Symposia
Addictive Behaviors
Kristen S. Regenauer, MS
Doctoral Student
University of Maryland
College Park, Maryland
Kristen S. Regenauer, MS
Doctoral Student
University of Maryland
College Park, Maryland
Yuche Jacobs, M.A.
Senior Research Technologist
South African Medical Research Council
Cape Town, Western Cape, South Africa
Nonceba Ciya, Other
Research Assistant
South African Medical Research Council
Cape Town, Western Cape, South Africa
Sibabalwe Ndamase, B.S., B.A.
Research Assistant
South African Medical Research Council
Cape Town, Western Cape, South Africa
Kim Johnson, M.A.
Project Leader
South African Medical Research Council
Cape Town, Western Cape, South Africa
Alexandra L. Rose, MSc
Doctoral Student
University of Maryland
College Park, Maryland
Jennifer M. Belus, PhD
Project Leader
Swiss Tropical and Public Health Institute
Allschwil, Basel-Landschaft, Switzerland
Bronwyn Myers, PhD
Director, Curtin EnAble Institute
Curtin University
Bentley, Western Australia, Australia
Jessica F. Magidson, PhD
Assistant Professor
University of Maryland
College Park, Maryland
Introduction: Depression and substance use (SU) contribute to poor engagement in HIV and tuberculosis (TB) care in South Africa (SA). There is evidence that community health workers (CHWs)—frontline lay health workers in SA who play a central role in re-engaging patients in care—display high rates of depression/SU stigma, which is a barrier to patient re-engagement in HIV/TB care. Therefore, we created a CHW stigma-reduction training (“Siyakhana”).
Methods: Siyakhana was piloted with small groups of CHWs and CHW supervisors in Cape Town, South Africa. The training lasted three days and consisted of psychoeducation on depression, SU, and stigma; self-care strategies (e.g., identifying values, mindfulness); non-judgmental communication skills; and components of motivational interviewing and problem-solving therapy. It utilized presentation, discussion, and role-play methods. CHW stigma towards depression/SU was measured at pre- and post-training assessments using the Social Distance Scale (SDS). The SDS measured how much social distance CHWs wanted from an imaginary patient portrayed in a vignette, with higher scores indicating more desired social distance. CHWs were presented with two vignettes: one with a HIV/TB patient with depressive symptoms, and one with an HIV patient struggling with SU.
Results: CHWs (n=10) and supervisors (n=7) participated in the pilot training. Their mean age was 47.5 (SD=9.8), and they were 94% female, 76% Black African, and 24% mixed-race. When asked about the most important parts of their identity, they endorsed religion (88%), gender (82%), where they grew up (64%), ethnicity (53%), race (47%), and sexuality (41%). Before training, SDS scores were significantly higher for SU than for depression (SU: M(SD)=14.0(3.8); depression: M(SD)=8.1(2.0); difference: M=5.9, p< 0.001). After the training, SDS scores remained significantly higher for SU than for depression (SU: M(SD)=11.2(3.4); depression: M(SD)=8.7(2.4); difference: M=2.47, p< 0.01). However, while SDS scores towards depression did not significantly change between pre- and post-training, SDS scores towards SU significantly decreased after the training (difference: M=-2.8, p< 0.001).
Conclusions: Results suggest that a three-day training utilizing psychoeducation, motivational interviewing, and problem-solving therapy may successfully reduce short-term SU stigma among CHWs in HIV/TB care in SA. These pilot findings will be used to inform a larger, stepped-wedge trial of this training.