. This modality should be incorporated into PEPFAR's programmatic toolkit of implementation strategies to improve PrEP services.
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Affiliation(s)
- Marie-Claude C Lavoie
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Center for International Health, Education, and Biosecurity (Ciheb), Maryland Global Initiative Corporation, University of Maryland Baltimore, Gaborone, Botswana
| | - Natalia Blanco
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Gadzikanani Gokatweng
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Kaizer Ikgopoleng
- Center for International Health, Education, and Biosecurity (Ciheb), Maryland Global Initiative Corporation, University of Maryland Baltimore, Gaborone, Botswana
| | - Manhattan E Charurat
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ndwapi Ndwapi
- Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
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Smith T, Seeley J, Shahmanesh M, Psaros C, Munikwa C, Ngwenya N. Influences on decision-making about disclosure of HIV status by adolescents and young adults living with HIV in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:306-315. [PMID: 38117742 DOI: 10.2989/16085906.2023.2277358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
Background: Adolescents and young adults living with HIV (AYA) are faced with the challenge of living with a life-long chronic condition. We investigated the influences on the decisions by AYA to disclose their HIV status to family, intimate partners and friends.Methods: Twenty AYA aged between 15 and 24 years were purposely selected through local community-based organisations in eThekwini municipality and uMkhanyakude district in KwaZulu-Natal Province, South Africa. Virtual in-depth interviews were conducted between September 2020 to October 2021 using a topic guide focusing on HIV-status disclosure and the impact of stigma on decision-making capacity. An iterative thematic process was used for analysis.Results: Findings revealed the challenges that AYA experience for disclosure because of stigma and how this impacts their decision-making capacity. Family and friends influenced AYA in processing their discovery of their HIV status offering support needed to manage living with HIV. However, for some AYA disclosing to relatives, friends and intimate partners was difficult because of fears of rejection and recrimination. The act of disclosure was influenced by both internalised and external stigma and the type of relationships and interactions that AYA had with relatives, friends and caregivers.Conclusions: The decision to disclose is challenging for AYA because of the fear of rejection, along with internal and external stigma. The provision of support, whether from family or peers, is important. Enhancing the decision-making capacity of AYA is essential for developing their self-esteem as well as supporting future healthcare choices.
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Affiliation(s)
- Thandeka Smith
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Christina Psaros
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | - Nothando Ngwenya
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
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Barnett ML, Puffer ES, Ng LC, Jaguga F. Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States. Glob Ment Health (Camb) 2023; 10:e26. [PMID: 37854408 PMCID: PMC10579690 DOI: 10.1017/gmh.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/06/2023] [Accepted: 04/29/2023] [Indexed: 10/20/2023] Open
Abstract
Mental health needs and disparities are widespread and have been exacerbated by the COVID-19 pandemic, with the greatest burden being on marginalized individuals worldwide. The World Health Organization developed the Mental Health Gap Action Programme to address growing global mental health needs by promoting task sharing in the delivery of psychosocial and psychological interventions. However, little is known about the training needed for non-specialists to deliver these interventions with high levels of competence and fidelity. This article provides a brief conceptual overview of the evidence concerning the training of non-specialists carrying out task-sharing psychosocial and psychological interventions while utilizing illustrative case studies from Kenya, Ethiopia, and the United States to highlight findings from the literature. In this article, the authors discuss the importance of tailoring training to the skills and needs of the non-specialist providers and their roles in the delivery of an intervention. This narrative review with four case studies advocates for training that recognizes the expertise that non-specialist providers bring to intervention delivery, including how they promote culturally responsive care within their communities.
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Affiliation(s)
- Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Eve S. Puffer
- Department of Psychology and Neuroscience, Global Health Institute, Duke University, Durham, NC, USA
| | - Lauren C. Ng
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
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Lewis-Kulzer J, Mburu M, Obatsa S, Cheruiyot J, Kiprono L, Brown S, Apaka C, Koros H, Muyindike W, Kwobah EK, Diero L, Aluda M, Wools-Kaloustian K, Goodrich S. Patient perceptions of facilitators and barriers to reducing hazardous alcohol use among people living with HIV in East Africa. Subst Abuse Treat Prev Policy 2023; 18:8. [PMID: 36737735 PMCID: PMC9896687 DOI: 10.1186/s13011-023-00520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hazardous alcohol use among people living with HIV is associated with poor outcomes and increased morbidity and mortality. Understanding the hazardous drinking experiences of people living with HIV is needed to reduce their alcohol use. METHODS We conducted 60 interviews among people living with HIV in East Africa with hazardous drinking histories. Interviews and Alcohol Use Disorder Identification Test (AUDIT) scores were conducted 41 - 60 months after their baseline assessment of alcohol use to identify facilitators and barriers to reduced alcohol use over time. RESULTS People living with HIV who stopped or reduced hazardous drinking were primarily motivated by their HIV condition and desire for longevity. Facilitators of reduced drinking included health care workers' recommendations to reduce drinking (despite little counseling and no referrals) and social support. In those continuing to drink at hazardous levels, barriers to reduced drinking were stress, social environment, alcohol accessibility and alcohol dependency. CONCLUSIONS Interventions that capacity-build professional and lay health care workers with the skills and resources to decrease problematic alcohol use, along with alcohol cessation in peer support structures, should be explored.
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Affiliation(s)
- Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16TH Street, 3rd Floor, San Francisco, CA, USA.
| | - Margaret Mburu
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Sarah Obatsa
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Julius Cheruiyot
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Lorna Kiprono
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Steve Brown
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, 410 W. 10th Street, HITS 3000, Indianapolis, IN, USA
| | - Cosmas Apaka
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Winnie Muyindike
- The Immune Suppression Syndrome Clinic, Mbarara University of Science and Technology, P.O. Box 40, Mbarara, Uganda
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, P.O. Box 3-30100, Eldoret, Kenya
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Maurice Aluda
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN, USA
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN, USA
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Bergman AJ, McNabb KC, Mlandu K, Akumbom A, Flores DD. Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000706. [PMID: 36962951 PMCID: PMC10022386 DOI: 10.1371/journal.pgph.0000706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/06/2022] [Indexed: 02/04/2023]
Abstract
While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso's metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH's ability to fit into social schemas and tailor care to individuals' unique intersecting identities. Economic security and safety should be considered in women's HIV care, while highlighting antiretrovirals' role in preserving strength and virility may improve care engagement among men.
