Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance Use

培训社区卫生工作者支持在抑郁和药物滥用的情况下重新参与结核病/艾滋病毒护理

• 批准号: 10212231
• 负责人: Jessica F Magidson
• 金额: $ 22.97万
• 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: 2020-07-07 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10212231
• 关键词: AIDS/HIV problem; Address; Affect; Africa South of the Sahara; Alcohol abuse; Behavior; Behavioral; Belief; Caring; Cause of Death; Cessation of life; Clinic; Community Health Aides; Data; Drug usage; Effectiveness; Exhibits; Feedback; HIV; HIV/TB; Health Personnel; Home; Home visitation; Incidence; Individual; Infrastructure; Interview; Link; Maintenance; Mental Depression; Mental Health; Methods; Modeling; Morbidity - disease rate; Motivation; National Institute of Mental Health; Outcome; Patient Care; Patients; Play; Population; Problem Solving; Provider; Qualitative Evaluations; Role; Sampling Studies; Site; South Africa; Structure; Training; Training Programs; Tuberculosis; Visit; Vulnerable Populations; Work; acceptability and feasibility; alcohol and other drug; antiretroviral therapy; barrier to care; base; care outcomes; co-infection; comorbidity; design; effectiveness implementation study; effectiveness implementation trial; follow-up; help-seeking behavior; implementation science; implementation strategy; improved; mortality; motivational enhancement therapy; novel; programs; skills; social stigma; substance use; treatment as usual; treatment optimization; tuberculosis treatment

Project Summary. South Africa (SA) is home to the largest number of people living HIV/AIDS (PLWH; 7.7 million) and one of the highest incidence rates of tuberculosis (TB) globally. Poor engagement in care contributes to HIV and TB morbidity and mortality in SA. Community health workers (CHWs) are frontline workers who play a central role in re-engaging patients who are lost to follow-up (LTFU) in TB/HIV care in SA. Despite existing CHW programs focused on re-engaging patients who are LTFU, people with depression, hazardous alcohol use, or other substance use (SU) are particularly susceptible to poor engagement in TB/HIV care and have a greater likelihood of being LTFU. Further, our pilot data shows that CHWs have high levels of stigma towards patients with depression, hazardous alcohol use, and other SU, which can further undermine engagement in TB/HIV care in this vulnerable population. Reducing CHW stigma towards depression and SU and providing CHWs skills to re-engage this population in care may be a unique opportunity to strengthen the TB/HIV care cascades and improve TB/HIV outcomes. Guided by the Link and Phelan stigma framework and the Situated Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM), this proposal builds upon our prior work by developing and adapting a novel CHW training program to reduce CHW stigma towards depression and SU, and evaluating theoretically-driven implementation science outcomes and patient re-engagement in TB/HIV care. We are leveraging a robust, existing infrastructure of CHWs doing home visits with patients with TB/HIV co-infection who are LTFU, thus promoting the sustainability of the proposed model. We propose to (1) identify multi-level barriers and facilitators to implementing a CHW-oriented training to reduce stigma towards patients with depression and substance use to promote re-engagement in TB/HIV care by conducting semi-structured interviews with CHWs, providers, and patients with TB/HIV and depression and/or SU (n=30) and observational assessments of CHWs making home visits (n=10) to individuals with TB/HIV who were LTFU. Using this feedback, we will (2) adapt the proposed CHW training and implementation strategy and obtain feedback on the feasibility and acceptability from five CHWs and their patients (four patients each; n=20). We will then (3) evaluate the implementation and preliminary effectiveness of the adapted CHW training program to reduce CHW stigma towards depression and SU and promote re-engagement in TB/HIV care using a Type 2, hybrid effectiveness-implementation study guided by Proctor’s implementation model. We propose a stepped wedge design with six clinics (10 CHWs in each), to evaluate: 1) Feasibility, acceptability and fidelity of the CHW training (primary; implementation); 2) CHW stigma towards depression and SU among TB/HIV co- infected patients (primary; effectiveness); 3) Patient re-engagement in TB/HIV care over six months (secondary). This proposal is responsive to the FOA and NIMH priorities as an implementation science study to optimize the reach and impact of CHW programs to reduce barriers to TB/HIV care for patients with depression and SU.

项目摘要。南非（SA）是艾滋病毒/艾滋病的人数最多的所在地（PLWH; 7.7 百万）是全球结核病（TB）的最高事件率之一。参与不良护理 SA中有助于艾滋病毒和结核病的发病率和死亡率。社区卫生工作者（CHW）是前线 在SA中在结核病/HIV护理中重新参与的患者（LTFU）中扮演核心角色的工人。 尽管现有的CHW计划着重于重新参与LTFU，抑郁症患者，但 危险饮酒或其他药物使用（SU）特别容易受到结核病/艾滋病毒的不良影响 关心，并有更大的可能性成为LTFU。此外，我们的飞行员数据表明​​，CHW具有很高的 对患有抑郁症，危险饮酒和其他SU的污名，可能会进一步破坏 在这个脆弱人群中参与结核病/艾滋病毒护理。减少对抑郁症和Su的污名 并提供CHWS技能来重新参与此人口，这可能是加强的独特机会 结核病/艾滋病毒护理级联并改善结核病/艾滋病毒结果。在链接和菲兰的污名框架和指导下 位置信息动机行为技能的护理启动和维护模型（SIMB-CIM），这 提案通过制定和改编新颖的CHW培训计划来基于我们先前的工作以减少CHW 对抑郁和SU的污名，并评估理论驱动的实施科学成果和 患者在结核病/艾滋病毒护理中重新接触。我们正在利用CHW的现有基础设施做家园的现有基础设施 与LTFU的TB/HIV共感染患者的访问，从而促进了建议的可持续性 模型。我们建议（1）确定多层障碍和促进者，以实施面向CHW的培训 减少对抑郁症患者的污名和使用物质使用的污名，以促进通过 对CHW，提供者和结核病/艾滋病毒和抑郁症患者进行半结构化访谈和/或 SU（n = 30）和对有TB/HIV的人进行家访的CHW的观察评估（n = 10） 是ltfu。使用此反馈，我们将（2）调整拟议的CHW培训和实施策略 并获得有关五个CHW及其患者的可行性和可接受性的反馈（每个患者； n = 20）。然后，我们将（3）评估改编的CHW培训的实施和初步效果 减少对抑郁症的污名，SU并促进结核病/艾滋病毒护理重新参与的计划 由Proctor的实施模型指导的2型，混合有效性研究研究。我们提出了一个 带有六个诊所（每个CHW的10个CHW）的梯级楔形设计，以评估：1）可行性，可接受性和忠诚度 CHW培训（主要；实施）； 2）在结核病/艾滋病毒共同的TB/HIV共同的CHW污名和SU 感染患者（初级；有效性）； 3）在六个月内（继发）患者在结核病/艾滋病毒护理中重新参与。 该建议对FOA和NIMH的优先级有响应，作为实施科学研究，以优化 CHW计划的覆盖范围和影响，以减少抑郁症和SU患者的结核病/HIV护理障碍。