Myers Bronwyn, Regenauer Kristen S, Rose Alexandra, Johnson Kim, Ndamase Sibabalwe, Ciya Nonceba, Brown Imani, Joska John, Bassett Ingrid V, Belus Jennifer M, Ma Tianzhou Charles, Sibeko Goodman, Magidson Jessica F
Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Perth, WA, Australia.
Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
Implement Sci Commun. 2024 Jan 2;5(1):1. doi: 10.1186/s43058-023-00537-w.
South Africa has deployed community health workers (CHWs) to support individuals to enter and stay in HIV/TB care. Although CHWs routinely encounter patients with mental health (particularly depression) and substance use (SU) conditions that impact their engagement in HIV/TB care, CHWs are rarely trained in how to work with these patients. This contributes to mental health and SU stigma among CHWs, a known barrier to patient engagement in care. Mental health and SU training interventions could reduce CHW stigma and potentially improve patient engagement in care, but evidence of the feasibility, acceptability, and preliminary effectiveness of these interventions is scarce. Therefore, we designed a hybrid type 2 effectiveness-implementation pilot trial to evaluate the implementation and preliminary effectiveness of a CHW training intervention for reducing depression and SU stigma in the Western Cape, South Africa.
This stepped wedge pilot trial will engage CHWs from six primary care clinics offering HIV/TB care. Clinics will be block randomized into three-step cohorts that receive the intervention at varying time points. The Siyakhana intervention involves 3 days of training in depression and SU focused on psychoeducation, evidence-based skills for working with patients, and self-care strategies for promoting CHW wellness. The implementation strategy involves social contact with people with lived experience of depression/SU during training (via patient videos and a peer trainer) and clinical supervision to support CHWs to practice new skills. Both implementation outcomes (acceptability, feasibility, fidelity) and preliminary effectiveness of the intervention on CHW stigma will be assessed using mixed methods at 3- and 6-month follow-up assessments.
This trial will advance knowledge of the feasibility, acceptability, and preliminary effectiveness of a CHW training for reducing depression and SU stigma towards patients with HIV and/or TB. Study findings will inform a larger implementation trial to evaluate the longer-term implementation and effectiveness of this intervention for reducing CHW stigma towards patients with depression and SU and improving patient engagement in HIV/TB care.
ClinicalTrials.gov NCT05282173. Registered on 7 March 2022.
南非已部署社区卫生工作者（CHW），以支持个人进入并持续接受艾滋病毒/结核病护理。尽管社区卫生工作者在日常工作中经常遇到患有心理健康问题（尤其是抑郁症）和物质使用问题的患者，这些问题会影响他们参与艾滋病毒/结核病护理，但社区卫生工作者很少接受如何与这些患者合作的培训。这加剧了社区卫生工作者对心理健康和物质使用问题的污名化，这是患者参与护理的一个已知障碍。心理健康和物质使用培训干预措施可以减少社区卫生工作者的污名化，并有可能提高患者参与护理的程度，但这些干预措施的可行性、可接受性和初步有效性的证据很少。因此，我们设计了一项混合型2期有效性-实施试点试验，以评估在南非西开普省开展的一项社区卫生工作者培训干预措施在减少抑郁症和物质使用污名化方面的实施情况和初步效果。
这项逐步楔形试点试验将纳入来自六个提供艾滋病毒/结核病护理的初级保健诊所的社区卫生工作者。诊所将被整群随机分为三个阶段的队列，在不同时间点接受干预。“Siyakhana干预措施”包括为期3天的抑郁症和物质使用培训，重点是心理教育、与患者合作的循证技能以及促进社区卫生工作者健康的自我护理策略。实施策略包括在培训期间与有抑郁症/物质使用经历的人进行社交接触（通过患者视频和同伴培训师）以及临床监督，以支持社区卫生工作者练习新技能。在3个月和6个月的随访评估中，将使用混合方法评估实施结果（可接受性、可行性、保真度）以及干预措施对社区卫生工作者污名化的初步效果。
这项试验将推进关于社区卫生工作者培训在减少对艾滋病毒和/或结核病患者的抑郁症和物质使用污名化方面的可行性、可接受性和初步效果的知识。研究结果将为一项更大规模的实施试验提供信息，以评估该干预措施在减少社区卫生工作者对抑郁症和物质使用患者的污名化以及提高患者参与艾滋病毒/结核病护理方面的长期实施情况和效果。
ClinicalTrials.gov NCT05282173。于2022年3月7日注册。