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Affiliation(s)
- Alanna J Bergman
- Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine C McNabb
- Center for Infectious Disease and Nursing Innovation, School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Khaya Mlandu
- Izikhuba Unjani Clinic, Mngungundlovu, South Africa
| | - Alvine Akumbom
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Dalmacio Dennis Flores
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
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Stanton AM, Hornstein BD, Musinguzi N, Dolotina B, Orrell C, Amanyire G, Asiimwe S, Cross A, Psaros C, Bangsberg D, Hahn JA, Haberer JE, Matthews LT. Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda. J Int Assoc Provid AIDS Care 2023; 22:23259582231161029. [PMID: 36945860 PMCID: PMC10034296 DOI: 10.1177/23259582231161029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Identifying factors associated with alcohol use changes during pregnancy is important for developing interventions for people with HIV (PWH). Pregnant PWH (n = 202) initiating antiretroviral therapy in Uganda and South Africa completed two assessments, 6 months apart (T1, T2). Categories were derived based on AUDIT-C scores: "no use" (AUDIT-C = 0 at T1 and T2), "new use" (AUDIT-C = 0 at T1, >0 at T2), "quit" (AUDIT-C > 0 at T1, =0 at T2), and "continued use" (AUDIT-C > 0, T1 and T2). Factors associated with these categories were assessed. Most participants had "no use" (68%), followed by "continued use" (12%), "quit" (11%), and "new use" (9%). Cohabitating with a partner was associated with lower relative risk of "continued use." Borderline significant associations between food insecurity and higher risk of "new use" and between stigma and reduced likelihood of "quitting" also emerged. Alcohol use interventions that address partnership, food security, and stigma could benefit pregnant and postpartum PWH.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychological and Brain Sciences, 1846Boston University, Boston, USA
- 446213The Fenway Institute, Boston, USA
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, USA
| | - Benjamin D Hornstein
- Department of Medicine, 9967University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas Musinguzi
- Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda
- 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brett Dolotina
- Department of Epidemiology, 33638Mailman School of Public Health, Columbia University, New York, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gideon Amanyire
- Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda
- 560159Africa Health Research Institute, Durban, South Africa
| | - Stephen Asiimwe
- Global Health Collaborative, Mbarara, Uganda
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | - Anna Cross
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christina Psaros
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, USA
- 1811Harvard Medical School, Boston, USA
| | - David Bangsberg
- School of Public Health, Oregon Health and Science University/Portland State, Portland, USA
| | - Judith A Hahn
- Department of Medicine, 8785University of California San Francisco, San Francisco, USA
| | - Jessica E Haberer
- 1811Harvard Medical School, Boston, USA
- Center for Global Health, 2348Massachusetts General Hospital, Boston, USA
| | - Lynn T Matthews
- Department of Medicine, 9967University of Alabama at Birmingham, Birmingham, USA
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12
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Rose AL, Jack HE, Wan C, Toloza E, Bhattiprolu K, Ragunathan M, Schwartz KT, Magidson JF. Implementing Task-Shared Child and Adolescent Psychological Interventions in Low- and Middle-Income Countries: A Scoping Review. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-16. [PMID: 36507739 PMCID: PMC10258230 DOI: 10.1080/15374416.2022.2151450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Effective "task shared," or nonspecialist delivered, psychological interventions for children and adolescents have been developed or adapted in low- and middle-income countries with the aim of closing the global treatment gap for youth mental health care. Yet, delivery remains limited, in part due to the lack of knowledge of associated implementation, or process, outcomes. This scoping review aims to describe, examine the quality of, and synthesize findings on implementation outcomes of child and adolescent psychological interventions in low-and middle-income countries. METHODS PubMed, Web of Science, and PsycInfo were searched for studies on child and adolescent psychological interventions in low- and middle-income countries reporting on implementation outcomes. After abstract and full-text review, data were extracted and summarized on implementation outcomes and quality of implementation outcomes reporting. Implementation barriers and recommendations for addressing barriers were also charted and narratively synthesized. RESULTS Out of 5,207 manuscripts, 86 met inclusion criteria. Younger children were underrepresented. Studies largely reported feasibility and acceptability and did not state hypotheses or use conceptual models. Barriers primarily related to interventions being too complex, not an acceptable fit with participant cultures, and facilitators lacking time for or experiencing distress delivering interventions. Recommendations focused on increasing intervention fit and flexibility, training and support for facilitators, and linkages with existing systems. CONCLUSIONS Rigorous, broader implementation outcomes research is needed within child and adolescent psychological intervention research in low-and middle-income countries. Current evidence suggests the importance of the further developing strategies to increase acceptability to participants and better support facilitators.
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Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E. Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christine Wan
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Emilia Toloza
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kavya Bhattiprolu
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Meera Ragunathan
- Department of Psychology, University of Maryland, College Park, MD, USA
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13
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Giusto A, Friis-Healy EA, Kaiser BN, Ayuku D, Rono W, Puffer ES. Mechanisms of change for a family intervention in Kenya: An Integrated Clinical and Implementation Mapping approach. Behav Res Ther 2022; 159:104219. [PMID: 36283239 PMCID: PMC10155602 DOI: 10.1016/j.brat.2022.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.
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Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA; Duke Global Health Institute, Durham, NC, USA.
| | - Elsa A Friis-Healy
- Duke Global Health Institute, Durham, NC, USA; Department of Psychiatry Duke University School of Medicine, Durham, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Durham, NC, USA; University of California San Diego, Anthropology Department and Global Health Program, La Jolla, CA, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya.
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya.
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA; Department of Neuroscience and Psychology, Duke University, Durham, NC, USA.
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14
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Raya RP, Curtis H, Kulasegaram R, Cooke GS, Burns F, Chadwick D, Sabin CA. The British HIV Association national clinical audit 2021: Management of HIV and hepatitis C coinfection. HIV Med 2022; 24:471-479. [PMID: 36172948 DOI: 10.1111/hiv.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to describe clinical policies for the management of people with HIV/hepatitis C virus (HCV) coinfection and to audit routine monitoring and assessment of people with HIV/HCV coinfection attending UK HIV care. METHODS This was a clinic survey and retrospective case-note review. HIV clinics in the UK participated in the audit from May to July 2021 by completing an online questionnaire regarding their clinic's policies for the management of people with HIV/HCV coinfection, and by contributing to a case-note review of people living with HIV with detectable HCV RNA who were under the care of their service. RESULTS Ninety-five clinics participated in the clinic survey; of these, 15 (15.8%) were regional specialist centres, 19 (20.0%) were HIV services with their own coinfection clinics, 40 (42.1%) were HIV services that referred coinfected individuals to a local hepatology service and 20 (21.1%) were HIV services that referred to a regional specialist centre. Eighty-one clinics provided full caseload estimates; of the approximately 3951 people with a history of HIV/HCV coinfection accessing their clinics, only 4.9% were believed to have detectable HCV RNA, 3.15% of whom were already receiving or approved for direct-acting antiviral (DAA) treatment. In total, 29 (30.5%) of the clinics reported an impact of COVID-19 on coinfection care, including delays or reductions in the frequency of services, monitoring, treatment initiation and appointments, and changes to the way that treatment was dispensed. Case-note reviews were provided for 283 people with detectable HCV RNA from 74 clinics (median age 42 years, 74.6% male, 56.2% HCV genotype 1, 22.3% HCV genotype 3). Overall, 56% had not received treatment for HCV, primarily due to lack of engagement in care (54.7%) and/or being uncontactable (16.4%). CONCLUSIONS Our findings show that the small number of people with HIV with detectable HCV RNA in the UK should mean that it is possible to achieve HCV micro-elimination. However, more work is needed to improve engagement in care for those who are untreated for HCV.
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Affiliation(s)
- Reynie P Raya
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, Royal Free Campus, London, UK.,Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, London, UK
| | | | | | - Graham S Cooke
- British HIV Association (BHIVA), Letchworth, UK.,Department of Infectious Disease, Imperial College London, St Mary's Campus, London, UK
| | - Fiona Burns
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - David Chadwick
- British HIV Association (BHIVA), Letchworth, UK.,Department of Infectious Diseases, South Tees Hospitals NHS Foundation Trust, Centre for Clinical Infections, Middlesbrough, UK
| | - Caroline A Sabin
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, Royal Free Campus, London, UK.,Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, London, UK
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15
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Magidson JF, Rose AL, Regenauer KS, Brooke-Sumner C, Anvari MS, Jack HE, Johnson K, Belus JM, Joska J, Bassett IV, Sibeko G, Myers B. "It's all about asking from those who have walked the path": Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa. Addict Sci Clin Pract 2022; 17:52. [PMID: 36131304 PMCID: PMC9490994 DOI: 10.1186/s13722-022-00330-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers-individuals with lived experience of SUD-may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care. METHODS Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles. RESULTS On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles. CONCLUSIONS Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA.
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Kristen S Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jennifer M Belus
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Goodman Sibeko
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa.
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Building 408, GPO Box U1987, Perth, WA, 6845, Australia.
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16
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Costa-Cordella S, Grasso-Cladera A, Rossi A, Duarte J, Guiñazu F, Cortes CP. Internet-based peer support interventions for people living with HIV: A scoping review. PLoS One 2022; 17:e0269332. [PMID: 36040950 PMCID: PMC9426879 DOI: 10.1371/journal.pone.0269332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.
