Dataset Information

Training the Addiction Treatment Workforce in HIV Endemic Regions: An Overview of the South Africa HIV Addiction Technology Transfer Center Initiative.

ABSTRACT: The South Africa HIV Addiction Technology Transfer Center (ATTC) was formed in 2017 to train health professionals and nonprofessional lay workers in evidence-based addiction interventions as a strategy for addressing the country's HIV epidemic. This article describes the Year 1 activities of the South Africa HIV ATTC including an initial needs assessment with high-level stakeholders, an advisory board meeting with South African government and nongovernment agencies, a learning exchange with other international ATTCs, and the identification of Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a focal intervention for widespread training. The article details the culmination of Year 1 activities via a national forum on SBIRT and presents posttraining satisfaction data across SBIRT events. Lessons learned during the first year include the importance of building strong partnerships with high-level stakeholders, conducting a targeted needs assessment, and identifying a focal intervention for widespread dissemination. Trainees reported high satisfaction and intention to use the knowledge and skills gained. Overall, the methods used by the South Africa HIV ATTC demonstrate a novel approach to training health professionals and lay health workers in evidence-based addiction services as a means of improving HIV outcomes.

SUBMITTER: Scott K

PROVIDER: S-EPMC8184107 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Training the Addiction Treatment Workforce in HIV Endemic Regions: An Overview of the South Africa HIV Addiction Technology Transfer Center Initiative.

Scott Kelli K Sibeko Goodman G Cummings Beverley B Myers Bronwyn B Sorsdahl Katherine K Stein Dan J DJ Kuo Caroline C Becker Sara J SJ

Training and education in professional psychology 20200201 1

The South Africa HIV Addiction Technology Transfer Center (ATTC) was formed in 2017 to train health professionals and nonprofessional lay workers in evidence-based addiction interventions as a strategy for addressing the country's HIV epidemic. This article describes the Year 1 activities of the South Africa HIV ATTC including an initial needs assessment with high-level stakeholders, an advisory board meeting with South African government and nongovernment agencies, a learning exchange with othe ...[more]

PMID: 34104286

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Project description:IntroductionAdolescent HIV prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa.MethodsThis study employed concept mapping to identify factors that impact the implementation of HIV prevention and intervention programs for adolescents in sub-Saharan Africa. Key stakeholders including researchers, policymakers, and non-governmental organization (NGO) personnel constituting membership of the NIH-sponsored Adolescent HIV Prevention and Treatment Implementation Science Alliance responded to the question: "In your experience, what factors have facilitated or hindered implementation of evidence-based HIV prevention or treatment for adolescents in sub-Saharan Africa?" Participants generated statements in response to the focus question, sorted them into thematically relevant groups, and rated each statement on its importance and changeability.ResultsThrough data analyses and participant feedback, 15 distinct themes were derived. "Workforce/Workflow" and "HIV Stigma and Adolescent Development" were rated highest for importance, and "Threshold Conditions for Treatment" and "Structure of Implementation Efforts" were rated most changeable.ConclusionsUnderstanding implementation science determinants and mechanisms can facilitate the uptake of successful implementation and sustainment strategies for the prevention and treatment of HIV in a given context. We placed determinants and mechanisms within the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to provide greater contextual integration with broader theories in implementation science. Implementers across multiple disciplines can use these findings to improve the scale-up of evidence-based practices for adolescent HIV prevention and treatment in sub-Saharan Africa. Implementation approaches that consider the determinants and mechanisms identified in this study and integrated in implementation frameworks will likely have utility for other health conditions and contexts.

Project description:BackgroundIntroduction of tenofovir (TDF) plus lamivudine (3TC) and dolutegravir (DTG) in first- and second-line HIV treatment regimens in South Africa warrants characterization of acquired HIV-1 drug resistance (ADR) mutations that could impact DTG-based antiretroviral therapy (ART). In this study, we sought to determine prevalence of ADR mutations and their potential impact on susceptibility to drugs used in combination with DTG among HIV-positive adults (≥ 18 years) accessing routine care at a selected ART facility in KwaZulu-Natal, South Africa.MethodsWe enrolled adult participants in a cross-sectional study between May and September 2019. Eligible participants had a most recent documented viral load (VL) ≥ 1000 copies/mL after at least 6 months on ART. We genotyped HIV-1 reverse transcriptase and protease genes by Sanger sequencing and assessed ADR. We characterized the effect of ADR mutations on the predicted susceptibility to drugs used in combination with DTG.ResultsFrom 143 participants enrolled, we obtained sequence data for 115 (80%), and 92.2% (95% CI 85.7-96.4) had ADR. The proportion with ADR was similar for participants on first-line ART (65/70, 92.9%, 95% CI 84.1-97.6) and those on second-line ART (40/44, 90.9%, 95% CI 78.3-97.5), and was present for the single participant on third-line ART. Approximately 89% (62/70) of those on first-line ART had dual class NRTI and NNRTI resistance and only six (13.6%) of those on second-line ART had major PI mutations. Most participants (82%) with first-line viraemia maintained susceptibility to Zidovudine (AZT), and the majority of them had lost susceptibility to TDF (71%) and 3TC (84%). Approximately two in every five TDF-treated individuals had thymidine analogue mutations (TAMs).ConclusionsSusceptibility to AZT among most participants with first-line viraemia suggests that a new second-line regimen of AZT + 3TC + DTG could be effective. However, atypical occurrence of TAMs in TDF-treated individuals suggests a less effective AZT + 3TC + DTG regimen in a subpopulation of patients. As most patients with first-line viraemia had at least low-level resistance to TDF and 3TC, identifying viraemia before switch to TDF + 3TC + DTG is important to avoid DTG functional monotherapy. These findings highlight a need for close monitoring of outcomes on new standardized treatment regimens.

Dataset Information

Training the Addiction Treatment Workforce in HIV Endemic Regions: An Overview of the South Africa HIV Addiction Technology Transfer Center Initiative.

Publications

Training the Addiction Treatment Workforce in HIV Endemic Regions: An Overview of the South Africa HIV Addiction Technology Transfer Center Initiative.

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