BACKGROUND:
Alcohol and other drug use (AOD) is a major driver of HIV care disengagement in South Africa, partially due to AOD stigma. Peer recovery coaches (PRCs), lay health workers with lived AOD recovery experience, are thought to reduce patient-level AOD stigma through lived experience and may represent a feasible way to improve engagement in HIV care among people living with HIV and AOD. Yet, PRCs’ impact on stigma or engagement remains untested. Therefore, this mixed-methods pilot study examined the effect of working with a PRC on AOD stigma and HIV care engagement in a low-resource South African community.

METHODS:
As part of a pilot study, we enrolled 50 patients living with HIV and problem AOD from two matched community health worker teams, one of which was randomized to have patients work with a PRC (intervention; n=25) and one of which provided patients with treatment-as-usual (control; n=25). Participants completed surveys of internalized AOD stigma, stigma towards others with AOD, and medication adherence at baseline, three-months, and six-months. Intervention participants completed semi-structured exit interviews on the effect of working with a PRC on AOD stigma and HIV care engagement.

RESULTS:
Retention rates at three- and six-months were 94% and 84%, and n=19 intervention participants completed exit interviews. While repeated measures ANOVAs did not identify significant differences between conditions over time, qualitatively intervention participants consistently described how working with the PRC increased self-confidence, belief that AOD recovery was possible, and strategies and confidence for staying engaged in HIV care.

CONCLUSIONS:
This pilot study provides preliminary qualitative evidence for the utility of integrating PRCs into community HIV care teams in a low-resource setting. Larger studies are needed to better understand whether working with a PRC has a significant effect on patient AOD stigma or HIV care engagement.