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Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low\u2010resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A pilot randomized hybrid type 1 effectiveness\u2010implementation trial (\n N<\/jats:italic>\n \u00a0=\u00a061) was conducted to evaluate the feasibility and acceptability of\n Khanya<\/jats:italic>\n , a task\u2010shared, peer\u2010delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA.\n Khanya<\/jats:italic>\n was compared to enhanced treatment as usual (ETAU), a facilitated referral to on\u2010site AOD treatment. Implementation outcomes, defined by Proctor\u2019s model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post\u2010treatment (three months) measured via real\u2010time electronic adherence monitoring, and AOD measured using biomarker and self\u2010report assessments over six months. Data collection was conducted from August 2018 to April 2020.\n <\/jats:p>\n <\/jats:sec>\n \n Results and discussion<\/jats:title>\n \n Ninety\u2010one percent of participants (\n n<\/jats:italic>\n \u00a0=\u00a056) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment\u2010by\u2010time interaction for ART adherence (estimate\u00a0=\u00a0\u22120.287 [95% CI\u00a0=\u00a0\u22120.507, \u22120.066]), revealing a 6.4 percentage point increase in ART adherence in\n Khanya<\/jats:italic>\n , and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (\n F<\/jats:italic>\n (2,101)\u00a0=\u00a04.16,\n p<\/jats:italic>\n \u00a0=\u00a00.01), significantly decreased likelihood of self\u2010reported moderate or severe AOD (\n F<\/jats:italic>\n (2,104)\u00a0=\u00a07.02,\n p<\/jats:italic>\n \u00a0=\u00a00.001), and significant declines in alcohol use quantity on the timeline follow\u2010back (\n F<\/jats:italic>\n (2,102)\u00a0=\u00a021.53,\n p<\/jats:italic>\n \u00a0<\u00a00.001). Among individuals using drugs\u00a0and alcohol, there was a greater reduction in alcohol use quantity in\n Khanya<\/jats:italic>\n compared to ETAU over six months (\n F<\/jats:italic>\n (2,31)\u00a0=\u00a03.28,\n p<\/jats:italic>\n \u00a0=\u00a00.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Results of this pilot trial provide initial evidence of the feasibility and acceptability of the\n Khanya<\/jats:italic>\n intervention for improving adherence in an underserved group at high risk for ongoing ART non\u2010adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task\u2010sharing models for behavioral health in resource\u2010limited, global settings.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.25720","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T03:03:12Z","timestamp":1624503792000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":67,"title":["Project Khanya: results from a pilot randomized type 1 hybrid effectiveness\u2010implementation trial of a peer\u2010delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3513-3255","authenticated-orcid":false,"given":"Jessica F","family":"Magidson","sequence":"first","affiliation":[{"name":"Department of Psychology University of Maryland College Park MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Joska","sequence":"additional","affiliation":[{"name":"HIV Mental Health Research Unit Division of Neuropsychiatry Department of Psychiatry and Mental Health Groote Schuur Hospital Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M","family":"Belus","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Maryland College Park MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena S","family":"Andersen","sequence":"additional","affiliation":[{"name":"HIV Mental Health Research Unit Division of Neuropsychiatry Department of Psychiatry and Mental Health Groote Schuur Hospital Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen S","family":"Regenauer","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Maryland College Park MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra L","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Maryland College Park MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0235-6716","authenticated-orcid":false,"given":"Bronwyn","family":"Myers","sequence":"additional","affiliation":[{"name":"Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council Division of Addiction Psychiatry Department of Psychiatry and Mental Health University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybil","family":"Majokweni","sequence":"additional","affiliation":[{"name":"HIV Mental Health Research Unit Division of Neuropsychiatry Department of Psychiatry and Mental Health Groote Schuur Hospital Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conall","family":"O\u2019Cleirigh","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Massachusetts General Hospital\/Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0121-0806","authenticated-orcid":false,"given":"Steven A","family":"Safren","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Miami Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Statistics South Africa. 2020 Mid\u2010year population estimates[Internet].2020. 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