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Affiliation(s)
- Stefanella Costa-Cordella
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Aitana Grasso-Cladera
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Alejandra Rossi
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Javiera Duarte
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Flavia Guiñazu
- Web Intelligence Centre, Facultad de Ingeniería Industrial, Universidad de Chile, Santiago, Chile
| | - Claudia P. Cortes
- Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile
- Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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17
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Rose AL, Belus JM, Hines AC, Barrie I, Regenauer KS, Andersen LS, Joska JA, Ciya N, Ndamase S, Myers B, Safren SA, Magidson JF. Patient and provider perceptions of a peer-delivered intervention (' Khanya') to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis. Glob Ment Health (Camb) 2022; 9:439-447. [PMID: 36618732 PMCID: PMC9807005 DOI: 10.1017/gmh.2022.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
Background Despite a high prevalence of problematic substance use among people living with HIV in South Africa, there remains limited access to substance use services within the HIV care system. To address this gap, our team previously developed and adapted a six-session, peer-delivered problem-solving and behavioral activation-based intervention (Khanya) to improve HIV medication adherence and reduce substance use in Cape Town. This study evaluated patient and provider perspectives on the intervention to inform implementation and future adaptation. Methods Following intervention completion, we conducted semi-structured individual interviews with patients (n = 23) and providers (n = 9) to understand perspectives on the feasibility, acceptability, and appropriateness of Khanya and its implementation by a peer. Patients also quantitatively ranked the usefulness of individual intervention components (problem solving for medication adherence 'Life-Steps', behavioral activation, mindfulness training, and relapse prevention) at post-treatment and six months follow-up, which we triangulated with qualitative feedback to examine convergence and divergence across methods. Results Patients and providers reported high overall acceptability, feasibility, and appropriateness of Khanya, although there were several feasibility challenges. Mindfulness and Life-Steps were identified as particularly acceptable, feasible, and appropriate components by patients across methods, whereas relapse prevention strategies were less salient. Behavioral activation results were less consistent across methods. Conclusions Findings underscore the importance of examining patients' perspectives on specific intervention components within intervention packages. While mindfulness training and peer delivery models were positively perceived by consumers, they are rarely used within task-shared behavioral interventions in low- and middle-income countries.
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Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Jennifer M. Belus
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Abigail C. Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Issmatu Barrie
- Department of Psychology, University of Maryland, College Park, MD, USA
- Westat, Rockville, MD, USA
| | | | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Nonceba Ciya
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa
| | - Sibabalwe Ndamase
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa
| | - Bronwyn Myers
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Australia
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Haldane V, Jung AS, De Foo C, Shrestha P, Urdaneta E, Turk E, Gaviria JI, Boadas J, Buse K, Miranda JJ, Strathdee SA, Barratt A, Kazatchkine M, McKee M, Legido-Quigley H. Integrating HIV and substance misuse services: a person-centred approach grounded in human rights. Lancet Psychiatry 2022; 9:676-688. [PMID: 35750060 DOI: 10.1016/s2215-0366(22)00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/13/2022]
Abstract
Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anne-Sophie Jung
- School of Politics and International Studies, University of Leeds, Leeds, UK.
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | | | - Eva Turk
- Institute for Health and Society, University of Oslo, Oslo, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Juan I Gaviria
- Coordinación de Vigilancia Epidemiologica e Infectologia, Hospital del Instituto Ecuatoriano del Seguro Social (IESS) Sur de Quito, Quito, Ecuador
| | - Jesus Boadas
- Centro de Rehabilitación Mental ANSALUD, Santo Domingo, Dominican Republic
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | | | - Ashley Barratt
- Positive21, London, UK; ReShape/International HIV Partnerships-European Chemsex Forum, London, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Morford KL, Muvvala SB, Chan PA, Cornman DH, Doernberg M, Porter E, Virata M, Yager JE, Fiellin DA, Edelman EJ. Patients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study. J Subst Abuse Treat 2022; 139:108767. [PMID: 35341613 PMCID: PMC9187601 DOI: 10.1016/j.jsat.2022.108767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/22/2021] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND While substance use disorders (SUD) disproportionately impact people with HIV (PWH), HIV clinics inconsistently provide evidence-based medications for addiction treatment (MAT). Patient receptivity to MAT is critical to enhance addiction treatment in these settings. However, we know little from patients about how to best integrate MAT into HIV clinics. METHODS This qualitative study used four focus groups informed by the Promoting Action on Research Implementation in Health Services framework to identify barriers and facilitators to receiving opioid, alcohol, and tobacco use disorder care in HIV clinics. The study population included 28 patients with HIV and SUD receiving care at one of four HIV clinics in the northeastern United States. Focus groups were recorded and transcribed for content analysis. The study also performed a brief survey assessing demographics and behaviors. RESULTS Focus groups revealed several major themes related to MAT in HIV clinics. Barriers included stigma around MAT, knowledge deficits about available MAT options and the impact of substance use on PWH, concerns about medication side effects, substance use screening without adequate clinician follow-up, and peers who discouraged MAT. Facilitators included recognition of substance use as a threat to overall health, integrated care from HIV clinicians, and support for addiction treatment from peers with lived experience. CONCLUSIONS Efforts to enhance MAT in HIV clinics should include patient education to help them recognize addiction as a chronic disease with available medication treatment options; clinician and staff training to promote integrated, multidisciplinary screening and treatment; and thoughtful inclusion of peers with lived experience.
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Affiliation(s)
- Kenneth L Morford
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States.
| | - Srinivas B Muvvala
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States
| | - Philip A Chan
- Department of Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, United States
| | - Deborah H Cornman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, United States
| | - Molly Doernberg
- Yale School of Public Health, 60 College Street, New Haven, CT 06510, United States
| | - Elizabeth Porter
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
| | - Michael Virata
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
| | - Jessica E Yager
- SUNY Downstate, 450 Clarkson Ave, Suite J, Brooklyn, NY 11203, United States
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, United States; Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue #260, New Haven, CT 06519, United States
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, United States
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20
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Belus JM, Rose AL, Andersen LS, Ciya N, Joska JA, Myers B, Safren SA, Magidson JF. Adapting a Behavioral Intervention for Alcohol Use and HIV Medication Adherence for Lay Counselor Delivery in Cape Town, South Africa: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 29:454-467. [PMID: 36171964 PMCID: PMC9512118 DOI: 10.1016/j.cbpra.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Human immunodeficiency virus (HIV) and problematic alcohol use are two ongoing and interconnected epidemics in South Africa, with untreated problematic alcohol use associated with poorer HIV treatment outcomes and disease progression. A lack of trained mental health providers is a primary barrier to increasing access to evidence-based treatment in this setting. To address this gap, we integrated evidence-based intervention components for problematic alcohol use and antiretroviral therapy (ART) adherence, adapted for lay provider delivery in an HIV primary care setting in Cape Town, South Africa. The intervention, locally termed "Khanya" in isiXhosa, which means glow, direction, or light, comprises Life Steps adherence counseling, motivational interviewing, behavioral activation, and relapse prevention, including mindfulness-based relapse prevention components. In this case series, we present a detailed description of the intervention and provide three clinical cases of individuals who received the Khanya intervention to showcase necessary clinical adaptations and the supervision needed for optimal treatment delivery, flexibility in intervention delivery, and overall successes and challenges. We present descriptive data on alcohol use and ART adherence outcomes for the cases to supplement the narrative discussion. Successes of intervention delivery included participant uptake of mindfulness skills, reductions in alcohol use despite varying levels of motivation, and interventionist mastery over various clinical skills. Challenges included delivering the intervention within the allotted time and the strong influence of substance-using social networks. Overall, a pragmatic approach to intervention delivery was necessary, as was ongoing support for the interventionist to promote fidelity to both treatment components and therapeutic skills. Trial registration ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
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Affiliation(s)
| | | | | | | | | | - Bronwyn Myers
- South African Medical Research Council, University of Cape Town
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21
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Regenauer KS, Kleinman MB, Belus JM, Myers B, Joska JA, Magidson JF. Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa. Drug Alcohol Depend 2022; 233:109364. [PMID: 35219998 PMCID: PMC8978067 DOI: 10.1016/j.drugalcdep.2022.109364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite HIV and problematic drinking often co-occurring in South Africa (SA), limited research has examined how HIV stigma relates to alcohol outcomes, how alcohol stigma relates to HIV outcomes, and moderators of these associations. This study examined the intersection of HIV and alcohol stigmas on HIV and alcohol outcomes, and the role of avoidant behavior in moderating these relationships in SA. METHODS We assessed biomarker-verified measures of antiretroviral therapy (ART) adherence, HIV viral load (VL), and alcohol consumption, and self-reported measures of internalized HIV/alcohol stigmas, avoidant behavior, ART adherence, and problematic drinking-alcohol use that will likely lead to health or other problems-cross-sectionally among people with HIV (PWH) and problematic drinking (N = 64). We conducted regression analyses with interaction terms. FINDINGS A significant relationship was found between internalized alcohol stigma and VL suppression, with higher levels of alcohol stigma associated with a lower likelihood of suppression (OR=1.68, 95%CI[1.11-2.65], p = .02). Avoidance significantly moderated the relationship between internalized HIV stigma and problematic drinking; higher HIV stigma was associated with lower problematic drinking only at low levels of avoidance (b(SE)= -1.92(.85), p = .03). CONCLUSIONS This study is the first to examine associations between HIV and alcohol stigmas, avoidance, and both HIV and alcohol outcomes in SA. Findings contribute to our understanding of how alcohol stigma relates to biological HIV outcomes, and the role of avoidance in the relationship between internalized HIV stigma and problematic drinking. Findings may inform future clinical interventions aiming to address the impact of stigma on HIV treatment outcomes and alcohol use among PWH in SA.
