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      Piloting Siyakhana: A community health worker training to reduce substance use and depression stigma in South African HIV and TB care

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          Abstract

          South Africa has one of the highest rates of HIV/tuberculosis (TB) co-infection, and poor engagement in HIV/TB care contributes to morbidity and mortality. In South Africa, community health workers (CHWs) are tasked with re-engaging patients who have dropped out of HIV/TB care. CHWs have described substantial challenges with substance use (SU) and depression among their patients, while patients have described CHW stigma towards SU and depression as barriers to re-engagement in care. Yet, CHWs receive little-to-no training on SU or depression. Therefore, we piloted Siyakhana, a brief CHW training to reduce stigma related to SU and depression while improving skills for re-engaging these patients in HIV and/or TB care. This study evaluated the preliminary effectiveness (stigma towards SU and depression; clinical competence assessed via roleplay) and implementation (quantitative ratings of feasibility, acceptability, appropriateness, adoption; semi-structured written qualitative feedback) of Siyakhana among CHWs and supervisors ( N = 17) at pre- and post-training assessments. SU stigma significantly decreased ( F(1,16) = 18.94, p < 0.001, η p 2 = 0.54). Depression stigma was lower than SU stigma at both timepoints and did not significantly decrease after training. CHW clinical competency towards patients with SU/depression significantly improved ( t(11) = -3.35, p = 0.007, d = 1.00). The training was rated as feasible, acceptable, appropriate, and likely to be adopted by CHWs and their supervisors. Nonjudgmental communication was commonly described as the most useful training component. Based on this pilot, the training is being refined and evaluated in a larger randomized stepped-wedge clinical trial.

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                Author and article information

                Contributors
                Role: Formal analysisRole: Project administrationRole: SoftwareRole: SupervisionRole: VisualizationRole: Writing – original draft
                Role: Formal analysisRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                7 May 2024
                2024
                : 4
                : 5
                : e0002657
                Affiliations
                [1 ] Department of Psychology, University of Maryland, College Park, College Park, Maryland, United States of America
                [2 ] University of Basel, Basel, Switzerland
                [3 ] Department of Clinical Research, University Hospital Basel, Basel, Switzerland
                [4 ] Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa
                [5 ] People Development Centre: Corporate Wellness, Western Cape Department of Health & Wellness, Plumstead, Cape Town, South Africa
                [6 ] EnAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
                [7 ] Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
                [8 ] Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
                [9 ] Center for Substance Use, Health & Addiction Research (CESAR), University of Maryland, College Park, College Park, Maryland, United States of America
                St John's National Academy of Health Sciences, INDIA
                Author notes

                The authors have declared that no competing interests exist.

                ‡ BM and JFM are joint senior authors to this work.

                Author information
                https://orcid.org/0000-0001-6463-967X
                https://orcid.org/0000-0003-4091-4889
                https://orcid.org/0000-0001-8680-6408
                https://orcid.org/0000-0002-0161-144X
                https://orcid.org/0000-0003-0235-6716
                Article
                PGPH-D-23-00892
                10.1371/journal.pgph.0002657
                11075908
                38713695
                57da4070-ae33-4b9e-a523-37238cb8f2da
                © 2024 Regenauer et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 May 2023
                : 3 November 2023
                Page count
                Figures: 3, Tables: 3, Pages: 20
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R34MH122268
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R34MH122268
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: R36DA057167
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: F31MH123020
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001711, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung;
                Award ID: PZ00P1_201690
                Award Recipient :
                This study was funded by the National Institute of Mental Health (NIMH) grant R34MH122268 (awardees: JFM, BM). Additional support was received from the National Institute on Drug Abuse (NIDA) grant R21DA053212 (awardees: JFM, BM). KSR's time was supported by the National Institute on Drug Abuse (NIDA) grant R36DA057167, ALR's time was supported by NIMH grant F31MH123020, and JMB's time was supported by the Swiss National Science Foundation (grant no. PZ00P1_201690). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Immunodeficiency Viruses
                HIV
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
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                Retroviruses
                Lentivirus
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                People and Places
                Population Groupings
                Professions
                Supervisors
                Medicine and Health Sciences
                Health Care
                Patients
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                Geographical locations
                Africa
                South Africa
                Medicine and Health Sciences
                Medical Conditions
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                Tuberculosis
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                Tuberculosis
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                Medicine and Health Sciences
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                Custom metadata
                De-identified data from this study has not been deposited into an open-access repository because it was not included in participants' consent forms. De-identified study materials, including the analysis code, are available from Dr. Michael Wagner ( wagner@ 123456umd.edu ) upon written request. Dr. Wagner is a consulting biostatistician in the Global Mental Health and Addiction Program (GMAP) at the University of Maryland, College Park and Director of Computer Operations at the Center for Substance Use, Addiction, & Health Research (CESAR) at the University of Maryland, College Park.

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