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
Abstract 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 m...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | Implementation Science Communications |
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| Online Access: | https://doi.org/10.1186/s43058-020-00004-w |
| _version_ | 1818370490066010112 |
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| author | Jessica F. Magidson John A. Joska Bronwyn Myers Jennifer M. Belus Kristen S. Regenauer Lena S. Andersen Sybil Majokweni Conall O’Cleirigh Steven A. Safren |
| author_facet | Jessica F. Magidson John A. Joska Bronwyn Myers Jennifer M. Belus Kristen S. Regenauer Lena S. Andersen Sybil Majokweni Conall O’Cleirigh Steven A. Safren |
| author_sort | Jessica F. Magidson |
| collection | DOAJ |
| description | Abstract 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 patient-level 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. Trial registration ClinicalTrials.gov identifier: NCT03529409 . Trial registered on May 18, 2018. |
| first_indexed | 2024-12-13T23:40:34Z |
| format | Article |
| id | doaj.art-1733e0984e374e529882c44b4b6741b5 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-13T23:40:34Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-1733e0984e374e529882c44b4b6741b52022-12-21T23:27:11ZengBMCImplementation Science Communications2662-22112020-03-011111210.1186/s43058-020-00004-wProject Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South AfricaJessica F. Magidson0John A. Joska1Bronwyn Myers2Jennifer M. Belus3Kristen S. Regenauer4Lena S. Andersen5Sybil Majokweni6Conall O’Cleirigh7Steven A. Safren8Department of Psychology, University of MarylandHIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape TownAlcohol, Tobacco and Other Drug Research Unit, South African Medical Research CouncilDepartment of Psychology, University of MarylandDepartment of Psychology, University of MarylandHIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape TownHIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape TownDepartment of Psychiatry, Massachusetts General Hospital/Harvard Medical SchoolDepartment of Psychology, University of MiamiAbstract 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 patient-level 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. Trial registration ClinicalTrials.gov identifier: NCT03529409 . Trial registered on May 18, 2018.https://doi.org/10.1186/s43058-020-00004-wRE-AIMHybrid designGlobal mental healthHIVSubstance useAntiretroviral therapy (ART) adherence |
| spellingShingle | Jessica F. Magidson John A. Joska Bronwyn Myers Jennifer M. Belus Kristen S. Regenauer Lena S. Andersen Sybil Majokweni Conall O’Cleirigh Steven A. Safren 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 Implementation Science Communications RE-AIM Hybrid design Global mental health HIV Substance use Antiretroviral therapy (ART) adherence |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | RE-AIM Hybrid design Global mental health HIV Substance use Antiretroviral therapy (ART) adherence |
| url | https://doi.org/10.1186/s43058-020-00004-w |
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