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Affiliation(s)
- Kristen S Regenauer
- Department of Psychology, University of Maryland, College Park, Maryland, United States.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, Maryland, United States
| | - Jennifer M Belus
- Department of Psychology, University of Maryland, College Park, Maryland, United States; Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia; Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, Tygerberg, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, Maryland, United States
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22
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Ngcobo S, Scheepers S, Mbatha N, Grobler E, Rossouw T. Roles, Barriers, and Recommendations for Community Health Workers Providing Community-Based HIV Care in Sub-Saharan Africa: A Review. AIDS Patient Care STDS 2022; 36:130-144. [PMID: 35438523 PMCID: PMC9057893 DOI: 10.1089/apc.2022.0020] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While the impact of Community Health Workers (CHWs) on home-based human immunodeficiency virus (HIV) care has been documented, barriers and recommendations have not been systematically reviewed. Following the reporting requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used an aggregative narrative synthesis approach to summarize the results of qualitative studies published between January 1, 2000, and November 6, 2020 in the following databases: PubMed, CINAHL, PsychINFO, Web of Science, and Google Scholar. In total, 17 studies met the selection criteria and were included in the analysis. They reported on a range of roles played by CHWs in HIV care, including education and health promotion; HIV-specific care (HIV testing services; screening for opportunistic infections and acute illness); medication delivery; tracing persons who had defaulted from care; and support (treatment support; referral; home-based care; and psychosocial support). Many different barriers to community-based HIV care were reported and centered on the following themes: Stigma and nondisclosure; inadequate support (lack of resources, inadequate training, inadequate funding, and inadequate monitoring); and health system challenges (patients' preference for more frequent visits and poor integration of CHWs in the wider health care system). Recommendations to mitigate these barriers included: addressing HIV-related stigma; introducing updated and relevant CHW training; strengthening the supervision of CHWs; coordinating care between the home and facilities; incorporating patient-centered mHealth approaches; and committing to the funding and resources needed for successful community-based care. In summary, CHWs are providing a variety of important community-based HIV services but face challenges with regards to training, resources, and supervision.
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Affiliation(s)
- Sanele Ngcobo
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Susan Scheepers
- Medical Library, University of Pretoria, Pretoria, South Africa
| | - Nothando Mbatha
- Department of Public Health and University of Pretoria, Pretoria, South Africa
| | - Estelle Grobler
- Medical Library, University of Pretoria, Pretoria, South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
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23
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Belus JM, Regenauer KS, Hutman E, Rose AL, Burnhams W, Andersen LS, Myers B, Joska JA, Magidson JF. Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100035. [PMID: 36845899 PMCID: PMC9948858 DOI: 10.1016/j.dadr.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/15/2021] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
Introduction Despite efforts to detect and treat problematic substance use (SU) among people living with HIV (PLWH) in South Africa, integration of HIV and SU services is limited. We sought to understand whether PLWH and problematic SU were: (a) routinely referred to SU treatment, a co-located Matrix clinic, (b) used SU treatment services when referred, and (c) the individual amount spent on SU. Methods Guided by the RE-AIM implementation science framework, we examined patient-level quantitative screening and baseline data from a pilot clinical trial for medication adherence and problematic SU. Qualitative data came from semi-structured interviews with HIV care providers (N = 8), supplemented by patient interviews (N = 15). Results None of the screened patient participants (N = 121) who were seeking HIV care and had problematic SU were engaged in SU treatment, despite the freely available co-located SU treatment program. Only 1.5% of the enrolled patient study sample (N = 66) reported lifetime referral to SU treatment. On average, patients with untreated SU spent 33.3% (SD=34.5%) of their monthly household income on substances. HIV care providers reported a lack of clarity about the SU referral process and a lack of direct communication with patients about patients' needs or interest in receiving an SU referral. Discussion SU treatment referrals and uptake were rare among PLWH reporting problematic SU, despite the high proportion of individual resources allocated to substances and the co-located Matrix site. A standardized referral policy between the HIV and Matrix sites may improve communication and uptake of SU referrals.
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Affiliation(s)
- Jennifer M. Belus
- Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland,University of Basel, Basel, Switzerland,University of Maryland, Department of Psychology, College Park, MD, USA,Corresponding author at: Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4051, Switzerland.
| | | | - Elizabeth Hutman
- University of Maryland, School of Public Health, College Park, MD, USA
| | - Alexandra L. Rose
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Warren Burnhams
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - Lena S. Andersen
- University of Copenhagen, Global Health Section, Department of Public Health, Copenhagen, Denmark
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa,University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
| | - John A. Joska
- University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
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24
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Myers B, Koch JR, Johnson K, Harker N. Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. Addict Sci Clin Pract 2022; 17:8. [PMID: 35109915 PMCID: PMC8812030 DOI: 10.1186/s13722-022-00289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nadine Harker
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
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Abbas R, Wason J, Michiels S, Teuff GL. Role of peer support in a hepatitis C elimination programme. J Viral Hepat 2022; 29:43-51. [PMID: 34664352 PMCID: PMC7613915 DOI: 10.1111/jvh.13626] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023]
Abstract
Many people with chronic hepatitis C infection don't engage in treatment. To eliminate hepatitis C and avoid health inequalities therapy must be provided to everyone. In other diseases peers with lived experience of the condition have improved care but, for hepatitis C, studies have not shown unequivocal benefit. We completed a retrospective analysis of the English National Health Service treatment registry comparing treatment networks with and without peers using Bayesian Poisson (for count outcomes) or Bayesian Binomial (for proportion outcomes) mixed effects models with time fixed effects. For each outcome, we estimated relative ratio (RR-Poisson model) or odds ratio (Odds Ratio (OR)-Binomial model) between peer and non-peer networks. We analysed 30,729 patients within 20 operational delivery networks. In networks with peers there was an increase in the number of people initiating therapy (RR 1.12 95%, credible interval 1.02-1.21) and an increase in the proportion completing therapy (OR 2.45 95%, credible interval 1.49-3.84). However, we saw no change in proportions of people using drugs who initiated therapy nor any significant change in virological response (OR 1.14 95% credible interval 0.979-1.36). We repeated the analysis looking at the impact of peers two months after they had been introduced, when they had established networks of contacts, and saw an increase in the proportion of people treated in addiction services. In treating patients with chronic hepatitis C infection the inclusion of peer supporters may increase the number of people who initiate and complete antiviral therapy.
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Affiliation(s)
- Rachid Abbas
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stefan Michiels
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
| | - Gwénaёl Le Teuff
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
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Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa. PLoS One 2021; 16:e0258352. [PMID: 34665831 PMCID: PMC8525762 DOI: 10.1371/journal.pone.0258352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background A systematic review of randomised trials may be conclusive signalling no further research is needed; or identify gaps requiring further research that may then be included in review updates. In qualitative evidence synthesis (QES), the rationale, triggers, and methods for updating are less clear cut. We updated a QES on adherence to anti-retroviral treatment to examine if thematic saturation renders additional research redundant. Methods We adopted the original review search strategy and eligibility criteria to identify studies in the subsequent three years. We assessed studies for conceptual detail, categorised as ‘rich’ or ‘sparse’, coding the rich studies. We sought new codes, and appraised whether findings confirmed, extended, enriched, or refuted existing themes. Finally, we examined if the analysis impacted on the original conceptual model. Results After screening 3895 articles, 301 studies met the inclusion criteria. Rich findings from Africa were available in 82 studies; 146 studies were sparse, contained no additional information on specific populations, and did not contribute to the analysis. New studies enriched our understanding on the relationship between external and internal factors influencing adherence, confirming, extending and enriching the existing themes. Despite careful evaluation of the new literature, we did not identify any new themes, and found no studies that refuted our theory. Conclusions Updating an existing QES using the original question confirmed and sometimes enriched evidence within themes but made little or no substantive difference to the theory and overall findings of the original review. We propose this illustrates thematic saturation. We propose a thoughtful approach before embarking on a QES update, and our work underlines the importance of QES priority areas where further primary research may help, and areas where further studies may be redundant.
