1
|
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.
Collapse
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
| |
Collapse
|
2
|
Bassett IV, Yan J, Giddy J, Ross D, Bogart LM, Stuckwisch A, Zionts D, Naidoo R, Parker RA. Geographic variation in 5-year mortality following HIV diagnosis: implications for clinical interventions. AIDS Care 2023; 35:2016-2023. [PMID: 36942651 PMCID: PMC10511661 DOI: 10.1080/09540121.2023.2189224] [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: 06/02/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
Characterizing spatial distribution of HIV outcomes is vital for targeting interventions to areas most at risk. We performed spatial analysis to identify geographic clusters and factors associated with mortality in KwaZulu-Natal, South Africa. We utilized Sizanani trial (NCT01188941) data, which enrolled participants August 2010-January 2013 and obtained vital status at 5.8 (IQR 5.0-6.4) years of follow-up. We mapped geocoded addresses to 2011 Census-defined small area layer (SAL) centroids, used Kulldorff's spatial scan statistic to identify mortality clusters, and compared socio-demographic factors for SALs within and outside mortality clusters. We assigned 1,143 participants living with HIV (260 [23%] of whom died during follow-up) to 677 SALs. One lower mortality cluster (n = 90, RR = 0.23, p = 0.022) was identified near a hospital outside Durban. SALs in the cluster were younger (24y vs 25y, p < 0.001); had fewer bedrooms/household (3 vs 4, p < 0.001); had more females (52% vs 51%, p = 0.013) and residents with no schooling past age 20 (4% vs 3%, p < 0.001) or no education at all (4% vs 3%, p < 0.001); had fewer residents with income >3,200 ZAR/month (5% vs 9%, p < 0.001); and had reduced access to piped water (p < 0.001), refuse disposal (p < 0.001), and toilets (p < 0.001). Targeted interventions may improve outcomes in areas with similar characteristics.
Collapse
Affiliation(s)
- Ingrid V. Bassett
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, United States of America
- Harvard University, Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joyce Yan
- Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, United States of America
| | | | - Douglas Ross
- St. Mary’s Hospital, Mariannhill, Durban, South Africa*
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, California, United States of America
| | - Ashley Stuckwisch
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, United States of America
| | - Dani Zionts
- Massachusetts General Hospital, Medical Practice Evaluation Center, Boston, Massachusetts, United States of America
| | - Ravi Naidoo
- Statistics South Africa, KwaZulu-Natal Provincial Office, Durban, South Africa
| | - Robert A. Parker
- Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, United States of America
- Harvard University, Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
3
|
Beeman A, Bengtson AM, Swartz A, Colvin CJ, Lurie MN. Cyclical Engagement in HIV Care: A Qualitative Study of Clinic Transfers to Re-enter HIV Care in Cape Town, South Africa. AIDS Behav 2022; 26:2387-2396. [PMID: 35061116 PMCID: PMC9167245 DOI: 10.1007/s10461-022-03582-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/25/2023]
Abstract
Long-term patient engagement and retention in HIV care is an ongoing challenge in South Africa's strained health system. However, some patients thought to be "lost to follow-up" (LTFU) may have "transferred" clinics to receive care elsewhere. Through semi-structured interviews, we explored the relationship between clinic transfer and long-term patient engagement among 19 treatment-experienced people living with HIV (PLWH) who self-identified as having engaged in a clinic transfer at least once since starting antiretroviral therapy (ART) in Gugulethu, Cape Town. Our findings suggest that patient engagement is often fluid, as PLWH cycle in and out of care multiple times during their lifetime. The linear nature of the HIV care cascade model poorly describes the lived realities of PLWH on established treatment. Further research is needed to explore strategies for reducing unplanned clinic transfers and offer more supportive care to new and returning patients.
Collapse
Affiliation(s)
- Aly Beeman
- Brown University School of Public Health, Providence, RI, USA
| | - Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
| | - Alison Swartz
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Mark N Lurie
- Department of Epidemiology, Brown University School of Public Health, Box GS-121-2, Room 221, 121 South Main Street, Providence, RI, 02912, USA.
