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: 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
• 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

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）是全球生活艾滋病毒（PLWH; 770万）的最多的家园。更远， 在SA中，PLWH中普遍存在药物使用障碍（SUD），并且在未经治疗的情况下会导致贫困 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 关心。然而，医疗保健工作者中的SUD污名（HCWS）是他们提供SUD服务的障碍和 导致PLWH中参与艾滋病毒护理的不良因素。同行可能是一个有前途的解决方案 解决HCW之间的SUD污名，同时也改善了与SUD的PLWH的艾滋病毒护理。 尽管同伴恢复教练（PRC）模型在美国迅速扩展，但尚未在低 - 具有普遍的艾滋病毒流行的收入设定，例如SA，中国可以在其中发挥重要作用 改善艾滋病毒护理结果。该建议旨在评估是否可以将PRC纳入病房 基于SA的基于外展团队（WBOTS） 脱离艾滋病毒护理。在我们的初步研究的基础上，我们的总体目的是探索可行性 以及将PRC整合到WBOT中以改善艾滋病毒护理的重新参与并减少SUD的可接受性 HCWS中的污名。我们的概念模型集成了链接和菲兰的污名框架并位于 信息动机行为技能的护理启动和维护模型，并使用合并的 实施研究框架（CFIR）确定实施障碍。我们提出了三个目标： （1）首先使用深入的访谈探索将PRC整合到SA中的WBOTS中的障碍和促进者 与经理（n = 10），HCW（n = 15）和患者（n = 15）的情况下，评估对与PRC合作的态度， 在患者和提供者级别与艾滋病毒和苏德犬的污名相交，以及上下文因素（例如，社区 在这种情况下，暴力和吸毒）可能是中国的障碍。 （2）接下来，我们将使用此反馈来调整 旨在改善艾滋病毒护理重新参与并减少SUD污名的WBOT中的PRC模型。 该模型将在与PLWH（n = 12）和HCW（n = 12）的4个研讨会中进行讨论，以提高可接受性。 （3）我们的最终目标将评估中国模型的可行性，可接受性和初步有效性 与匹配的比较团队相比，WBOT团队像往常一样接受增强的治疗方法，以改善患者的重新治疗 参与HIV护理（n = 50例）和HCW SUD污名（n = 30 HCWS）。可行性和可接受性将 通过混合方法进行评估。该提案对Par-19-326的响应有响应，作为对 如何将同伴整合到新型的HIV护理环境中，以及PRC如何改变SUD污名并改善HIV 护理参与。能力建设工作将支持建立一个针对艾滋病毒和SUD的研究网络 撒哈拉以南非洲的污名。调查结果将为R01提案提供评估和实施的建议 可伸缩的PRC模型可减少SUD污名并改善使用SUD的PLWH的HIV护理参与度。