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Giusto A, Johnson SL, Lovero KL, Wainberg ML, Rono W, Ayuku D, Puffer ES. Building community-based helping practices by training peer-father counselors: A novel intervention to reduce drinking and depressive symptoms among fathers through an expanded masculinity lens. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103291. [PMID: 34107387 PMCID: PMC8530851 DOI: 10.1016/j.drugpo.2021.103291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/31/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Problem drinking and co-occurring depression symptoms affect men at high rates and are associated with increased risk of family violence. In low- and middle-income countries, there is a large treatment gap for services due to a lack of human resources. Moreover, masculine norms are a barrier to men seeking treatment for drinking and depression in healthcare settings. We examined an approach for engaging peer-fathers to deliver an intervention to reduce alcohol use, improve depressive symptoms, and increase family involvement among fathers in Kenya with problem drinking. The intervention-LEAD (Learn, Engage, Act, Dedicate)-combines motivational interviewing, behavioral activation, and masculinity discussion strategies. METHODS Community and religious leaders nominated fathers with no mental health training to serve as counselors (N=12); clients were recruited through community referrals. Nominated fathers completed a 10-day training beginning with treatment principles followed by manualized content. Three counselors were selected after training based on quantitative and qualitative assessments of communication skills, intervention knowledge, willingness to learn, ability to use feedback, and empathy. Supervision was tiered with local supervisors and clinical psychologist consultation. During LEAD delivery, counselor fidelity, delivery quality, and general and intervention-specific competencies were assessed. To evaluate acceptability, qualitative interviews were conducted with lay-counselors and clients (N=11). Descriptive statistics were calculated for quantitative outcomes; interviews were analyzed using thematic analysis. RESULTS Peer-father lay counselors treated nine clients, with eight completing treatment. Counselors reached high rates of fidelity (93.8%) and high to optimal ratings on quality of delivery, clinical competency, and intervention-specific competencies. Qualitative results suggested high acceptability, with counselors expressing satisfaction and empowerment in their roles. Clients likewise described positive experiences with counselors. CONCLUSIONS Findings provide initial support for the acceptability and feasibility of recruitment, selection, and training processes for peer-father lay counselors to deliver LEAD through a lens of masculinity that aligned with clients help-acceptance practices.
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Affiliation(s)
- Ali Giusto
- Columbia University Medical Center, USA.
| | - Savannah L Johnson
- Duke University, Department of Psychology and Neuroscience, Durham, NC, 27705, USA
| | - Kathryn L Lovero
- New York State Psychiatric Institute, Columbia, University, Department of Psychiatry, New York, NY 10032, USA
| | - Milton L Wainberg
- New York State Psychiatric Institute, Columbia, University, Department of Psychiatry, New York, NY 10032, USA
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya
| | - David Ayuku
- Moi Teaching & Referral Hospital, Department of Behavioral Sciences, Eldoret, Rift Valley, Kenya
| | - Eve S Puffer
- Duke University, Department of Psychology and Neuroscience; Duke Global Health Institute, Durham, NC, 27705, USA
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Magidson JF, Joska JA, Belus JM, Andersen LS, Regenauer KS, Rose AL, Myers B, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa. J Int AIDS Soc 2021; 24 Suppl 2:e25720. [PMID: 34164935 PMCID: PMC8222840 DOI: 10.1002/jia2.25720] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low-resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. METHODS A pilot randomized hybrid type 1 effectiveness-implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task-shared, peer-delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on-site AOD treatment. Implementation outcomes, defined by Proctor's model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post-treatment (three months) measured via real-time electronic adherence monitoring, and AOD measured using biomarker and self-report assessments over six months. Data collection was conducted from August 2018 to April 2020. RESULTS AND DISCUSSION Ninety-one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment-by-time interaction for ART adherence (estimate = -0.287 [95% CI = -0.507, -0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self-reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow-back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). CONCLUSIONS Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non-adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task-sharing models for behavioral health in resource-limited, global settings.
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Affiliation(s)
| | - John A Joska
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | - Lena S Andersen
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilDivision of Addiction PsychiatryDepartment of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Sybil Majokweni
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | - Conall O’Cleirigh
- Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
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Kuo CC, Sibeko G, Akande M, Allie S, Tisaker N, Stein DJ, Becker SJ. Advancing a cascading train-the-trainer model of frontline HIV service providers in South Africa: protocol of an implementation trial. Addict Sci Clin Pract 2021; 16:27. [PMID: 33931100 PMCID: PMC8085637 DOI: 10.1186/s13722-021-00236-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND South Africa is marked by high rates of both HIV and alcohol use, and there is a detrimental synergistic relationship between these two epidemics. The Institute of Medicine recommends integrated care for alcohol use treatment and HIV, but implementation of integrated services remains a challenge in South Africa. This protocol describes a study designed to evaluate trainer, provider-, and patient encounter-level outcomes relating to the national rollout of a cascade train-the-trainer model of task-sharing to build capacity of the HIV workforce to deliver Screening, Brief Intervention, and Referral to Treatment (SBIRT) to address risky alcohol use. METHODS This 5 year protocol consists of two phases. First, we will finalize development of a robust SBIRT train-the-trainer model, which will include an SBIRT Trainer Manual, Provider Resource Guide, fidelity observational coding system, case vignettes, and a curriculum for ongoing consultation sessions. Materials will be designed to build the capacity of novice trainers to train lay workers to deliver SBIRT with fidelity. Second, we will recruit 24-36 trainers and 900 providers in order to evaluate the effects of the SBIRT train-the-trainer model on trainer- (e.g., fidelity, knowledge), provider- (e.g., SBIRT attitudes, confidence, acceptability), and patient encounter- (e.g., proportion receiving screening, brief intervention, referral to treatment) level variables. Data on patient encounters will be tracked by providers on programmed tablets or scannable paper forms in real-time. Providers will report on SBIRT delivery on an ongoing basis over a 6-months period. Additionally, we will test the hypothesis that trainer-level factors will account for a substantial proportion of variability in provider-level factors which will, in turn, account for a substantial proportion of variability in patient encounter-level outcomes. DISCUSSION This protocol will allow us to take advantage of a unique national training initiative to gather comprehensive data on multi-level factors associated with the implementation of SBIRT in HIV service settings. In the long-term, this research can help to advance the implementation of integrated alcohol-HIV services, providing lessons that can extend to other low-and-middle income countries confronting dual epidemics.
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Affiliation(s)
- Caroline C Kuo
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, P.O. Box G-S121-5, Providence, RI, 02912, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Morayo Akande
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, P.O. Box G-S121-5, Providence, RI, 02912, USA
| | - Shaheema Allie
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nurain Tisaker
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sara J Becker
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, P.O. Box G-S121-5, Providence, RI, 02912, USA.
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Nguemo Djiometio JB, Djiadeu P, Mbuagbaw L, Njoroge I, Nelson LE, Kahan M. Individuals' experiences of the integration of substance use/addiction and HIV/AIDS services in community settings: a qualitative systematic review protocol. JBI Evid Synth 2021; 18:2687-2693. [PMID: 32740031 DOI: 10.11124/jbisrir-d-19-00391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of this systematic review are: i) to identify, appraise, and synthesize the best available evidence on individuals' experiences of the integration of substance use/addiction and HIV/AIDS services in community settings, and ii) to identify barriers to and facilitators of the integration of the services. INTRODUCTION The integration of drug use treatment and HIV services has shown to improve HIV prevention, decrease HIV infection and progression, while improving access to social and support services among substance users. Combined pharmacological and behavioral drug use treatments have been proven to diminish behaviors that increase HIV risk, decrease incidence of the disease, and improve adherence to antiretroviral therapy among individuals who use drugs and are HIV-positive. INCLUSION CRITERIA The populations of interest in this review include patients who have experienced integrated substance use/addiction and HIV services, as well as health care professionals and policy makers who have been involved in developing or implementing integrated substance use/addiction and HIV/AIDS services. Eligible studies will focus on the views, attitudes, understandings, and perceptions of patients, health care professionals, and policy makers resulting from experience in developing or implementing strategies that have or could inform the integration of substance use/addiction and HIV/AIDS services in community settings. METHODS Searches will be conducted in MEDLINE, Embase, PsycINFO, and CINHAL. The search for unpublished studies will include OpenGrey, Grey Matters, New York Academy of Medicine's Grey Literature Report, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Selected studies will be critically appraised by two independent reviewers for methodological quality. Data will be extracted and then synthesized following the JBI meta-aggregative approach. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020185858.