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
4
|
Bassett IV, Yan J, Govere S, Khumalo A, Ngobese N, Shazi Z, Nzuza M, Bunda BA, Wara NJ, Stuckwisch A, Zionts D, Dube N, Tshabalala S, Bogart LM, Parker RA. Uptake of community‐ versus clinic‐based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa. J Int AIDS Soc 2022; 25:e25877. [PMID: 35077611 PMCID: PMC8789242 DOI: 10.1002/jia2.25877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/28/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction South Africa's government‐led Central Chronic Medication Dispensing and Distribution (CCMDD) program offers people living with HIV the option to collect antiretroviral therapy at their choice of community‐ or clinic‐based pick‐up points intended to increase convenience and decongest clinics. To understand CCMDD pick‐up point use among people living with HIV, we evaluated factors associated with uptake of a community‐ versus clinic‐based pick‐up point at CCMDD enrolment. Methods We collected baseline data from October 2018 to March 2020 on adults (≥18 years) who met CCMDD clinical eligibility criteria (non‐pregnant, on antiretroviral therapy for ≥1 year and virologically suppressed) as part of an observational cohort in seven public clinics in KwaZulu‐Natal. We identified factors associated with community‐based pick‐up point uptake and fit a multivariable logistic regression model, including age, gender, employment status, self‐perceived barriers to care, self‐efficacy, HIV‐related discrimination, and perceived benefits and challenges of CCMDD. Results and Discussion Among 1521 participants, 67% were females, with median age 36 years (IQR 30–44). Uptake of a community‐based pick‐up point was associated with younger age (aOR 1.18 per 10‐year decrease, 95% CI 1.05–1.33), being employed ≥40 hours per week (aOR 1.42, 95% CI 1.10–1.83) versus being unemployed, no self‐perceived barriers to care (aOR 1.42, 95% CI 1.09–1.86) and scoring between 36 and 39 (aOR 1.44, 95% CI 1.03–2.01) or 40 (aOR 1.91, 95% CI 1.39–2.63) versus 10–35 on the self‐efficacy scale, where higher scores indicate greater self‐efficacy. Additional factors included more convenient pick‐up point location (aOR 2.32, 95% CI 1.77–3.04) or hours (aOR 5.09, 95% CI 3.71–6.98) as perceived benefits of CCMDD, and lack of in‐clinic follow‐up after a missed collection date as a perceived challenge of CCMDD (aOR 4.37, 95% CI 2.30–8.31). Conclusions Uptake of community‐based pick‐up was associated with younger age, full‐time employment, and systemic and structural factors of living with HIV (no self‐perceived barriers to care and high self‐efficacy), as well as perceptions of CCMDD (convenient pick‐up point location and hours, lack of in‐clinic follow‐up). Strategies to facilitate community‐based pick‐up point uptake should be tailored to patients’ age, employment, self‐perceived barriers to care and self‐efficacy to maximize the impact of CCMDD in decongesting clinics.
Collapse
Affiliation(s)
- Ingrid V. Bassett
- Massachusetts General Hospital Division of Infectious Diseases Boston Massachusetts USA
- Massachusetts General Hospital Medical Practice Evaluation Center Boston Massachusetts USA
- Center for AIDS Research (CFAR) Harvard University Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Joyce Yan
- Massachusetts General Hospital Biostatistics Center Boston Massachusetts USA
| | | | | | | | | | | | - Bridget A. Bunda
- Massachusetts General Hospital Medical Practice Evaluation Center Boston Massachusetts USA
| | - Nafisa J. Wara
- Massachusetts General Hospital Medical Practice Evaluation Center Boston Massachusetts USA
| | - Ashley Stuckwisch
- Massachusetts General Hospital Medical Practice Evaluation Center Boston Massachusetts USA
| | - Dani Zionts
- Massachusetts General Hospital Medical Practice Evaluation Center Boston Massachusetts USA
| | | | - Sandile Tshabalala
- South Africa Department of Health Province of KwaZulu‐Natal South Africa
| | | | - Robert A. Parker
- Center for AIDS Research (CFAR) Harvard University Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
- Massachusetts General Hospital Biostatistics Center Boston Massachusetts USA
| |
Collapse
|