Evaluating the Role of Peers to Reduce Substance Use Stigma and Improve HIV Care Outcomes in South Africa

项目摘要 南非是全球艾滋病毒携带者最多的国家(PLWH；770万人)。此外， 物质使用障碍(SUD)在SA的PLWH中很普遍，如果不治疗，会导致贫困 参与艾滋病毒护理和艾滋病毒传播。需要干预措施来帮助PLWH重新参与SUD 关心。然而，卫生保健工作者(HCW)中的SUD污名是他们提供SUD服务的障碍， 导致公共卫生部门在艾滋病毒护理方面参与度低的因素。Peers可能是一种很有前途的解决方案 解决卫生工作者中的SUD污名，同时也通过SUD改善对PLWH的艾滋病毒护理的参与度。 虽然同伴恢复教练(PRC)模式在美国已经迅速扩大，但它们还没有在较低的 收入环境与普遍的艾滋病毒流行，如沙门氏菌，在这种情况下，初级保健机构可以在 改善艾滋病毒护理成果。这项建议旨在评估是否可以将临立会纳入病房- 基于外展团队(WBOT)，正在南卡罗来纳州试行，以接触到有 脱离艾滋病护理。在初步研究的基础上，我们的整体目标是探讨 将PRC整合到WBOT中以提高艾滋病毒护理的重新参与度并减少SUD的可接受性 在卫生工作者中的耻辱。我们的概念模型集成了Link和Phelan Stamma框架，并位于 关爱启动和维护的信息激励行为技能模型，并使用综合 实施研究框架(CFIR)，以确定实施障碍。我们提出三个目标： (1)首先，通过深入访谈，探索将PRC融入SA WBOT的障碍和促进者 与管理人员(n=10)、卫生工作者(n=15)和患者(n=15)一起评估对与PRC合作的态度， 在患者和提供者层面以及背景因素(例如，社区)上交叉的艾滋病毒和性病污名 暴力和吸毒)，在这种情况下，这可能是临立会的障碍。(2)接下来，我们将使用此反馈来改编 将PRC模式整合到WBOTS中，旨在改善艾滋病毒护理的重新参与，并减少对SUD的耻辱。 这一模式将在4个讲习班上进行讨论，其中将有12名妇女和12名妇女保健工作者参加，以提高接受度。 (3)我们的最终目标是评估PRC模式的可行性、可接受性和初步有效性 与匹配的对照相比，WBOT小组照常接受强化治疗以提高患者的复发率 参与艾滋病毒护理(n=50名患者)和HCW SUD污名(n=30名HCW)。可行性和可接受性将 通过混合方法进行评估。本提案是对PAR-19-326的响应，是对 如何将同伴融入新的艾滋病毒护理环境，以及PRC如何改变SUD污名并改善艾滋病毒 关爱参与。能力建设工作将支持建立以艾滋病毒和性病为重点的研究网络。 撒哈拉以南非洲的耻辱。调查结果将成为R01提案的依据，以评估有效性和实施情况 一种可扩展的PRC模式，以减少对SUD的污名，并改善PLWH与SUD的艾滋病毒护理参与度。

Project Summary South Africa (SA) is home to the largest number globally of people living HIV (PLWH; 7.7 million). Further, substance use disorder (SUD) is prevalent among PLWH in SA, and when untreated, contributes to poor engagement in HIV care and HIV transmission. Interventions are needed to help PLWH with SUD re-engage in care. Yet, SUD stigma among health care workers (HCWs) is a barrier to their provision of SUD services and a contributing factor to poor engagement in HIV care among PLWH. Peers may be a promising solution for addressing SUD stigma among HCWs while also improving engagement in HIV care for PLWH with SUD. Although peer recovery coach (PRC) models have rapidly scaled in the US, they have yet to be tested in a low- income setting with a generalized HIV epidemic such as SA, where PRCs could play an important role in improving HIV care outcomes. This proposal aims to evaluate whether PRCs can be integrated into ward- based outreach teams (WBOTs), which are being piloted in SA to reach vulnerable PLWH who have disengaged from HIV care. Building upon our preliminary studies, our overall aim is to explore the feasibility and acceptability of integrating PRCs into WBOTs to improve re-engagement in HIV care and reduce SUD stigma among HCWs. Our conceptual model integrates the Link and Phelan Stigma Framework and Situated Information Motivation Behavioral Skills Model of Care Initiation and Maintenance, and uses the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. We propose three aims: (1) First to explore barriers and facilitators to integrating PRCs into WBOTs in SA using in-depth interviews with managers (n=10), HCWs (n=15), and patients (n=15), assessing attitudes towards working with PRCs, intersecting HIV and SUD stigmas at the patient and provider levels, and contextual factors (e.g., community violence and drug use) that may be barriers for PRCs in this setting. (2) Next, we will use this feedback to adapt a PRC model integrated into WBOTs aimed at improving re-engagement in HIV care and reducing SUD stigma. This model will be discussed in 4 workshops with PLWH (n=12) and HCWs (n=12) to increase acceptability. (3) Our final aim will evaluate the feasibility, acceptability, and preliminary effectiveness of the PRC model compared to a matched comparison WBOT team receiving enhanced treatment as usual to improve patient re- engagement in HIV care (n=50 patients) and HCW SUD stigma (n=30 HCWs). Feasibility and acceptability will be assessed via mixed methods. This proposal is responsive to PAR-19-326 as an innovative evaluation of how to integrate peers into a novel HIV care setting, and how PRCs can shift SUD stigma and improve HIV care engagement. Capacity building efforts will support building a research network focused on HIV and SUD stigma in sub-Saharan Africa. Findings will inform an R01 proposal to evaluate effectiveness and implementation of a scalable PRC model to reduce SUD stigma and improve HIV care engagement for PLWH with SUD.