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Cited by 12HIV/AIDS Research and InterventionsMental Health Treatment and AccessSubstance Abuse Treatment and Outcomes

Piloting Siyakhana: A community health worker training to reduce substance use and depression stigma in South African HIV and TB care

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Regenauer, Kristen S., Rose, Alexandra L., Belus, Jennifer M., Johnson, Kim, Ciya, Nonceba, Ndamase, Sibabalwe, Jacobs, Yuche, Staniland, Lexy +5 more·2024·PLOS Global Public Health
DOI 10.1371/journal.pgph.0002657PMC PMC11075908
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Abstract

South Africa has one of the highest rates of HIV/tuberculosis (TB) co-infection, and poor engagement in HIV/TB care contributes to morbidity and mortality. In South Africa, community health workers (CHWs) are tasked with re-engaging patients who have dropped out of HIV/TB care. CHWs have described substantial challenges with substance use (SU) and depression among their patients, while patients have described CHW stigma towards SU and depression as barriers to re-engagement in care. Yet, CHWs receive little-to-no training on SU or depression. Therefore, we piloted Siyakhana, a brief CHW training to reduce stigma related to SU and depression while improving skills for re-engaging these patients in HIV and/or TB care. This study evaluated the preliminary effectiveness (stigma towards SU and depression; clinical competence assessed via roleplay) and implementation (quantitative ratings of feasibility, acceptability, appropriateness, adoption; semi-structured written qualitative feedback) of Siyakhana among CHWs and supervisors (N = 17) at pre- and post-training assessments. SU stigma significantly decreased (F(1,16) = 18.94, p < 0.001, η p2 = 0.54). Depression stigma was lower than SU stigma at both timepoints and did not significantly decrease after training. CHW clinical competency towards patients with SU/depression significantly improved (t(11) = -3.35, p = 0.007, d = 1.00). The training was rated as feasible, acceptable, appropriate, and likely to be adopted by CHWs and their supervisors. Nonjudgmental communication was commonly described as the most useful training component. Based on this pilot, the training is being refined and evaluated in a larger randomized stepped-wedge clinical trial.

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Authors
Regenauer, K. S., Rose, A. L., Belus, J. M., Johnson, K., Ciya, N., Ndamase, S., Jacobs, Y., Staniland, L., Sibeko, G., Bassett, I. V., Joska, J., Myers, B., & Magidson, J. F.
Affiliations
  • University of Maryland, College Park (US)
  • University of Basel (CH)
  • South African Medical Research Council (ZA)
  • Curtin University (AU)
  • University of Cape Town (ZA)
  • Harvard University (US)
Corresponding author
Regenauer, Kristen S.
ORCID
Venue
PLOS Global Public Health
Publisher
Public Library of Science (PLoS)
Published
2024-05-07
Volume
4
Issue
5
Pages
e0002657
ISSN
2767-3375 (ISSN-L)
DOI
10.1371/journal.pgph.0002657
PMC
PMC11075908
OpenAlex
W4396708424
Cited by
12
References
69
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 1
FWCI
3.80
Type
journal article
Language
en
Open access
Licence
Locations
  • PLOS Global Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute of Mental Health (R34MH122268, F31MH123020)
  • National Institute on Drug Abuse (R36DA057167)
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PZ00P1_201690)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
community health workers, substance use stigma, depression stigma, HIV/TB coinfection, re-engagement in care, CHW training, clinical competence, role play, implementation feasibility, South Africa

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