权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

评估同伴在南非减少药物使用耻辱和改善艾滋病毒护理成果方面的作用

基本信息

批准号：
10397860
负责人：
Jessica F Magidson
金额：
$ 0.94万
依托单位：
UNIV OF MARYLAND, COLLEGE PARK
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10397860
关键词：
Address Africa South of the Sahara Attitude Back Behavioral Caring Clinic Visits Communities Consolidated Framework for Implementation Research Discrimination Drug usage Educational workshop Effectiveness Epidemic Evaluation Feedback HIV Health Personnel Home Improve Access Individual Intervention Interview Link Low income Maintenance Mental Health Methods Modeling Motivation Patient Care Patient-Centered Care Patients Play Provider Recovery Research Role Services South Africa Stigmatization Structure Substance Use Disorder Testing Time Training Violence Viral Viremia Virus Vulnerable Populations Work acceptability and feasibility antiretroviral therapy barrier to care base brief intervention care outcomes contextual factors effectiveness evaluation effectiveness implementation study effectiveness implementation trial evidence base experience feasibility testing high risk implementation barriers implementation outcomes improved innovation novel outreach patient engagement patient subsets peer premature recruit reduced substance use response scale up screening skills social stigma substance use success transmission process treatment adherence treatment as usual ward

项目摘要

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.

项目总结