Task Shifting and Delivery of Behavioral Medicine Interventions in Resource-Poor Global Settings: HIV/AIDS Treatment in sub-Saharan Africa

Magidson, Jessica F.; Gouse, Hetta; Psaros, Christina; Remmert, Jocelyn E.; O’Cleirigh, Conall; Safren, Steven A.

doi:10.1007/978-3-319-29294-6_14

Cited by 20 publications

(14 citation statements)

References 64 publications

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“…In sub-Saharan contexts, CHWs have proven effective for implementing various in-home health services, including the delivery of HIV testing services, linking PLHIV to care and treatment adherence support ( Wahl et al , 2019 ). CHWs have also provided other services, including services related to tuberculosis ( Sinha et al , 2019 ), child care ( Schneider et al , 2016 ; O’Donovan et al , 2018 ), maternal care ( Medhanyie et al , 2012 ; August et al , 2016 ), mental health ( Magidson et al , 2017 ), reproductive care ( Gullo et al , 2017 ) and non-communicable diseases ( Jeet et al , 2017 ). CHWs have been especially valuable in contexts where public health facilities face challenges, such as staff shortages ( Joseph et al , 2012 ; Koto and Maharaj, 2016 ; Schneider et al , 2016 ; Rao Seshadri and Kothai, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Community-based health workers implementing universal access to HIV testing and treatment: lessons from South Africa and Zambia—HPTN 071 (PopART)

Viljoen

Mainga

Casper

et al. 2021

Health Policy and Planning

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The global expansion of HIV testing, prevention and treatment services is necessary to achieve HIV epidemic control and promote individual and population health benefits for people living with HIV (PLHIV) in sub-Saharan Africa. Community-based health workers (CHWs) could play a key role in supporting implementation at scale. In the HPTN 071 (PopART) trial in Zambia and South Africa, a cadre of 737 study-specific CHWs, working closely with government-employed CHW, were deployed to deliver a ‘universal’ door-to-door HIV prevention package, including an annual offer of HIV testing and referral services for all households in 14 study communities. We conducted a process evaluation using qualitative and quantitative data collected during the trial (2013–2018) to document the implementation of the CHW intervention in practice. We focused on the recruitment, retention, training and support of CHWs, as they delivered study-specific services. We then used these descriptions to: (i) analyse the fidelity to design of the delivery of the intervention package, and (ii) suggest key insights for the transferability of the intervention to other settings. The data included baseline quantitative data collected with the study-specific CHWs (2014–2018); and qualitative data from key informant interviews with study management (n = 91), observations of CHW training events (n = 12) and annual observations of and group discussions (GD) with intervention staff (n = 68). We show that it was feasible for newly recruited CHWs to implement the PopART intervention with good fidelity, supporting the interpretation of the trial outcome findings. This was despite some challenges in managing service quality and CHW retention in the early years of the programme. We suggest that by prioritizing the adoption of key elements of the in-home HIV services delivery intervention model—including training, emotional support to workers, monitoring and appropriate remuneration for CHWs—these services could be successfully transferred to new settings.

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Section: Introductionmentioning

confidence: 99%

Community-based health workers implementing universal access to HIV testing and treatment: lessons from South Africa and Zambia—HPTN 071 (PopART)