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Affiliation(s)
- Joseph B Nguemo Djiometio
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.,Substance Use Service/META:PHI, Women's College Hospital, Toronto, ON, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Irene Njoroge
- Substance Use Service/META:PHI, Women's College Hospital, Toronto, ON, Canada
| | - LaRon E Nelson
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,School of Nursing, Yale University, New Haven, CT, USA
| | - Meldon Kahan
- Substance Use Service/META:PHI, Women's College Hospital, Toronto, ON, Canada
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Satinsky EN, Kleinman MB, Tralka HM, Jack HE, Myers B, Magidson JF. Peer-delivered services for substance use in low- and middle-income countries: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103252. [PMID: 33892281 DOI: 10.1016/j.drugpo.2021.103252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Addressing the burden of disease associated with substance use is a global priority, yet access to treatment is limited, particularly in low- and middle-income countries (LMICs). Peers, individuals with lived experience of substance use, may play an important role in expanding access to treatment, supporting outcomes, and reducing stigma. While peer-delivered services for substance use have been scaling up in high-income countries (HICs), less is known about their application in LMICs. This systematic review synthesizes the evidence of peer-delivered services for substance use in LMICs. METHODS PsycINFO, Embase, Global Health, PubMed, and six region-specific databases were searched, and articles that described peer-delivered services for substance use and related outcomes in LMICs were included. Risk of bias was evaluated using tools appropriate for each study design. To provide a more stringent evaluation of structured interventions, a subset of articles was analyzed using the Cochrane Effective Practice and Organization of Care (EPOC) framework. RESULTS The search yielded 6540 articles. These were narrowed down to 34 included articles. Articles spanned four continents, included quantitative and qualitative methodologies, and primarily targeted infectious disease risk behaviors. Ten articles were included in the EPOC sub-analysis. In the context of high risk of bias, some of these articles demonstrated positive impacts of the peer-delivered services, including reductions in risk behaviors and increases in infectious disease knowledge scores, while many others showed no significant difference in outcomes between peer intervention and control groups. CONCLUSIONS Peer-delivered services may be feasible for addressing substance use and reducing infectious disease risk behaviors in LMICs, where there are severe human resource shortages. Globally, peers' lived experience is valuable for engaging patients in substance use treatment and harm reduction services. Further research is needed to better characterize and quantify outcomes for peer-delivered services for substance use in LMICs.
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Affiliation(s)
- Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Hannah M Tralka
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Department of Medicine, University of Washington, Seattle, WA, USA; Centre for Global Mental Health, King's College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South Africa Medical Research Council, Cape Town, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Ametaj AA, Smith AM, Valentine SE. A Stakeholder-Engaged Process for Adapting an Evidence-Based Intervention for Posttraumatic Stress Disorder for Peer Delivery. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:793-809. [PMID: 33813717 DOI: 10.1007/s10488-021-01129-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Peer providers represent a growing sector of the U.S. workforce, yet guidance is needed on best practices for adapting behavioral health interventions for peer delivery. METHODS We utilized the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME; Wiltsey Stirman et al. 2013, 2019) to describe how we systematically adapted Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD) for peer delivery. Our process was iterative and relied on engagement of multiple stakeholders, including a work group of organizational leaders (N = 5), peer interventionists (N = 4), intervention experts (N = 2), and trial participants (N = 18). The FRAME was used to guide rapid coding across multiple data sources, including researcher field notes, meeting minutes, and intervention manual documents, and content analysis of semi-structured interviews with peer interventionists and trial participants. RESULTS Phase 1 (pre-trial) focused on modifications for fit with the local context and peer model. Key modifications focused on improving intervention design and packaging, removing clinical and stigmatizing language, and addressing peer interventionist training gaps. We used a hybrid approach to delivery, whereby we integrated peer model principles (self-disclosure, mutuality) into a directive approach. Phase 2 (trial) included reactive fidelity-consistent adaptations, such as additional educational resources. Phase 3 (post-trial) focused on adaptations to support roll-out of the intervention at the peer organization (e.g., group format). CONCLUSION Our stakeholder-engaged process may serve as a helpful exemplar to others tailoring interventions for peer delivery. Future research is needed to understand the role of stakeholder engagement and adaptation in implementation success.
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Affiliation(s)
- Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Ash M Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA
| | - Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA. .,Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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Kleinman MB, Doran K, Felton JW, Satinsky EN, Dean D, Bradley V, Magidson JF. Implementing a peer recovery coach model to reach low-income, minority individuals not engaged in substance use treatment. Subst Abus 2020; 42:726-734. [PMID: 33270540 DOI: 10.1080/08897077.2020.1846663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Low-income, racial/ethnic minority individuals face significant barriers in access to substance use (SU) treatment. Peer recovery coaches (PRCs), individuals with lived experience with substance use disorder (SUD), may be uniquely well suited to assist those encountering barriers to treatment. PRCs can also help reach those not engaged in treatment to promote harm reduction and support linkage-to-care when embedded in community rather than clinical settings. This study evaluated a community-based program in which a PRC facilitated linkage to and supported retention in SU treatment. Methods: Guided by the RE-AIM framework, we evaluated implementation of the intervention in a community resource center (CRC) serving homeless and low-income residents of Baltimore City. We examined the reach, effectiveness, adoption, and implementation of this PRC model. Results: Of 199 clients approached by or referred to the PRC, 39 were interested in addressing their SU. Of those interested in addressing SU, the PRC linked 64.1% (n = 25) to treatment and was able to follow up with 59.0% (n = 23) at prespecified time points after linkage (24-48 hours, 2 weeks, and 1 month). Fifty-two percent (n = 13) of clients linked to SU treatment remained in treatment at 30 days post-linkage. Of clients who did not remain in treatment, 77% (n = 10) continued contact with the PRC. Conclusions: Results indicate the utility of the CRC's approach in linking people to treatment for SU and addressing barriers to care through work with a PRC. Findings also highlight important barriers and facilitators to implementation of this model, including the need for adaptation based on individual goals and fluctuations in readiness for treatment.
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Affiliation(s)
- Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kelly Doran
- Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Julia W Felton
- Department of Public Health, Michigan State University, Flint, MI, USA
| | - Emily N Satinsky
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Dwayne Dean
- Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Valerie Bradley
- Department of Psychology, University of Maryland, College Park, MD, USA
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Regenauer KS, Myers B, Batchelder AW, Magidson JF. "That person stopped being human": Intersecting HIV and substance use stigma among patients and providers in South Africa. Drug Alcohol Depend 2020; 216:108322. [PMID: 33010712 PMCID: PMC7673102 DOI: 10.1016/j.drugalcdep.2020.108322] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND South Africa has the largest number of people living with HIV in the world. Concurrently, problematic alcohol and other drug use (AOD) is prevalent in the country and associated with poor HIV treatment outcomes. Further, the high rates of stigma surrounding HIV and AOD contribute to poor HIV outcomes. Yet, how HIV stigma and AOD stigma together may affect HIV care has not been extensively studied in this context. Thus, we explored HIV and AOD providers' and patients' experiences of HIV and AOD stigma. METHODS We conducted 30 semi-structured interviews with patients living with HIV who were struggling with HIV medication adherence and problematic AOD use (n = 19), and providers involved in HIV or AOD treatment (n = 11) in Cape Town, South Africa to assess how HIV and AOD stigmas manifest and relate to HIV care. FINDINGS Two main themes around the intersection of HIV and AOD and their related stigmas were identified: (1) how patients use AOD to cope with HIV stigma; and (2) enacted/ anticipated AOD stigma from HIV care providers, which acts as a barrier to HIV care. CONCLUSIONS Intersecting HIV and AOD stigmas exist at multiple levels and increase barriers to HIV care in this setting. Accordingly, it is important that future interventions address both these stigmas at multiple levels.
