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

Journal: PLOS global public health

Volume: 4

Issue: 5

Year of Publication: 

Affiliated Institutions:  Department of Psychology, University of Maryland, College Park, College Park, Maryland, United States of America. University of Basel, Basel, Switzerland. Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa. EnAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America.

Abstract summary 

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, ηp2 = 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.

Authors & Co-authors:  Regenauer Kristen S KS Rose Alexandra L AL Belus Jennifer M JM Johnson Kim K Ciya Nonceba N Ndamase Sibabalwe S Jacobs Yuche Y Staniland Lexy L Sibeko Goodman G Bassett Ingrid V IV Joska John J Myers Bronwyn B Magidson Jessica F JF

Study Outcome 

Source Link: Visit source

Statistics
Citations :  UNAIDS. UNAIDS. 2021 [cited 2023 Jun 1]. Country Factsheets: South Africa 2021. Available from: https://www.unaids.org/en/regionscountries/countries/southafrica
Authors :  13
Identifiers
Doi : e0002657
SSN : 2767-3375
Study Population
Male,Female
Mesh Terms
Other Terms
Study Design
Study Approach
Country of Study
South Africa
Publication Country
United States