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

> **NIH NIH R34** · UNIV OF MARYLAND, COLLEGE PARK · 2021 · $229,713

## Abstract

Project Summary. South Africa (SA) is home to the largest number of people living HIV/AIDS (PLWH; 7.7
million) and one of the highest incidence rates of tuberculosis (TB) globally. Poor engagement in care
contributes to HIV and TB morbidity and mortality in SA. Community health workers (CHWs) are frontline
workers who play a central role in re-engaging patients who are lost to follow-up (LTFU) in TB/HIV care in SA.
Despite existing CHW programs focused on re-engaging patients who are LTFU, people with depression,
hazardous alcohol use, or other substance use (SU) are particularly susceptible to poor engagement in TB/HIV
care and have a greater likelihood of being LTFU. Further, our pilot data shows that CHWs have high levels of
stigma towards patients with depression, hazardous alcohol use, and other SU, which can further undermine
engagement in TB/HIV care in this vulnerable population. Reducing CHW stigma towards depression and SU
and providing CHWs skills to re-engage this population in care may be a unique opportunity to strengthen the
TB/HIV care cascades and improve TB/HIV outcomes. Guided by the Link and Phelan stigma framework and the
Situated Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM), this
proposal builds upon our prior work by developing and adapting a novel CHW training program to reduce CHW
stigma towards depression and SU, and evaluating theoretically-driven implementation science outcomes and
patient re-engagement in TB/HIV care. We are leveraging a robust, existing infrastructure of CHWs doing home
visits with patients with TB/HIV co-infection who are LTFU, thus promoting the sustainability of the proposed
model. We propose to (1) identify multi-level barriers and facilitators to implementing a CHW-oriented training to
reduce stigma towards patients with depression and substance use to promote re-engagement in TB/HIV care by
conducting semi-structured interviews with CHWs, providers, and patients with TB/HIV and depression and/or
SU (n=30) and observational assessments of CHWs making home visits (n=10) to individuals with TB/HIV who
were LTFU. Using this feedback, we will (2) adapt the proposed CHW training and implementation strategy
and obtain feedback on the feasibility and acceptability from five CHWs and their patients (four patients each;
n=20). We will then (3) evaluate the implementation and preliminary effectiveness of the adapted CHW training
program to reduce CHW stigma towards depression and SU and promote re-engagement in TB/HIV care using
a Type 2, hybrid effectiveness-implementation study guided by Proctor’s implementation model. We propose a
stepped wedge design with six clinics (10 CHWs in each), to evaluate: 1) Feasibility, acceptability and fidelity
of the CHW training (primary; implementation); 2) CHW stigma towards depression and SU among TB/HIV co-
infected patients (primary; effectiveness); 3) Patient re-engagement in TB/HIV care over six months (secondary).
...

## Key facts

- **NIH application ID:** 10212231
- **Project number:** 5R34MH122268-02
- **Recipient organization:** UNIV OF MARYLAND, COLLEGE PARK
- **Principal Investigator:** Jessica F Magidson
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $229,713
- **Award type:** 5
- **Project period:** 2020-07-07 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10212231

## Citation

> US National Institutes of Health, RePORTER application 10212231, Training CHWs to Support Re-Engagement in TB/HIV Care in the Context of Depression and Substance Use (5R34MH122268-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10212231. Licensed CC0.

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