"Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care.
Int J Drug Policy. 2019 08; 70:61-69.IJ

Abstract

South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a "siloed treatment experience"), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting.

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Authors+Show Affiliations

Magidson JF

University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA. Electronic address: jmagidso@umd.edu.

Joska JA

HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Anzio Road, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa. Electronic address: John.Joska@uct.ac.za.

Regenauer KS

Massachusetts General Hospital, One Bowdoin Square, Boston, MA, USA. Electronic address: kregenauer@mgh.harvard.edu.

Satinsky E

University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA. Electronic address: esatinsk@umd.edu.

Andersen LS

Seitz-Brown CJ

University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA. Electronic address: cj.seitzbrown@gmail.com.

Borba CPC

Boston University/Boston Medical Center, 85 E. Newton St., Fuller Building, Boston, MA, USA. Electronic address: Christina.Borba@bmc.org.

Safren SA

University of Miami, Clinical Research Building, Miller School of Medicine, 1120 NW 14th St., Suite, 787, Miami, FL, USA. Electronic address: ssafren@miami.edu.

Myers B

Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council Francie Van Zyl Drive, Parow, 7505, South Africa; Division of Addiction Psychiatry, Department of Psychiatry, and Mental Health, University of Cape Town, Cape Town, South Africa. Electronic address: bmyers@mrc.ac.za.

MeSH

AdolescentAdultAgedAttitude of Health PersonnelComorbidityDelivery of Health Care, IntegratedFemaleHIV InfectionsHealth Services AccessibilityHumansMaleMedication AdherenceMiddle AgedPeer GroupQualitative ResearchSouth AfricaSubstance-Related DisordersYoung Adult

Pub Type(s)

Journal Article

Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31082664

Citation

Magidson, Jessica F., et al. ""Someone Who Is in This Thing That I Am Suffering From": the Role of Peers and Other Facilitators for Task Sharing Substance Use Treatment in South African HIV Care." The International Journal On Drug Policy, vol. 70, 2019, pp. 61-69.

Magidson JF, Joska JA, Regenauer KS, et al. "Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. Int J Drug Policy. 2019;70:61-69.

Magidson, J. F., Joska, J. A., Regenauer, K. S., Satinsky, E., Andersen, L. S., Seitz-Brown, C. J., Borba, C. P. C., Safren, S. A., & Myers, B. (2019). "Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. The International Journal On Drug Policy, 70, 61-69. https://doi.org/10.1016/j.drugpo.2018.11.004

Magidson JF, et al. "Someone Who Is in This Thing That I Am Suffering From": the Role of Peers and Other Facilitators for Task Sharing Substance Use Treatment in South African HIV Care. Int J Drug Policy. 2019;70:61-69. PubMed PMID: 31082664.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - "Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. AU - Magidson,Jessica F, AU - Joska,John A, AU - Regenauer,Kristen S, AU - Satinsky,Emily, AU - Andersen,Lena S, AU - Seitz-Brown,C J, AU - Borba,Christina P C, AU - Safren,Steven A, AU - Myers,Bronwyn, Y1 - 2019/05/10/ PY - 2018/06/26/received PY - 2018/11/07/revised PY - 2018/11/19/accepted PY - 2019/5/15/pubmed PY - 2020/4/21/medline PY - 2019/5/15/entrez KW - Global mental health KW - HIV/AIDS KW - Integrated care KW - Problematic substance use KW - South Africa KW - Task sharing SP - 61 EP - 69 JF - The International journal on drug policy JO - Int J Drug Policy VL - 70 N2 - South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a "siloed treatment experience"), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/31082664/"Someone_who_is_in_this_thing_that_I_am_suffering_from":_The_role_of_peers_and_other_facilitators_for_task_sharing_substance_use_treatment_in_South_African_HIV_care_ DB - PRIME DP - Unbound Medicine ER -

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"Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care.Int J Drug Policy. 2019 08; 70:61-69.IJ