Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Psychology, University of Maryland, College Park, MD, USA.
Int J Drug Policy. 2023 Oct;120:104144. doi: 10.1016/j.drugpo.2023.104144. Epub 2023 Aug 9.
Globally, there is a treatment gap for substance use treatment and harm reduction services. As peer-delivered interventions expand to address this gap in both high-income countries (HICs) and low and middle-income countries (LMICs), they provide an opportunity to examine mutual capacity building, the bidirectional exchange of ideas between distinct settings to address common challenges.
The aim of this study was to explore the perspectives of patients in Cape Town and Baltimore about the acceptability and feasibility of a peer-delivered intervention using a combined qualitative analysis across a HIC and LMIC. Semi-structured qualitative interviews were conducted with participants in pilot trials in Cape Town, South Africa and Baltimore, USA (n=55). Across both trials, participants received a peer-delivered behavioral intervention focused on problem solving strategies for medication adherence, behavioral activation, and other cognitive-behavioral skills. The datasets from each location were merged and analyzed jointly using thematic analysis to develop codes and themes. Transcripts were coded to theoretical saturation (n=21 from Baltimore, n=16 from Cape Town).
Participants highlighted what they valued about the peer-delivered intervention: 1) behavioral skills learned, 2) relationship with the peer, 3) ability to help others based on what they learned, 4) improved adherence to HIV or substance use medications, and 5) changes in substance use behaviors. In Baltimore, participants were typically more focused on their supportive relationship with the peer, which contrasted with many other relationships in their lives. In Cape Town, many participants highlighted the value of the skills they learned, such as mindfulness and activity scheduling.
Across sites, participants valued that the peer could support them to accomplish meaningful life goals beyond substance use recovery, such as building relationships or health. Differences between settings may highlight the importance of tailoring peer interventions to fill context-specific gaps in available services.
在全球范围内，物质使用治疗和减少伤害服务存在治疗缺口。随着同伴提供的干预措施在高收入国家（HIC）和中低收入国家（LMIC）中扩大以填补这一缺口，它们提供了一个机会，可以检验相互能力建设，即在不同环境中双向交流思想以应对共同挑战。
本研究旨在探讨开普敦和巴尔的摩的患者对使用 HIC 和 LMIC 联合定性分析的同伴提供的干预措施的可接受性和可行性的看法。在南非开普敦和美国巴尔的摩的试点试验中对参与者进行了半结构化定性访谈（n=55）。在两项试验中，参与者均接受了同伴提供的行为干预，重点是解决药物依从性、行为激活和其他认知行为技能的问题解决策略。合并了来自每个地点的数据集，并使用主题分析联合分析这些数据集，以开发代码和主题。对来自巴尔的摩的 21 份和来自开普敦的 16 份转录本进行编码，直至理论饱和。
参与者强调了他们对同伴提供的干预措施的重视：1）学到的行为技能，2）与同伴的关系，3）根据所学知识帮助他人的能力，4）提高了对 HIV 或物质使用药物的依从性，以及 5）改变物质使用行为。在巴尔的摩，参与者通常更关注他们与同伴的支持性关系，这与他们生活中的许多其他关系形成了对比。在开普敦，许多参与者强调了他们所学技能的价值，例如正念和活动安排。
在不同的地点，参与者都重视同伴可以支持他们实现有意义的生活目标，而不仅仅是物质使用康复，例如建立关系或保持健康。不同环境之间的差异可能强调了针对特定背景的服务缺口调整同伴干预措施的重要性。
