Home-Based Community Health Worker Support for Mental Health among People Living with HIV in South Africa: A Hybrid Effectiveness Implementation Trial

Background: South Africa is home to the largest number globally of people with HIV. Mental health conditions, particularly depression and harmful alcohol use, are non-communicable diseases contributing greatly to HIV morbidity and mortality in South Africa due to poorer quality of life, lower engagement in HIV care, and worse disease progression. Community health workers (CHW) conducting home visits to engage PWH who are initiating, or re-initiating HIV treatment often encounter patients with mental health conditions, yet receive little mental health training despite interest. Training community health workers in an evidence-based intervention to support people with HIV with mental health concerns is a unique opportunity to improve HIV and mental health outcomes.

Study design: We are developing and evaluating a home-based model for community health workers to address common mental health conditions among people living with HIV in South Africa. This trial builds upon our prior work that developed clinic-based interventions for people with HIV to support mental health and HIV care outcomes based on motivational interviewing, problem solving, and behavioral activation, and aims to adapt the approach and implementation strategies for home-delivery (“Khanya-Ekhaya”). We are leveraging a robust, existing infrastructure of community health workers doing home visits with people with HIV, thus promoting the sustainability of the proposed model.

Aims: First, we are conducting formative qualitative work to guide adaptation of the intervention and implementation strategies, then conducting iterative refinement through human-centered design workshops, and finally a Type 1 pilot hybrid effectiveness-implementation trial (N=20 CHWs) to evaluate the adapted approach.

Location: Cape Town, South Africa

Funding: Fogarty (R21TW012347-01A1; 2024-2026)

Principal Investigators: Jessica Magidson, Bronwyn Myers, Tara Carney

Partners/collaborators: South African Medical Research Council, Curtin University

Opportunities: Staff and graduate students can be involved in study coordination, primary data collection, secondary data analysis, and future grant submissions.