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ViewAttendees 2

Individual Oral Paper

Global Mental Health

At the Intersection of HIV and Behavioral Health: Predictors and Outcomes Across the Care Cascade

2 - (IOP 21) Integrating a Peer Recovery Coach into Community-oriented HIV Care to Reduce Staff Substance Use Stigma in South Africa: Results from a Pilot Hybrid Effectiveness-implementation Trial

Saturday, November 22, 2025
3:15 PM - 3:30 PM CST
Location: Celestin H, Level 3
Keywords: Global Mental Health, Stigma, Substance Abuse
Recommended Readings: Myers, B., Regenauer, K. S., Johnson, K., Brown, I., Rose, A. L., Ciya, N., Ndamase, S., Jacobs, Y., Anvari, M., Hines, A., Dean, D., Baskar, R., & Magidson, J. F. (2025). A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa. Addiction Science & Clinical Practice, 20, 15.,   Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O'Reilly, C., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123-1132.,   Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence, 131(1-2), 23-35.,   ,  
Introduction: Undertreated substance use (SU) greatly contributes to HIV care disengagement in South Africa (SA), the country with the highest HIV burden. Rates of HIV, SU, and care disengagement are especially high in resource-limited, racially segregated, urban areas created under apartheid. To increase care engagement in these areas, SA has introduced community-oriented primary care teams (COPCs), comprised of community health workers who work to engage people living with HIV (PLWH) in clinic-based care. Yet, largely due to SU stigma, COPCs rarely address SU, and COPC stigma towards SU hinders care engagement among PLWH and SU. In high-income countries, preliminary research suggests that working alongside a peer recovery coach (PRC)—a lay provider with lived SU recovery experience—may reduce provider-level SU stigma. However, no work has directly studied this in low-and-middle income countries like SA or within HIV care. Therefore, following a multi-stage process to design a PRC role for this context, we examined if integrating a PRC onto a COPC reduced stigma towards PLWH and SU.

Methods: In a pilot hybrid type 1 effectiveness-implementation trial, two matched COPC teams were randomized to have a PRC join their COPC (intervention; n=21 staff) or continue usual care (control; n=20 staff). The PRC was trained in basic evidence-based skills like motivational interviewing, problem-solving, behavioral activation, and mindfulness. To enhance usual care, both COPC teams received a one-day training in SU/HIV psychoeducation, screening for SU, and referring patients to SU treatment. COPC stigma towards PLWH and SU was measured using the Social Distance Scale (timepoints: baseline, 3-months post-PRC integration, 6-months post-PRC integration). Implementation outcomes included acceptability and feasibility, assessed quantitatively via the Applied Mental Health Research (AMHR) assessment and qualitatively via semi-structured interviews with COPC staff in the intervention (n=19). Thematic analysis was used to code interviews.

Results: COPC staff were M=42.2 (SD=9.1) year old, 98% female, 93% Black, and 100% isiXhosa speaking. Nearly half (49%) did not finish secondary school, and only 15% endorsed any lifetime SU training. To examine changes in SU stigma over time and between groups, generalized linear models were conducted with time dummy coded and treated categorically. Analysis revealed a significant moderation such that stigma reduced more strongly compared to baseline in the intervention than in the control (3-months: B=-2.23, p=0.023; 6-months: B=-2.87, p=0.042). Quantitative implementation findings indicated decent feasibility (M=2.43/3.00; SD=0.58) and acceptability (M=2.46/3.00; SD=0.55), which were reinforced by qualitative findings.

Conclusion: Integrating PRCs trained in basic evidence-based skills onto community healthcare teams may be a feasible way to reduce SU stigma in a low-resource HIV care context. Our findings represent a first step in studying potentially scalable strategies to reduce SU stigma towards PLWH in historically oppressed communities. Next steps include examining if the intervention affected patient engagement, and refining the intervention for a fully powered trial.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Understand why integrating PRCs onto existing healthcare teams may be an effective, acceptable, and feasible way to reduce provider substance use stigma.