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Affiliation(s)
- Kristen S Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, 20740, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zyl Drive, Parow, 7505, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital/ Harvard Medical School, 1 Bowdoin Square, Boston, MA, 02114, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, 20740, USA
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Rogers BG, Arnold T, Schierberl Scherr A, Strong SH, Holcomb R, Daley Ndoye C, Pinkston M, Chan PA. Adapting Substance Use Treatment for HIV Affected Communities During COVID-19: Comparisons Between a Sexually Transmitted Infections (STI) Clinic and a Local Community Based Organization. AIDS Behav 2020; 24:2999-3002. [PMID: 32462344 PMCID: PMC7251798 DOI: 10.1007/s10461-020-02933-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Medicine, The Miriam Hospital, Providence, RI, USA.
| | - Trisha Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Anna Schierberl Scherr
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychology, University of Massachusetts, Dartmouth, Dartmouth, MA, USA
- Department of Psychiatry, The Miriam Hospital, Providence, RI, USA
| | - Sabrina H Strong
- Department of Medicine, The Miriam Hospital, Providence, RI, USA
| | | | | | - Megan Pinkston
- Department of Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, The Miriam Hospital, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, The Miriam Hospital, Providence, RI, USA
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Gichane MW, Wechsberg WM, Ndirangu J, Browne FA, Bonner CP, Grimwood A, Shaikh N, Howard B, Zule WA. Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa. Drug Alcohol Depend 2020; 215:108206. [PMID: 32771909 PMCID: PMC7502463 DOI: 10.1016/j.drugalcdep.2020.108206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND South Africa has the highest HIV prevalence globally, which disproportionately affects women. Hazardous alcohol use reduces antiretroviral adherence which can lead to adverse health. Few evidence-based interventions addressing hazardous alcohol use and HIV have been implemented in real-world settings. This study aimed to evaluate implementation outcomes from the Women's Health CoOp (WHC)-an evidence-based gender-focused HIV intervention-which was implemented in Cape Town. METHODS We conducted this implementation science trial using a modified stepped-wedge design. Four health clinics were paired with four substance use rehabilitation programs and randomized into four cycles. Women living with HIV and who use alcohol or other drugs were recruited into each cycle (n = 120 each cycle). We assessed adoption, acceptability, appropriateness, cost, and fidelity using a mixed methods approach. RESULTS Adoption: 100 % of staff trained in the WHC and designated as interventionists delivered one or more workshops. Acceptability: Interventionists found the WHC content beneficial to their patients and the WHC improved connections between clinical units in facilities. Appropriateness: The WHC aligned with facility goals to improve antiretroviral adherence and reduce alcohol use; however, there were implementation challenges, including staff shortages, stigma, and few places to refer women for supportive services. Cost: The cost of implementing the WHC was 20.59 ZAR (1.40 USD) per attendee. Fidelity: Interventionists implemented the WHC with high fidelity and quality. CONCLUSIONS The findings suggest it is feasible to integrate the WHC into usual-care settings. Future efforts to scale up the intervention will need to address social and structural implementation challenges. TRIAL REGISTRATION NCT02733003 approved 1/21/2016.
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Affiliation(s)
- Margaret W Gichane
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Wendee M Wechsberg
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445, Chapel Hill, NC, 27599, USA; Department of Psychology, North Carolina State University, 2310 Katharine Stinson Drive Raleigh, Raleigh, NC, 27607, USA; Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Jacqueline Ndirangu
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Felicia A Browne
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445, Chapel Hill, NC, 27599, USA
| | | | - Ashraf Grimwood
- Kheth'Impilo AIDS Free Living, 11th Floor, Metlife Centre, 7 Walter Sisulu Avenue, Cape Town, 8000, South Africa
| | - Najma Shaikh
- Kheth'Impilo AIDS Free Living, 11th Floor, Metlife Centre, 7 Walter Sisulu Avenue, Cape Town, 8000, South Africa
| | - Brittni Howard
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - William A Zule
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
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ART uptake and adherence among women who use drugs globally: A scoping review. Drug Alcohol Depend 2020; 215:108218. [PMID: 32916450 PMCID: PMC7899784 DOI: 10.1016/j.drugalcdep.2020.108218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the state of peer-reviewed literature surrounding uptake and adherence of antiretroviral therapy (ART) among HIV-positive women who use drugs (WWUD). METHODS Consistent with PRISMA-ScR guidelines, we conducted a scoping literature review on ART uptake and adherence among WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting at least one ART uptake or adherence related result among WWUD aged 18 or older; peer-reviewed; published in English between 1996-2018. RESULTS Our search identified 6735 studies; 86 met eligibility requirements. ART uptake ranged from 30 % to 76 % and adherence ranged from 27 % to 95 %. Substance use, co-morbid psychiatric disorders, and side effects emerged as the primary ART uptake and adherence barriers among this population. Few facilitators were identified. CONCLUSION This study is the first scoping review to look at ART uptake and adherence among WWUD globally. The wide range in uptake and adherence outcomes indicates the need for gold standard assessments, which may differ between high and low resource settings. This study offers rich insight into uptake and adherence barriers and facilitators, primarily at the intrapersonal level. More research is needed to examine interventions that focus on additional levels of the SEM (e.g., community and policy levels). These review findings can inform ART interventions, future research, and offer guidance to other support services with WWUD, such as PrEP interventions.
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"Now We Are Told That We Can Mix": Messages and Beliefs Around Simultaneous Use of Alcohol and ART. AIDS Behav 2020; 24:2680-2690. [PMID: 32162093 DOI: 10.1007/s10461-020-02825-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
South Africa (SA) has the most people living with HIV/AIDS (PLWH) globally and prevalent alcohol use. Beliefs that mixing alcohol and antiretroviral therapy (ART) can lead to adverse reactions may promote ART nonadherence. Healthcare providers (n = 11) and patients (n = 19) recruited from primary HIV and substance use care in SA described their messages, beliefs, and behaviors around simultaneous use of alcohol and ART. Transcripts were analyzed using thematic analysis: (1) most providers indicated a message shift to reflect harm reduction principles: PLWH should manage alcohol use but not let it interfere with taking ART; however, (2) patients recalled conflicting messages from their providers and some displayed interactive toxicity beliefs and behaviors. Despite progress demonstrated by 2016 national adherence guidelines and shifted provider messaging, interactive toxicity beliefs remain a barrier to ART adherence. Results have implications for the adaptation of adherence counseling to minimize the impact of alcohol use on HIV treatment.
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"Moving Forward with Life": Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165706. [PMID: 32784613 PMCID: PMC7459709 DOI: 10.3390/ijerph17165706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Background: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.
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Petersen Williams P, Brooke-Sumner C, Joska J, Kruger J, Vanleeuw L, Dada S, Sorsdahl K, Myers B. Young South African Women on Antiretroviral Therapy Perceptions of a Psychological Counselling Program to Reduce Heavy Drinking and Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2249. [PMID: 32230712 PMCID: PMC7178219 DOI: 10.3390/ijerph17072249] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 01/06/2023]
Abstract
Young women in South Africa remain most at risk for HIV infection. Several factors contribute to the high incidence rate in this population, including hazardous drinking and depression. Addressing common mental disorders (CMDs) such as depression and alcohol use disorders is key to effective HIV treatment. We explored the experiences and perceptions of young South African women on antiretroviral therapy (ART) of a lay health worker (LHW)-delivered psychosocial intervention based on motivational interviewing (MI) and problem-solving therapy (PST) to reduce heavy drinking and depression. We conducted 27 in-depth interviews with young women (aged 18-35) recruited from 16 primary care clinics in the Western Cape province of South Africa. Discussion topics included young women's life experiences leading to their enrollment in the program, their perceptions of the counselling sessions and the quality of their interaction with the counsellor. Qualitative data were analyzed using a framework approach. The findings highlighted the impact adverse life experiences and stressful life circumstances have on young women's use of alcohol and symptoms of depression and the effect this has on ART adherence. The findings suggest that women found the intervention components that helped them develop strategies for coping with their past experiences, managing current life stressors, and regulating negative thoughts and emotions most beneficial. Taken together, these findings confirm the acceptability of LHW-delivered MI-PST counselling for this population, but suggest that the relevance of the MI-PST intervention for this highly vulnerable population could be further enhanced by including a focus on psychological trauma.
