“Someone who is in this thing that I am suffering from”: The role of peers and other facilitators for task sharing substance use treatment in South African HIV care

Magidson, Jessica F.; Joska, John A.; Regenauer, Kristen S.; Satinsky, Emily N.; Andersen, Lena S.; Seitz-Brown, C. J.; Borba, Christina P.C.; Safren, Steven A.; Myers, Bronwyn

doi:10.1016/j.drugpo.2018.11.004

Cited by 57 publications

(59 citation statements)

References 65 publications

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“…The Pleasant Events Schedule comprises an inventory of potentially reinforcing events and has been widely used in behavioral depression interventions and dialectical behavior therapy [56]. We used an adapted version of the Pleasant Events Schedule that we had previously modified for an underserved, substance using population in a low-income setting [27] and further adapted for this setting. As part of step three of the ADAPT-ITT framework (Administration), participants were asked to identify items from the list, as well as come up with their own activities, that they enjoyed and did not associate with substance use.…”

Section: Key Informant Interview Proceduresmentioning

confidence: 99%

“…Peer recovery coaches (PRCs), individuals with lived substance use experience and who have gone through the recovery process themselves, may be uniquely suited to address the barriers faced by low-income, racial/ethnic minority individuals with SUD [24][25][26][27]. PRCs have scaled in the US recently, and the majority of states now have formal state certification programs [28].…”

Section: Introductionmentioning

confidence: 99%

“…As such, BA has specific promise for delivery by PRCs within a recovery support context. Yet, despite empirical support for positive effects of BA on substance use treatment outcomes [41,42], and evidence to support acceptability for peer or lay counselor-delivery in low-and middle-income countries [27,39,[43][44][45][46][47][48][49][50][51], to date, there has been little research to develop or adapt PRC-delivered BA for problematic substance use in underserved settings in the US.…”

Section: Introductionmentioning

confidence: 99%

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Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

et al. 2020

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Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.

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Section: Key Informant Interview Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

et al. 2020

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“…Although the two sites are not connected from the inside, a Matrix treatment center shares a driveway and a wall with the clinic at which this study is taking place. Yet, there is evidence from our preliminary work from this study that clinic patients may not be aware of Matrix [20]. Therefore, we enhance SOC (ESOC) by facilitating screening for SU using the WHO-ASSIST and support the referral to Matrix, which includes offering to accompany participants to the Matrix clinic to schedule an intake, providing a direct referral, and following up on the referral at each subsequent study visit.…”

Section: Interventions Esocmentioning

confidence: 99%

“…Peers add an ability to share lived experience that can foster connection with patients and potentially reduce stigma [21]. Indeed, formative work leading up to this trial pointed to an overwhelming preference for peer-delivered SU counseling [20]. Peer-delivered SU interventions have been scaling in the USA and have been shown to be efficacious for improving engagement in care, reducing costly utilization, and improving SU outcomes [22].…”

Section: Introductionmentioning

confidence: 99%

Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa

Magidson

Joska

Myers

et al. 2020

Implement Sci Commun

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Background: Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population.Methods: Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one's environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor's model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patientlevel effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome.Discussion: Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally.

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Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

et al. 2021

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Introduction South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low‐resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. Methods A pilot randomized hybrid type 1 effectiveness‐implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task‐shared, peer‐delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on‐site AOD treatment. Implementation outcomes, defined by Proctor’s model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post‐treatment (three months) measured via real‐time electronic adherence monitoring, and AOD measured using biomarker and self‐report assessments over six months. Data collection was conducted from August 2018 to April 2020. Results and discussion Ninety‐one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment‐by‐time interaction for ART adherence (estimate = −0.287 [95% CI = −0.507, −0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self‐reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow‐back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). Conclusions Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non‐adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task‐sharing models for behavioral health in resource‐limited, global settings.

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“Someone who is in this thing that I am suffering from”: The role of peers and other facilitators for task sharing substance use treatment in South African HIV care

Cited by 57 publications

References 65 publications

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

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