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：
10053798
负责人：
Jessica F Magidson
金额：
$ 20.25万
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/10053798
关键词：
Address Africa South of the Sahara Alcohol or Other Drugs use Attitude Back Behavioral Caring Clinic Visits Communities Discrimination Drug usage Educational workshop Effectiveness Epidemic Evaluation Feedback HIV Health Personnel Home environment Improve Access Individual Intervention Interview Link Low income Maintenance Mental Health Methods Modeling Motivation Outcome 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 antiretroviral therapy barrier to care base brief intervention care outcomes contextual factors effectiveness evaluation effectiveness implementation study effectiveness implementation trial evidence base experience high risk implementation research improved innovation novel outreach patient engagement patient subsets peer premature recruit reduced substance use response scale up screening skills social stigma 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.

项目概要南非 (SA) 是全球艾滋病病毒感染者人数最多的国家（艾滋病病毒感染者；770 万）。更远，物质使用障碍 (SUD) 在南澳的 PLWH 中普遍存在，如果不加以治疗，会导致贫困参与艾滋病毒护理和艾滋病毒传播。需要采取干预措施来帮助患有 SUD 的 PLWH 重新参与关心。然而，医疗保健工作者 (HCW) 中的 SUD 污名是他们提供 SUD 服务的障碍，并且 PLWH 中艾滋病毒护理参与度低的一个因素。同行可能是一个有前途的解决方案解决医护人员中 SUD 的耻辱，同时还通过 SUD 提高 PLWH 的艾滋病毒护理参与度。尽管同伴恢复教练（PRC）模型在美国已迅速扩大规模，但它们尚未在低水平环境中进行测试。艾滋病毒普遍流行的收入环境，例如南澳，PRC 可以在其中发挥重要作用改善艾滋病毒护理结果。该提案旨在评估PRC是否可以融入病房基础外展小组 (WBOT)，正在南澳进行试点，以接触那些患有艾滋病的弱势 PLWH。脱离艾滋病毒护理。在我们的初步研究的基础上，我们的总体目标是探索可行性将 PRC 纳入 WBOT 的可接受性，以改善 HIV 护理的重新参与并减少 SUD 医护人员之间的耻辱。我们的概念模型集成了 Link 和 Phelan Stigma 框架和情境护理启动和维护的信息动机行为技能模型，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) 首先通过深度访谈探讨将 PRC 纳入 SA WBOT 的障碍和促进因素与管理者 (n=10)、医护人员 (n=15) 和患者 (n=15) 一起评估与 PRC 合作的态度，在患者和提供者层面上交叉的 HIV 和 SUD 耻辱以及背景因素（例如社区暴力和吸毒）可能会成为中国人在这种情况下的障碍。 (2)接下来，我们将利用这些反馈来调整 PRC 模式融入 WBOT，旨在改善艾滋病毒护理的重新参与并减少 SUD 耻辱。该模型将在 4 场研讨会上与 PLWH (n=12) 和 HCW (n=12) 进行讨论，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像往常一样接受强化治疗以改善患者康复的匹配比较 WBOT 团队相比参与艾滋病毒护理（n=50 名患者）和 HCW SUD 耻辱（n=30 名 HCW）。可行性和可接受性将通过混合方法进行评估。该提案响应 PAR-19-326，作为对如何将同龄人融入新的艾滋病毒护理环境，以及 PRC 如何改变 SUD 耻辱并改善艾滋病毒护理参与。能力建设工作将支持建立专注于艾滋病毒和 SUD 的研究网络撒哈拉以南非洲地区的耻辱。研究结果将为 R01 提案提供信息，以评估有效性和实施情况建立一个可扩展的 PRC 模型，以减少 SUD 的耻辱并提高 SUD 感染者的艾滋病毒护理参与度。