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Affiliation(s)
- Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa;
| | - John Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa;
| | - James Kruger
- Western Cape Department of Health., 8 Riebeeck Street, Cape Town 8000, South Africa;
| | - Lieve Vanleeuw
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa;
| | - Siphokazi Dada
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa;
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa
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Magidson JF, Joska JA, Myers B, Belus JM, Regenauer KS, Andersen LS, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa. Implement Sci Commun 2020; 1:23. [PMID: 32607502 PMCID: PMC7326344 DOI: 10.1186/s43058-020-00004-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population. METHODS Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one's environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor's model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patient-level effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome. DISCUSSION Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
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Affiliation(s)
- Jessica F. Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer M. Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - Kristen S. Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sybil Majokweni
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, USA
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Magidson JF, Andersen LS, Satinsky EN, Myers B, Kagee A, Anvari M, Joska JA. "Too much boredom isn't a good thing": Adapting behavioral activation for substance use in a resource-limited South African HIV care setting. Psychotherapy (Chic) 2020; 57:107-118. [PMID: 31670529 PMCID: PMC7069775 DOI: 10.1037/pst0000257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South
African Medical Research Council; Division of Addiction Psychiatry, Department of
Psychiatry and Mental Health, University of Cape Town
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University
| | - Morgan Anvari
- Department of Psychology, University of Maryland, College
Park
| | - John A. Joska
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
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Satinsky EN, Doran K, Felton JW, Kleinman M, Dean D, Magidson JF. Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City. PLoS One 2020; 15:e0228084. [PMID: 32004328 PMCID: PMC6993963 DOI: 10.1371/journal.pone.0228084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023] Open
Abstract
Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.
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Affiliation(s)
- Emily N. Satinsky
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Kelly Doran
- Department of Nursing, University of Maryland, Baltimore, Maryland, United States of America
| | - Julia W. Felton
- Department of Public Health, Michigan State University, Flint, Michigan, United States of America
| | - Mary Kleinman
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Dwayne Dean
- Department of Nursing, University of Maryland, Baltimore, Maryland, United States of America
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
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Myers B, Carney T, Johnson K, Browne FA, Wechsberg WM. Service providers' perceptions of barriers to the implementation of trauma-focused substance use services for women in Cape Town, South Africa. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 75:102628. [PMID: 31830616 PMCID: PMC7021212 DOI: 10.1016/j.drugpo.2019.102628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/14/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND A substantial number of South African women with substance use disorders also report psychological trauma related to experiences of physical and sexual abuse. Trauma-focused substance use programmes may support recovery from co-occurring substance use disorders and psychological trauma, yet integrated programmes are not widely available in South Africa. As part of the process of developing a trauma-focused substance use programme for South African women, we explored service providers' views of the feasibility of implementing trauma-focused substance use interventions within usual care settings in Cape Town, including potential barriers that need to be considered when planning for implementation. METHODS We conducted 16 in-depth interviews with key informants responsible for planning or delivering substance use, psychological trauma or gender-based violence services to women in Cape Town. Guided by Extended Normalisation Process Theory, interviews explored participants' perceptions of the potential value of trauma-focused substance use programmes, the feasibility of their implementation, and factors that may facilitate or hinder the implementation of trauma-focused substance use programmes. Qualitative data were analysed using the framework approach. RESULTS Three themes emerged: (1) Potential for the implementation of trauma-focused substance use programmes, describing participants' views of the acceptability of these programmes; (2) Capacity for intersectoral collaboration, which participants considered necessary for limiting barriers to implementation; and (3) Co-operation with community structures to enhance capability for implementation. CONCLUSION Findings show potential for implementing trauma-focused substance use interventions in South Africa, however context-specific capacity and capability barriers need to be considered and addressed for implementation to be successful.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Francie van Zyl Drive, Tygerberg 7505, South Africa; Division of Addiction Psychiatry, Psychiatry and Mental Health, University of Cape Town, South Africa.
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Francie van Zyl Drive, Tygerberg 7505, South Africa; Division of Addiction Psychiatry, Psychiatry and Mental Health, University of Cape Town, South Africa.
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Francie van Zyl Drive, Tygerberg 7505, South Africa.
| | - Felicia A Browne
- Substance Use, Gender and Applied Research, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States.
| | - Wendee M Wechsberg
- Substance Use, Gender and Applied Research, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; Health Policy and Administration, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, United States; Department of Psychology, North Carolina State University, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, United States.
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Magidson JF, Jack HE, Regenauer KS, Myers B. Applying lessons from task sharing in global mental health to the opioid crisis. J Consult Clin Psychol 2019; 87:962-966. [PMID: 31556672 DOI: 10.1037/ccp0000434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current opioid crisis in the United States has been considered an "epidemic of poor access to care." Similar to the shortage of trained providers to prescribe medications to treat opioid use disorder (OUD), there is a severe shortage of trained providers to meet the mental health needs of patients with OUD. These workforce shortages are evident nationwide, yet are particularly salient in rural areas. In this commentary in response to the article "Integrating Addiction Medicine into Rural Primary Care: Strategies and Initial Outcomes (Logan et al., 2019)," we propose that we can apply lessons learned from working in resource-constrained settings globally to improve access to mental health care for patients with OUD in rural areas in the United States. We expand upon Logan et al. (2019) by discussing how non-specialist health workers, including community health workers and peer providers, under the supervision of psychologists and other specialists, can expand access to evidence-based mental health care for patients with OUD, particularly those receiving medications for opioid use disorder (MOUD). We draw from established models in global mental health that rely on "task sharing" mental health care to discuss ways in which lessons learned from scaling up evidence-based interventions with lay health workers in low and middle-income countries can directly inform efforts to increase access to mental health care to address the opioid crisis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Helen E Jack
- Department of Medicine, University of Washington
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council
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Magidson JF, Iyer HS, Regenauer KS, Grelotti DJ, Dietrich JJ, Courtney I, Tshabalala G, Orrell C, Gray GE, Bangsberg DR, Katz IT. Recreational ART use among individuals living with HIV/AIDS in South Africa: Examining longitudinal ART initiation and viral suppression. Drug Alcohol Depend 2019; 198:192-198. [PMID: 30953938 PMCID: PMC6644059 DOI: 10.1016/j.drugalcdep.2019.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND South Africa has the highest number of people living with HIV (PLWH) and one of the largest antiretroviral therapy (ART) programs globally. High rates of substance use comorbidity exist, including speculation of recreational ART use (i.e., mixing ART with other illicit drugs). Recreational ART use may affect viral load among PLWH due to ART nonadherence and/or viral resistance; however, prior quantitative research has not examined rates of recreational ART use, nor associations with HIV treatment outcomes longitudinally. METHODS Data were drawn from a prospective, observational cohort study (n = 500) of ART-eligible adults recruited from two HIV voluntary counseling and testing centers in Cape Town, and Johannesburg, South Africa. Multiple logistic regression models assessed recreational ART use as a predictor of ART initiation over six months and viral load suppression over nine months, above and beyond other substance use (binge drinking and illicit drug use). RESULTS Approximately 5% (n = 24) reported recreational ART use, which was less frequent in Cape Town compared to Johannesburg (AOR = 0.025; 95%CI: 0.003-0.19; p < 0.001). Recreational ART use was not significantly associated with ART initiation or viral suppression. Other substance use, but not recreational ART use, was significantly associated with lower odds of ART initiation (AOR = 0.54; 95%CI: 0.33-0.87; p = .01) and viral suppression (AOR = 0.47; 95%CI: 0.25-0.89; p = .02). CONCLUSIONS Recreational ART use was infrequent and not uniquely associated with ART initiation or viral suppression. Findings suggest that comorbid use of other substances is ultimately what may make recreational ART use problematic for ongoing engagement in care and viral suppression.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, 4095 Campus Drive, College Park, MD, USA.
| | - Hari S Iyer
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Kristen S Regenauer
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, USA.
| | - David J Grelotti
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Ingrid Courtney
- Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa.
| | - Gugu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Catherine Orrell
- Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa.
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Office of the President, South African Medical Research Council, Western Cape, ZA, South Africa.
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Global Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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