Advancing Integrated Alcohol-HIV Training of Frontline Providers in a Global Priority Setting

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PROJECT SUMMARY South Africa is at the epicenter of the global HIV pandemic with the largest country population of individuals living with HIV in the world. South Africa also has alarming rates of alcohol use, which pose a significant challenge to the HIV care cascade. Integrated alcohol-HIV care is the gold standard, but delivery of integrated care in South Africa is extremely rare. To promote treatment integration, the South Africa HIV ATTC (led by M- PIs Becker, Kuo, and Sibeko) was established in October 2017. The South Africa HIV ATTC is a national center, jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the President’s Emergency Plan for AIDS Relief (PEPFAR), dedicated to providing training to health professionals and lay workers who serve patients with HIV, alcohol use, and other mental health problems. On an annual basis, the South Africa HIV ATTC is charged with training 1,000 individuals as a means of driving the uptake of evidence-based approaches to address alcohol-HIV throughout the country. Recognizing the detrimental effects of heavy alcohol use and alcohol use disorders on the HIV care cascade, and in response to a needs assessment of national stakeholders and policy-makers, the South Africa HIV ATTC is preparing to roll out a national training initiative on Screening, Brief Intervention, and Referral to Treatment (SBIRT) for risky alcohol use. Using a novel task sharing approach, the South Africa HIV ATTC will provide SBIRT training and ongoing consultation to over 900 health professionals and lay workers embedded within HIV treatment organizations over a three-year period. Rollout of this national initiative presents unparalleled opportunities to advance implementation science for integrated alcohol-HIV treatment in a global priority site. However, research and data collected by the South Africa HIV ATTC is severely restricted under the SAMSHA and PEPFAR funded streams. Indeed, the only data currently collected by the South Africa HIV ATTC is a brief SAMHSA-required form called the Government Performance and Reporting Act (GPRA) tool, which measures satisfaction of training attendees. Thus, the current study proposes to first codify and then conduct comprehensive evaluation of training effectiveness on a range of key implementation science constructs. Study activities will occur across three phases. First, we will develop a SBIRT train-the-trainer manual consisting of a coding system to measure training fidelity, which will greatly enhance the rigor of the proposed training rollout. Second, we will evaluate the effectiveness of the SBIRT train-the-trainer model on key implementation science outcomes measured at the trainer (e.g., fidelity, knowledge), provider (e.g., attitudes, self-efficacy, acceptability), and patient levels (e.g., proportion of patients who receive each component of SBIRT – screening, brief intervention, and referral to treatment). Finally, we will examine the relationship among trainer-level, provider-level, and patient-level outcomes. Results of this study will advance knowledge of key implementation science questions, while promoting the integration of alcohol and HIV care, in a global priority setting.