Evidence map›Paper›PMID 39892671›Full record

Trial reportJournal of substance use and addiction treatment2025

Siyakhana: A hybrid type 2 effectiveness-implementation stepped-wedge trial to reduce stigma towards substance use and depression among community health workers in HIV/TB care in South Africa.

Jessica F Magidson, Kristen S Regenauer, Kim Johnson, Tianzhou Ma, Jennifer M Belus, Alexandra L Rose, Imani Brown, Nonceba Ciya, Sibabalwe Ndamase, Caroline Sacko and 4 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of substance use and addiction treatment, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05282173 (Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance Use), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05282173 nacompletednot on this map

Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance Use

TypeinterventionalSponsorUniversity of Maryland, College ParkRan2022 to 2023Enrolled82ConditionsSubstance-Related Disorders, Mental Disorder, Social Stigma, DepressionArmsSiyakhana CHW Training
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Jessica F MagidsonDepartment of Psychology, University of Maryland, College Park, College Park, MD, USA; Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, College Park, MD, USA. Electronic address: jmagidso@umd.edu.
Kristen S RegenauerDepartment of Psychology, University of Maryland, College Park, College Park, MD, USA.
Kim JohnsonMental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
Tianzhou MaCenter for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, College Park, MD, USA.
Jennifer M BelusDepartment of Psychology, University of Maryland, College Park, College Park, MD, USA; Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
Alexandra L RoseDepartment of Psychology, University of Maryland, College Park, College Park, MD, USA.
Imani BrownDepartment of Psychology, University of Maryland, College Park, College Park, MD, USA.
Nonceba CiyaMental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
Sibabalwe NdamaseMental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa.
Caroline SackoDepartment of Psychology, University of Maryland, College Park, College Park, MD, USA.
John JoskaHIV Mental Health Research Unit, Division of Neuropsychiatry, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
Goodman SibekoHIV Mental Health Research Unit, Division of Neuropsychiatry, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
Ingrid V BassettDivision of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Africa Health Research Institute, Durban, South Africa.
Bronwyn MyersMental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Parow, Cape Town, South Africa; Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia; West Australian Country Health Service (WACHS) and Curtin University Research and Innovation Alliance, Western Australia, Australia.

Funding

Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance UseR34MH122268 · NIMH · UNIV OF MARYLAND, COLLEGE PARK · PI MAGIDSON, JESSICA F, MYERS, BRONWYN · 2020 to 2022
$606k
Effectiveness and implementation of pre-training interpersonal skills assessment of community health workers in South Africa to predict post-training competence in mental health careF31MH123020 · NIMH · UNIV OF MARYLAND, COLLEGE PARK · PI ROSE, ALEXANDRA LEAH · 2021 to 2023
$127k
Examining the Effect of Peers on Internalized Substance Use Stigma in the Context of HIV and Substance Use Care Engagement in South AfricaR36DA057167 · NIDA · UNIV OF MARYLAND, COLLEGE PARK · PI REGENAUER, KRISTEN SATU · 2022 to 2023
$106k
NIDA NIH HHS R36 DA057167NIMH NIH HHS F31 MH123020NIMH NIH HHS R34 MH122268
6 · The paper itself

Abstract

introductionSubstance use (SU) and other mental health conditions, such as depression, contribute to poor engagement in HIV and TB care in South Africa, a country with the highest global prevalence of HIV and a significant TB burden. Yet, community health workers (CHWs)-frontline lay health workers who play a central role in re-engaging patients in HIV/TB care-receive little-to-no training on supporting patients with SU or other mental health concerns. CHWs also display stigma towards patients with SU and depression, which may contribute to HIV/TB care disengagement. We developed and tested a CHW training ("Siyakhana") to reduce CHW stigma towards SU and depression in HIV/TB care.

methodsA cluster randomized, stepped-wedge hybrid type 2 effectiveness-implementation trial (N = 82 CHWs) evaluated Siyakhana across six clinics in a low-resource area of Cape Town, SA. The three-day Siyakhana training included psychoeducation, self-care strategies, non-judgmental communication, problem solving, and contact-based stigma reduction using lived experience narratives. Pre-training and three- and six-month post-training assessments were conducted. Primary effectiveness outcomes were CHW stigma towards SU and depression, assessed using the Social Distance Scale. Primary implementation outcomes were guided by Proctor's model, including fidelity, acceptability, appropriateness, and feasibility, assessed using structured coding of role plays and a validated quantitative measure for assessing implementation outcomes in low- and middle-income countries.

resultsParticipants were on average 46.8 years old (SD = 8.9), 99% female, and 100% Black African. Ninety-five percent of CHWs completed the Siyakhana training, with approximately 90% retention over six months. A linear mixed effects model showed a significant effect of the Siyakhana training on reducing SU stigma over six months after adjusting for time (β = -1.46, SE = 0.67, p < 0.05), but no effect on depression stigma (β = -0.20, SE = 0.57, p > 0.05). CHW fidelity was 89.4% (SD = 11.3%) at six-months. Quantitative implementation outcomes indicated high acceptability (M = 2.85, SD = 0.27), appropriateness (M = 2.77, SD = 0.31), and feasibility (M = 2.41, SD = 0.38).

conclusionsSiyakhana was associated with reductions in CHW SU stigma in the context of HIV/TB care, with promising implementation outcomes. Findings will inform a larger randomized trial evaluating the effectiveness and implementation of Siyakhana and examine whether shifting CHW stigma improves patient-level health outcomes.

trial registrationClinicalTrials.gov: NCT05282173. Registered on 7 March 2022.

Indexed as

Community Health WorkersDepressionHIV InfectionsSocial StigmaSubstance-Related DisordersTuberculosisAdultFemaleHumansMaleMiddle AgedSouth AfricaDepressionGlobal mental healthImplementation scienceLow-and-middle income countryStigmaSubstance useTask-sharing

Identifiers

PMID39892671
PMCPMC11908925

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.