Increases in employment over six months following Khanya: A secondary analysis of a pilot randomized controlled trial of a peer-delivered behavioral intervention for substance use and HIV medication adherence in Cape Town, South Africa.

Journal: The International journal on drug policy

Volume: 134

Issue: 

Year of Publication: 

Affiliated Institutions:  University Hospital Basel, Division of Clinical Epidemiology, Department of Clinical Research, Basel, Switzerland; University of Basel, Basel, Switzerland. University of Maryland College Park, Department of Psychology, College Park, MD, USA. Weill Cornell Medicine, Department of Population Health Sciences, New York, NY, USA. Weill Cornell Medicine, Department of Population Health Sciences, New York, NY, USA; Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), Weill Cornell Medicine, New York, NY, USA. University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa. University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa; University of Copenhagen, Global Health Section, Department of Public Health, Copenhagen, Denmark. Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Western Australia, Australia; South African Medical Research Council, Mental Health, Alcohol, Substance Use and Tobacco Research Unit, Tygerberg, South Africa; University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa. University of Miami, Department of Psychology, Coral Gables, FL, USA. University of Maryland College Park, Department of Psychology, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA. Electronic address: jmagidso@umd.edu.

Abstract summary 

Evidence suggests that brief, skills-based behavioral interventions are effective at improving clinical outcomes related to substance use and HIV, but little data exists on whether such interventions can incidentally improve employment. We examined preliminary changes in employment over six months following Khanya, a brief peer-delivered behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence compared to enhanced treatment as usual (ETAU).Adults living with HIV (N = 61) with at least moderate substance use and ART non-adherence were recruited from a primary care clinic in Khayelitsha, South Africa, a community with high rates of unemployment. Participants were randomized 1:1 to Khanya versus ETAU and assessed at baseline, 3- and 6-months. Employment was categorized as unemployed, casually, or full-time employed. Multilevel modeling was used to predict log odds and probability of categorical employment status over time, by arm.At baseline, 78.7% of the sample were unemployed, 16.4% were casually employed, and 4.9% were employed full-time. There was a significant increase in employment in both treatment arms at 3-months (p = 0.03) but only the Khanya arm demonstrated significant increases at 6-months (p = 0.02). At 6-months, 59% of participants in Khanya had any employment (from 13% at baseline), compared to 38% in ETAU (from 29% at baseline).Study data suggest a brief behavioral intervention for substance use and ART adherence may support employment among people with HIV living in a resource-constrained community. However, future research with larger sample sizes and longer-term follow ups is needed to replicate these findings.ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

Authors & Co-authors:  Belus Jennifer M JM Regenauer Kristen S KS Lu Thanh T Murphy Sean M SM Rose Alexandra L AL Ochieng Yvonne Akinyi YA Joska John J Majokweni Sybil S Andersen Lena S LS Myers Bronwyn B Safren Steven A SA Magidson Jessica F JF

Study Outcome 

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Citations : 
Authors :  12
Identifiers
Doi : 10.1016/j.drugpo.2024.104632
SSN : 1873-4758
Study Population
Male,Female
Mesh Terms
Other Terms
Behavioral intervention;Employment;HIV;Medication adherence;South Africa;Substance use
Study Design
Randomized Control Trial
Study Approach
Country of Study
South Africa
Publication Country
Netherlands