Background. Substance abuse is largely not addressed in HIV care in South Africa (SA). This is despite the fact that SA has the largest number of people living with HIV/AIDS globally, and that substance abuse is prevalent and associated with worse antiretroviral therapy (ART) adherence. Implementing evidence-based interventions for substance abuse and ART nonadherence in HIV care by paraprofessionals may improve HIV treatment and prevention. Research Strategy. The current study uses a theoretically-driven approach to adapt and evaluate a paraprofessional-delivered intervention for substance abuse and ART nonadherence in HIV care in SA. Three phases include: (1) Qualitative assessment phase of barriers and facilitators to implementation using in-depth individual interviews with patients, providers and staff (n=30); (2) Treatment adaptation phase based upon qualitative analysis in Aim 1; and (3) Randomized pilot hybrid effectiveness-implementation trial1 (n=60) to evaluate the adapted, paraprofessional delivered intervention compared to enhanced standard of care (SOC) over 6 months. Effectiveness outcomes include: (1) ART adherence (real-time wireless electronic monitoring); (2) substance use (urinalysis and self-report); and (3) viral load (exploratory). Implementation outcomes follow recommendations in the field and include feasibility, acceptability, and barriers and facilitators to implementation.2 The K23 lays the groundwork for an R01 to propose a larger-scale trial using clinic-based randomization to evaluate the implementation of the intervention. Training Plan. Coordinated with the research plan, Dr. Magidson will receive mentorship and training to correspond with each aim in the following: (1) implementation science methodology relevant to substance abuse treatment and HIV care in resource-limited global settings; (2) competence for conducting independent, global clinical research; and (3) qualitative analysis. Mentorship. K23 mentors offer complementary expertise central to project aims. Her primary mentor, Dr. Bangsberg, is an expert in ART adherence implementation research in resource-limited global settings, and mentoring K awardees to transition to independent investigators. Her co-mentors combine expertise intervention development for ART adherence and psychiatric comorbidity (Safren), screening for substance abuse in HIV clinic settings in SA (Joska), and developing and evaluating evidence-based interventions for substance use in SA using implementation science and qualitative methods (Myers). This mentorship is supported by a team of consultants who comprise internationally recognized investigators in ART adherence, qualitative analysis, substance abuse and HIV, biostatistics, and implementation research in SA. Candidate. Dr. Magidson has been productive as an early career researcher (with 38 publications, 22 first author, and an F31 and R36 focused on domestic HIV and substance abuse effectiveness research). The K23 would expand her career focus to become an independent investigator with expertise in implementation science for substance abuse and HIV in resource-limited settings.

Public Health Relevance

South Africa (SA) has the largest number of HIV-infected individuals in the world. Substance abuse is prevalent in SA and associated with poor HIV/AIDS treatment outcomes; yet, substance abuse is largely not addressed in HIV care in SA. Implementing an evidence-based intervention for HIV medication adherence and substance abuse by paraprofessionals in HIV care may be a sustainable and effective way to improve HIV treatment outcomes and reduce substance abuse in this population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
3K23DA041901-05S1
Application #
9850788
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Flournoy Floyd, Minnjuan Wyncephel
Project Start
2018-01-01
Project End
2021-06-30
Budget Start
2019-07-01
Budget End
2020-06-30
Support Year
5
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of Maryland College Park
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
790934285
City
College Park
State
MD
Country
United States
Zip Code
20742
Andersen, Lena S; Magidson, Jessica F; O'Cleirigh, Conall et al. (2018) A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa. J Health Psychol 23:776-787
McIntyre, Tracy-Leigh; Elkonin, Diane; de Kooker, Margo et al. (2018) The application of mindfulness for individuals living with HIV in South Africa: A hybrid effectiveness-implementation pilot study. Mindfulness (N Y) 9:871-883
Daughters, Stacey B; Magidson, Jessica F; Anand, Deepika et al. (2018) The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial. Addiction 113:535-544
Abas, Melanie; Nyamayaro, Primrose; Bere, Tarisai et al. (2018) Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa. AIDS Behav 22:86-101
Bere, Tarisai; Nyamayaro, Primrose; Magidson, Jessica F et al. (2017) Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva. J Health Psychol 22:1265-1276
Magidson, Jessica F; Lee, Jasper S; Johnson, Kim et al. (2017) Openness to adopting evidence-based practice in public substance use treatment in South Africa using task shifting: Caseload size matters. Subst Abus :1-5
Magidson, Jessica F; Gouse, Hetta; Burnhams, Warren et al. (2017) Beyond methamphetamine: Documenting the implementation of the Matrix model of substance use treatment for opioid users in a South African setting. Addict Behav 66:132-137
Magidson, Jessica F; Robustelli, Briana L; Seitz-Brown, C J et al. (2017) Activity enjoyment, not frequency, is associated with alcohol-related problems and heavy episodic drinking. Psychol Addict Behav 31:73-78
Magidson, Jessica F; Dietrich, Janan; Otwombe, Kennedy N et al. (2017) Psychosocial correlates of alcohol and other substance use among low-income adolescents in peri-urban Johannesburg, South Africa: A focus on gender differences. J Health Psychol 22:1415-1425
Magidson, Jessica F; Saal, Wylene; Nel, Adriaan et al. (2017) Relationship between depressive symptoms, alcohol use, and antiretroviral therapy adherence among HIV-infected, clinic-attending patients in South Africa. J Health Psychol 22:1426-1433

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