Florence Jaguga, MBChB, MMed
Nominated From: Indiana University
Research Site: Moi University
Research Area: Mental Health, HIV
Primary Mentor: Mary Ott
Research Project
Feasibility and acceptability of a peer-delivered substance use screening and brief intervention for youth attending Rafiki clinic in Eldoret, Kenya
Globally, youth are disproportionately affected by substance use. In sub-Saharan Africa (SSA), an estimated 41% of youth have used at least one substance in their lifetime. Youth Living with HIV (YLH) have not been spared. In a study conducted in Kenya, 33% and 46% of youth attending a HIV clinic reported harmful patterns of alcohol and illicit substance use respectively. Substance use among YLH has been associated with negative outcomes including antiretroviral therapy (ART) non-adherence, neurocognitive deficits, poor virologic control and depression. Unfortunately, YLH in SSA lack access to substance use interventions.
The World Health Organization (WHO) recommends screening and brief intervention (SBI) in primary healthcare for identification and early intervention for substance use. Primary healthcare workers in LMICs are however often unable to implement SBI due to heavy workload. Peers represent a potential means through which SBI may be delivered in adolescent and youth HIV settings and presents a number of advantages. First, peer support systems are well established in many adolescent & youth HIV clinics in SSA. Secondly, by drawing upon their shared experiences as youth living with HIV, the peers can provide empathic support to the adolescents.
Few studies have evaluated implementation of peer-delivered SBI for adolescents. Available studies have been conducted in high-income countries. To our knowledge, no study has evaluated implementation of peer-delivered SBI among YLH. Our project seeks to fill this gap by evaluating the feasibility and acceptability of a peer-delivered SBI for youth attending Rafiki clinic, (a clinic for YLH) in Kenya. This project is in line with: (i) Kenyan Ministry of Health guidelines for delivery of adolescent and youth friendly services which lists substance use counseling as an essential service, and (ii) United Nations Programme on HIV/AIDS (UNAIDS) Fast-track target 95-95-95, which requires that by 2030, 95% of people on ART be virally suppressed as well as target 3.5 of the Sustainable Development Goals (SDGs) which requires that governments strengthen the treatment and prevention of substance abuse. Data from this study will set the stage for full-efficacy trials and ultimately to scale-up efforts to other LMICs.
Research Significance
This work is important because it seeks to provide a practical and sustainable solution to substance use, which is a major problem among youth living with HIV in Kenya. Substance use among this population has significant negative consequences including poor viral suppression and poor mental health.
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