Siyakhana Peer: Evaluating a Peer Recovery Coach Model to Reduce Substance Use Stigma in South African HIV Care

NCT05907174 | Completed Results

• 2 other identifiers: EC016-7/2022R21DA053212
• Study Type: interventional
• Target: 91
• Locations: 1 country
• Sites: 1

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.

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

Outcome Measures

Primary Outcomes (1)

• Healthcare Worker Substance Use Stigma

  Healthcare worker stigma towards substance use measured using the Social Distance Scale (SDS). SDS scores range from 6 to 24, with higher scores indicating more desired social distance (higher stigma).

  3-months post-baseline assessment

Secondary Outcomes (2)

• Healthcare Worker Feasibility (Intervention Arm Only)

  6-months post-integration assessment

• Healthcare Worker Acceptability (Intervention Arm Only)

  6-months post-integration assessment

Other Outcomes (3)

• Patient Re-Engagement in HIV Care

  3-months post-baseline assessment

• Patient Feasibility (Intervention Arm Only)

  3-months post-baseline assessment

• Patient Acceptability (Intervention Arm Only)

  3-months post-baseline assessment

Study Arms (4)

Enhanced Treatment as Usual (Healthcare Workers)

NO INTERVENTION

Monitoring of treatment as usual (i.e., routine interactions between healthcare workers and patients). Treatment as usual will be enhanced by providing healthcare workers with a substance use psychoeducation and screening training.

Siyakhana - P (Healthcare Workers)

EXPERIMENTAL

Providers working with PRC. Siyakhana - P healthcare workers will also receive a substance use psychoeducation and screening training, and a workshop for healthcare workers to get to know the PRC and learn more about the PRC role.

Behavioral: Siyakhana - P

Enhanced Treatment as Usual (Patients)

NO INTERVENTION

Monitoring of treatment as usual (i.e., routine interactions between healthcare workers and patients). Treatment as usual will be enhanced by providing healthcare workers with a substance use psychoeducation and screening training.

Siyakhana - P (Patients)

EXPERIMENTAL

Patients seen by the team of health care workers with an integrated PRC. Patients will have the opportunity to meet with the PRC for about 3-months after their baseline assessment. Siyakhana - P healthcare workers will also receive a substance use psychoeducation and screening training, and a workshop for healthcare workers to get to know the PRC and learn more about the PRC role.

Behavioral: Siyakhana - P

Interventions

Siyakhana - P BEHAVIORAL

A trained peer recovery coach (PRC) will be integrated onto the healthcare worker team randomized to Siyakhana - P. The PRC on this team will work with eligible and consenting patients who are seen by members of this healthcare team.

Also known as: Peer Recovery Coach Integrated Intervention, PRC Integration

Siyakhana - P (Healthcare Workers); Siyakhana - P (Patients)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• University of Maryland, College Park: lead
• Medical Research Council, South Africa: collaborator
• National Institute on Drug Abuse (NIDA): collaborator

Study Sites (1)

South African Medical Research Council - Delft Office

Cape Town, Western Cape, 7580, South Africa

Location

MeSH Terms

Conditions

Substance-Related Disorders; Social Stigma; Stereotyping; Treatment Adherence and Compliance; Patient Acceptance of Health Care

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders; Mental Disorders; Social Behavior; Behavior; Health Behavior

Results Point of Contact

• Title: Dr. Jessica Magidson
• Organization: University of Maryland, College Park

jmagidso@umd.edu

301-405-5095

Study Officials

• Jessica F Magidson, PhD

  University of Maryland, College Park

  PRINCIPAL INVESTIGATOR

• Bronwyn Myers, PhD

  Medical Research Council, South Africa

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: 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.

Study Record Dates

• First Submitted: June 7, 2023
• First Posted: June 18, 2023
• Study Start: February 22, 2021
• Primary Completion: January 29, 2024
• Study Completion: August 29, 2024
• Last Updated: February 10, 2025
• Results First Posted: February 10, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ICF

Locations

ZA (1)