Table 2 A description of the changes made to the peer recovery coach prototype at each stage of the co-design process
Role description | Peer prototype (Version 1); produced after ideation workshops (Step 3) | Revised prototype (Version 2); produced after co-design workshops (Step 4) | Revised prototype (Version 3); produced after consultation with health leaders (Step 5) |
|---|---|---|---|
Role Prerequisites | • Lived experience of SU • At least one year of SU recovery • Lived experience of HIV is not essential • Understanding of community dynamics • Share language and culture of community | No changes | No changes |
Role expectations and core activities | • Provide education on HIV and SU • Support patients to connect to and navigate SU and health services • Support to enhance motivation and overcome barriers to SU and health service use | Added: • Sharing of personal experience to reduce stigma and instill hope for recovery | Added: • Participation in supervision and peer mentorship • Participation in self-care activities • Participation in community-oriented primary care team activities and meetings |
Working conditions | Not addressed | Added: • Safety: peer to work in pairs or be accompanied by a CHW • Working hours and conditions identical to those of community-oriented primary care team • No after-hours contact; respond to messages on next working day • No uniform due to stigma concerns | No changes |
Core elements of Peer training | • Confidentiality and professional ethics • Content knowledge: - SU, HIV, and how they relate - Local SU services and how these can be accessed • Basic counselling skills to support behavior change: - Motivational Interviewing - Nonjudgmental communication - Problem Solving - Behavioral Activation | Added: • Training on safe sharing of personal experiences of SU and SU recovery | Added: • Information and training on community-oriented primary care team Self-care skills to support peer well-being and recovery • Benefits of supervision and peer mentorship/debriefing |
Structure and content of peer sessions | • Structure: - One-on-one sessions for 12 weeks - Session 1: Describe peerC role, establish confidentiality and preferences for session format and location - Weeks 1–4: 1 session per week - Weeks 5–8: 1 session every 2 weeks - Weeks 9–12: Patient and peer to decide on frequency • Duration: ~ 30 min, with up to an hour scheduled • Location: Initial contact (session one) at patient’s home, community-oriented primary care team will introduce peer, location of other visits to be decided • Mode: Face-to-face delivery with telephonic delivery if required | Added: • Structure: - Session 1: Establish preferences for session times. Clarify boundaries of peer role and after-hours availability. Share personal experience to engage patient - Weeks 1–4: Help identify and navigate challenges to engaging in SU/HIV care via education, sharing lived experience and teaching skills for behavior change - Weeks 5–8: Provide support for recovery and enhance motivation for care engagement, using skills described above - Weeks 9–12: Provide support for care engagement (if required). Help patient transition from the peer to other recovery supports in the community (e.g. support groups) • Location: Not all patients endorsed an initial home visit due to stigma and safety concerns. To enhance acceptability, the initial peer session will not occur in a separate home visit. It will be delivered during CHWs’ routine visits to the patient’s household | No changes |
Strategies to facilitate peer integration into community-oriented primary care team | Not addressed | Not addressed | Added: • community-oriented primary care team training prior to integration: - Information on SU, HIV and stigma - Information on peerC role and how it can support the community-oriented primary care team - peer video - Strategies for supporting community-oriented primary care team wellness - Opportunities to discuss and resolve any concerns • Formal introduction of peer to community-oriented primary care team at a team meeting • Peer to accompany CHWs on home visits for 8–10 weeks to ensure familiarity with team activities and processes, patients, and the community and to build team relationships • Peer supervision and mentoring |