Viljoen

Mainga

Casper

et al. 2021

Health Policy and Planning

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“…Given the prevalence of SU among PLWH in SA and interference with HIV care outcomes across the continuum [ 5 – 7 , 9 , 61 ], it is crucial to identify how to integrate and implement evidence-based interventions to treat substance use in HIV care in SA. Identifying intervention components that can be feasibly and sustainably delivered using a task sharing model is essential, as there are significant workforce shortages for behavioral health interventions in SA and other LMICs [ 15 , 62 ]. Task sharing efforts in SA and elsewhere to date have largely involved task sharing with lay counselors, such as lay adherence counselors or CHWs, as opposed to peers [ 15 , 16 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Identifying intervention components that can be feasibly and sustainably delivered using a task sharing model is essential, as there are significant workforce shortages for behavioral health interventions in SA and other LMICs [ 15 , 62 ]. Task sharing efforts in SA and elsewhere to date have largely involved task sharing with lay counselors, such as lay adherence counselors or CHWs, as opposed to peers [ 15 , 16 , 18 , 19 ]. This trial will contribute new knowledge about the effectiveness and implementation of a peer-delivered intervention using a task sharing model.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, sustainability must be considered, especially for LMICs. Given the lack of availability of trained mental health and SU professionals in this setting, an implementation strategy will require “task sharing” [ 15 , 16 ]. Task sharing models include hiring and training less specialized health care workers, such as community health workers (CHWs) or lay counselors, to deliver mental health services under the supervision of more highly trained professionals [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa

Magidson

Joska

Myers

et al. 2020

Implement Sci Commun

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Background: Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population.Methods: Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one's environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor's model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patientlevel effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome.Discussion: Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally.

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“…Future directions following from the current study include conducting a larger randomized clinical trial to evaluate this approach, identifying mediators of the effects of MBSR on disease progression (i.e., changes in mindfulness or coping styles; Riley & Kalichman, 2015; Witek-Janusek et al, 2008), as well as evaluating the feasibility and acceptability of a task shifting model for delivery of this approach. Sustainable and scalable delivery in this resource-limited setting will have to be led by peers, lay counselors, or perhaps nurses (Magidson et al, 2017). Future adaptations may also consider specifically focusing on ARV initiation or adherence, particularly given the low rates of ARV use in this sample.…”

Section: Discussionmentioning

confidence: 99%

The Application of Mindfulness for Individuals Living with HIV in South Africa: a Hybrid Effectiveness-Implementation Pilot Study

et al. 2017

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Despite the recent growth of mindfulness research worldwide, there remains little research examining the application of mindfulness-based interventions in resource-limited, international settings. This study examined the application of Mindfulness Based Stress Reduction (MBSR) for HIV-infected individuals in South Africa, where rates of HIV are highest in the world. Mixed methods were used to examine the following over a three-month follow up: (1) feasibility, acceptability, and preliminary adaptation of MBSR for this new context; and (2) effects of MBSR on immune functioning, self-reported mindfulness (MAAS, FFMQ), depression, anxiety, and stress (DASS-21). Ten individuals initiated MBSR, and seven completed all eight sessions. Results indicated medium effect size improvements in immune functioning (CD4 count and t-cell count; d = .5) through the three-month follow up, though the small sample size limited power to detect a statistically significant effect. From baseline to post-treatment, improvements in “Observing” and “Non-reactivity” (FFMQ) approached statistical significance with large effect sizes (observing: d = 1.5; p = .08; non-reactivity: d = .7; p = .07). There were no statistically significant changes in depression, anxiety, or stress throughout the study period. Primary areas for adaptation of MBSR included emphasis on informal practice, ways to create “space” without much privacy, and ways to concretize the concepts and definitions of mindfulness. Feedback from participants can shape future adaptations to MBSR for this and similar populations. Findings provide preliminary evidence regarding the implementation of MBSR for individuals living with HIV in South Africa. A future randomized clinical trial with a larger sample size is warranted.

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Task Shifting and Delivery of Behavioral Medicine Interventions in Resource-Poor Global Settings: HIV/AIDS Treatment in sub-Saharan Africa

Cited by 20 publications

References 64 publications

Community-based health workers implementing universal access to HIV testing and treatment: lessons from South Africa and Zambia—HPTN 071 (PopART)

Community-based health workers implementing universal access to HIV testing and treatment: lessons from South Africa and Zambia—HPTN 071 (PopART)

Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa

The Application of Mindfulness for Individuals Living with HIV in South Africa: a Hybrid Effectiveness-Implementation Pilot Study

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