Clinical trial NCT05907174: Siyakhana Peer: Evaluating a Peer Recovery Coach Model to Reduce Substance Use Stigma in South African HIV Care
Official title: Evaluating the Role of Peers to Reduce Substance Use Stigma and Improve HIV Care Outcomes in South Africa
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Substance-Related Disorders
Substance Use
Substance Use Disorders
Stigma, Social
Stigmatization
Attitude of Health Personnel
Treatment Adherence
Treatment Adherence and Compliance
Health Care Seeking Behavior
HIV
Mental Health Recovery
Delivery of Health Care
Global Health
South Africa
Health Personnel Attitude
Health Personnel
Community Health Workers
Substance Use Recovery
Keywords: Substance-Related Disorders
Substance Use
Substance Use Disorders
Social Stigma
Substance Use Stigma
Attitude of Health Personnel
Treatment Adherence and Compliance
Health Care Seeking Behavior
HIV
Mental Health Recovery
Substance Use Recovery
Global Health
South Africa
Health Personnel
Community Health Workers
Lead sponsor: University of Maryland, College Park
Sponsor class: OTHER
Collaborators: name: Medical Research Council, South Africa
name: National Institute on Drug Abuse (NIDA)
First posted: 2023-06-18
Enrollment: 91
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This study uses a parallel design. Two existing teams of healthcare workers will be randomized 1:1 at the team level to either have a PRC integrated onto their team or to continue their patient care as usual.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Alcohol and other drug use is common among people living with HIV in South Africa and is associated with worse engagement in HIV care. There is evidence that healthcare workers in this setting, including community health workers who play a central role in re-engaging patients back into HIV care, exhibit stigmatizing behaviors towards HIV patients who use substances. In general, healthcare worker stigma towards alcohol and other drug use is associated with poorer treatment of patients who use substances, and in this setting, healthcare worker stigma towards alcohol and other drug use has been associated with worse patient engagement in HIV care. In the United States, peer recovery coaches (PRCs), who are trained individuals with lived substance use recovery experience, have helped patients who use substances engage in healthcare. Theoretically, integrating a PRC onto a healthcare team also increases healthcare worker contact with a person with substance use experience, which may be associated with lower stigma. Yet, a PRC model has not yet been tested in South African HIV care. Therefore, the purpose of this study is to develop and pilot a PRC model integrated into community-based primary care teams providing HIV services in South Africa. The study aims to compare a healthcare team with a PRC to a team without a PRC. The investigators will primarily assess the implementation of this PRC model and rates of patient re-engagement in care.

Detailed description: South Africa has the most people living with HIV in the world, many of whom use alcohol and other drugs. Alcohol and other drug use is associated with worse HIV care engagement, contributing to increased HIV-related morbidity and mortality.

Healthcare worker stigma towards alcohol and other drug use is associated with poorer treatment of patients who use substances and worse patient engagement in HIV care. There is evidence that healthcare workers in this setting, including community health workers who play a central role in re-engaging patients who are lost to follow-up from HIV care, exhibit stigmatizing behaviors towards HIV patients who use substances.

Peer recovery coaches (PRCs) are trained individuals with lived substance use recovery experience who are integrated into healthcare teams. Healthcare workers who work with PRCs have sustained contact with a person with lived substance use experience, which is associated with lower stigma. In the United States, preliminary research has demonstrated that PRCs can be successfully integrated into healthcare teams, and that PRC contact is associated with increased patient engagement in healthcare. Yet, a PRC model has not yet been tested in South African HIV care.

Therefore, the purpose of this study is to examine the preliminary implementation and effectiveness of integrating a PRC model into existing teams of healthcare workers who are tasked with re-engaging patients in HIV care through community-based primary care teams. In a type 1, hybrid effectiveness-implementation trial, and comparing a healthcare worker team that works with a PRC to one that does not, the investigators will primarily assess the rate of patient re-engagement in care and implementation (i.e., feasibility, acceptability) of the model. Healthcare worker stigma towards patients living with HIV who use substances will also be measured.

Eligibility criteria: 1. HEALTHCARE WORKER:

   1. Inclusion Criteria:

      * At least 18 years old
      * Employed as a healthcare worker (e.g., community health worker, nurse, supervisor, etc.,) for one of the partner healthcare worker teams that provides HIV re-engagement services
   2. Exclusion Criteria:

      * Unable or unwilling to complete informed consent and study procedures in English, isiXhosa, or Afrikaans
2. PATIENT:

   1. Inclusion Criteria:

      * At least 18 years old
      * Living with HIV
      * Problematic alcohol or other drug use defined by either: a) AUDIT-C score ≥ 2; or b) self-report illicit drug use within past 3 months
      * Seen by a healthcare worker from one of the healthcare teams partnered with this study because of recent disengagement in HIV care
   2. Exclusion Criteria:

      * Unable or unwilling to complete informed consent and study procedures in English, isiXhosa, or Afrikaans

Primary outcomes:
measure: Healthcare Worker Substance Use Stigma
timeFrame: 3-months post-baseline assessment
Secondary outcomes:
measure: Healthcare Worker Feasibility (Intervention Arm Only)
timeFrame: 6-months post-integration assessment
measure: Healthcare Worker Acceptability (Intervention Arm Only)
timeFrame: 6-months post-integration assessment
Other outcomes:
measure: Patient Re-Engagement in HIV Care
timeFrame: 3-months post-baseline assessment
measure: Patient Feasibility (Intervention Arm Only)
timeFrame: 3-months post-baseline assessment
measure: Patient Acceptability (Intervention Arm Only)
timeFrame: 3-months post-baseline assessment
Locations:
city: Cape Town
country: South Africa
facility: South African Medical Research Council - Delft Office
state: Western Cape
Study officials:
affiliation: University of Maryland, College Park
name: Jessica F Magidson, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Medical Research Council, South Africa
name: Bronwyn Myers, PhD
role: PRINCIPAL_INVESTIGATOR
References: