3 - (SYM 101) Using a Stakeholder-driven Approach to Develop a Peer Recovery Coach Role for Task-sharing Substance Use Interventions in Community-based HIV Teams in South Africa

Introduction: In South Africa (SA), community-oriented primary care (COPC) teams, comprised of community health workers and nurses, work to re-engage people with HIV (PWH) to facility-based HIV treatment. Substance use (SU) is associated with worse HIV care engagement among patients, and many COPC workers display high levels of SU stigma, which is also a key barrier to HIV care re-engagement. Peer recovery coach (PRC) models—individuals with lived SU and recovery experience who are trained and supervised to support patients—have expanded rapidly in the US to help engage patients in care. While task-sharing to PRCs who are integrated into COPCs may help re-engage patients using substances in HIV care, the PRC role has yet to be developed in SA. Therefore, we used a multi-stage, stakeholder-driven approach to develop a task-shared PRC model.

Methods: We conducted semi-structured interviews with key stakeholders (n=25) and patients (n=15) involved in or receiving community-based HIV/SU care to identify barriers to the PRC role. Findings guided initial adaptations to a US-based PRC model. We then elicited feedback on this adapted model via co-design workshops with COPC stakeholders (n=12) and patients (n=12) focused on scope, structure and format; ideal characteristics; and suitable tasks for a PRC. This feedback guided further model adaptations, which we presented to the same stakeholders and patients in subsequent workshops. Final feedback then refined and finalized the PRC model for pilot implementation.

Results: Stakeholders perceived the PRC role to be acceptable and feasible to integrate into COPCs. Feedback highlighted the value of PRCs’ personal history of SU, and suggested PRCs should have 1-2 years of recovery and strong knowledge of HIV, the community, and common substances with which they did not have personal experience. Safety concerns were also raised, and stakeholders recommended that PRCs work with a second person and conduct activities in safe community spaces. Finally, stakeholders recommended that the PRC work with patients for a three-month period, with intensity of contact diminishing over time.

Conclusion: Stakeholder feedback helped evaluate the acceptability of a PRC role of this context, along with guidance on implementing the PRC role into COPCs. Feedback was used to create and train a PRC for a pilot implementation study.