Community health worker training to reduce mental health and substance use stigma towards patients who have disengaged from HIV/TB care in South Africa: protocol for a stepped wedge hybrid type II pilot implementation trial

Bronwyn Myers; Kristen S Regenauer; Alexandra Rose; Kim Johnson; Sibabalwe Ndamase; Nonceba Ciya; Imani Brown; John Joska; Ingrid V Bassett; Jennifer M Belus; Tianzhou Charles Ma; Goodman Sibeko; Jessica F Magidson

doi:10.1186/s43058-023-00537-w

Community health worker training to reduce mental health and substance use stigma towards patients who have disengaged from HIV/TB care in South Africa: protocol for a stepped wedge hybrid type II pilot implementation trial

Implement Sci Commun. 2024 Jan 2;5(1):1. doi: 10.1186/s43058-023-00537-w.

Authors

Bronwyn Myers^{1

2

3}, Kristen S Regenauer⁴, Alexandra Rose⁴, Kim Johnson⁵, Sibabalwe Ndamase⁵, Nonceba Ciya⁵, Imani Brown⁴, John Joska⁶, Ingrid V Bassett⁷, Jennifer M Belus^{8

9}, Tianzhou Charles Ma¹⁰, Goodman Sibeko¹¹, Jessica F Magidson⁴

Affiliations

¹ Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Perth, WA, Australia. bronwyn.myers-franchi@curtin.edu.au.
² Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa. bronwyn.myers-franchi@curtin.edu.au.
³ Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Cape Town, South Africa. bronwyn.myers-franchi@curtin.edu.au.
⁴ Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
⁵ Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
⁶ Department of Psychiatry and Mental Health, Division of Neuropsychiatry, University of Cape Town, HIV Mental Health Research Unit, Cape Town, South Africa.
⁷ Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
⁸ Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
⁹ Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
¹⁰ Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA.
¹¹ Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Cape Town, South Africa.

Abstract

Background: 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.

Methods: 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.

Discussion: 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.

Trial registration: ClinicalTrials.gov NCT05282173. Registered on 7 March 2022.

Keywords: Depression; Global mental health; Low- and middle-income country; Stigma; Task-sharing.

Associated data

ClinicalTrials.gov/NCT05282173

Abstract

Associated data

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