Increases in employment over six months following Khanya: A secondary analysis of a pilot randomized controlled trial of a peer-delivered behavioral intervention for substance use and HIV medication adherence in Cape Town, South Africa

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE International Journal of Drug Policy Pub Date : 2024-11-21 DOI:10.1016/j.drugpo.2024.104632

Jennifer M. Belus , Kristen S. Regenauer , Thanh Lu , Sean M. Murphy , Alexandra L. Rose , Yvonne Akinyi Ochieng , John Joska , Sybil Majokweni , Lena S. Andersen , Bronwyn Myers , Steven A. Safren , Jessica F. Magidson

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Abstract

Introduction

Evidence suggests that brief, skills-based behavioral interventions are effective at improving clinical outcomes related to substance use and HIV, but little data exists on whether such interventions can incidentally improve employment. We examined preliminary changes in employment over six months following Khanya, a brief peer-delivered behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence compared to enhanced treatment as usual (ETAU).

Methods

Adults living with HIV (N = 61) with at least moderate substance use and ART non-adherence were recruited from a primary care clinic in Khayelitsha, South Africa, a community with high rates of unemployment. Participants were randomized 1:1 to Khanya versus ETAU and assessed at baseline, 3- and 6-months. Employment was categorized as unemployed, casually, or full-time employed. Multilevel modeling was used to predict log odds and probability of categorical employment status over time, by arm.

Results

At baseline, 78.7% of the sample were unemployed, 16.4% were casually employed, and 4.9% were employed full-time. There was a significant increase in employment in both treatment arms at 3-months (p = 0.03) but only the Khanya arm demonstrated significant increases at 6-months (p = 0.02). At 6-months, 59% of participants in Khanya had any employment (from 13% at baseline), compared to 38% in ETAU (from 29% at baseline).

Conclusions

Study data suggest a brief behavioral intervention for substance use and ART adherence may support employment among people with HIV living in a resource-constrained community. However, future research with larger sample sizes and longer-term follow ups is needed to replicate these findings.

Trial registration

ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018

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Khanya之后六个月内就业率的提高：对南非开普敦由同伴提供的药物使用和艾滋病药物依从性行为干预试点随机对照试验的二次分析。

导言：有证据表明，以技能为基础的简短行为干预能有效改善与药物使用和艾滋病相关的临床结果，但关于此类干预是否能附带改善就业的数据却很少。Khanya 是一种由同伴提供的简短行为干预措施，旨在减少药物使用并改善抗逆转录病毒疗法（ART）的依从性：从南非失业率较高的社区 Khayelitsha 的一家初级保健诊所招募了至少有中度药物使用和抗逆转录病毒疗法未坚持治疗的成年 HIV 感染者（N = 61）。参与者按 1:1 随机分配到 Khanya 和 ETAU，并在基线、3 个月和 6 个月时进行评估。就业分为失业、临时就业和全职就业。我们采用多层次模型来预测随着时间的推移，各部门分类就业状况的对数几率和概率：基线时，78.7% 的样本处于失业状态，16.4% 的样本处于临时就业状态，4.9% 的样本处于全职就业状态。两个治疗组的就业率在 3 个月后都有明显提高（p = 0.03），但只有康亚治疗组的就业率在 6 个月后有明显提高（p = 0.02）。在 6 个月时，59% 的 Khanya 参与者有工作（基线时为 13%），而 ETAU 为 38%（基线时为 29%）：研究数据表明，针对药物使用和坚持抗逆转录病毒疗法的简短行为干预可以帮助生活在资源有限社区的艾滋病病毒感染者实现就业。然而，未来的研究需要更大的样本量和更长期的随访，以复制这些发现：试验注册：ClinicalTrials.gov identifier：NCT03529409。试验注册时间：2018年5月18日。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.