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

• 批准号: 10245294
• 负责人: Jessica F Magidson
• 金额: $ 16万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10245294
• 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

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.

项目摘要 南非（SA）是全球艾滋病毒感染者（PLWH; 770万）人数最多的国家。此外，本发明还 物质使用障碍（SUD）在南非的PLWH中普遍存在，如果不治疗， 参与艾滋病毒护理和艾滋病毒传播。需要采取干预措施，帮助患有SUD的PLWH重新参与 在乎然而，医护人员（HCW）中的SUD耻辱是他们提供SUD服务的障碍，也是 艾滋病毒/艾滋病感染者中艾滋病毒护理参与不足的一个促成因素。对等可能是一个有前途的解决方案， 解决保健工作者对未成年人吸毒的污名化问题，同时改善对患有未成年人吸毒的艾滋病毒感染者的艾滋病毒护理。 虽然同伴恢复教练（PRC）模型在美国迅速扩大，但它们还没有在低- 艾滋病毒普遍流行的收入环境，如南非， 改善艾滋病毒护理成果。该提案旨在评估是否可以将PRC纳入病房- 在南澳大利亚州试行的外展小组，以接触那些 脱离了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PRCs纳入WBOT以改善重新参与艾滋病毒护理和减少SUD的可接受性 HCW中的耻辱。我们的概念模型整合了Link和Stigma框架以及Situated 护理启动和维护的信息激励行为技能模型，并使用统一的 执行研究框架（CFIR），以确定执行障碍。我们提出三个目标： (1)第一次使用深度访谈探索将PRC整合到SA WBOT中的障碍和促进因素 与管理者（n=10）、医务工作者（n=15）和患者（n=15）一起，评估与PRC合作的态度， 交叉艾滋病毒和SUD的耻辱在病人和提供者的水平，和背景因素（例如，社区 暴力和毒品使用），这可能是中国在这种情况下的障碍。(2)接下来，我们将使用此反馈来调整 将PRC模式纳入WBOT，旨在改善重新参与艾滋病毒护理和减少SUD耻辱。 将在4个讲习班上与艾滋病毒携带者（n=12）和卫生保健工作者（n=12）讨论该模型，以提高可接受性。 (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 与匹配的对照组相比，WBOT团队像往常一样接受强化治疗，以改善患者的再 参与艾滋病毒护理（n=50例患者）和HCW SUD污名（n=30例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 如何将同龄人纳入新的艾滋病毒护理环境，以及PRCs如何改变SUD的耻辱感并改善艾滋病毒 关怀参与能力建设工作将支持建立一个以艾滋病毒和南部非洲发展为重点的研究网络 撒哈拉以南非洲的耻辱。调查结果将告知R 01提案，以评估有效性和实施情况 一个可扩展的PRC模式，以减少SUD的耻辱和改善艾滋病毒护理参与PLWH与SUD。