Table 1 Siyakhana training components
Theoretical framework | • Link and Phelan’s stigma framework informed the design of the stigma reduction component [36]. The Situated Information Motivation Behavioral Skills Model of Care Initiation and Maintenance framework [37] informed training components focused on patient re-engagement in care |
Trainers | • A psychological counselor, registered with the Health Professions Council of South Africa (HPCSA) with 5 years of experience in motivational interviewing and problem-solving therapy and training CHWs • A peer interventionist |
Training overview | • 3 days of training covering psychoeducation on depression, SU, stigma, HIV, TB; self-care strategies for CHWs; evidence-based strategies for working with patients who may have depression or SU and patient videos of lived experience with mental health and SU challenges • Mixture of didactic teaching and experiential group activities including skills rehearsal exercises and role plays |
Training content | |
 Day #1 | • Welcome to training, training expectations • Psychoeducation on the role of a CHW, depression, substance use, HIV, TB, stigma, and culture ▪ Video shown: patient talking about lived depression experience ▪ Video shown: patient talking about lived substance use experience • Self-Care Skill: Mindfulness exercise • Evidence-Based Skill: Problem-Solving Skill |
 Day #2 | • Welcome, reflection on previous day, reflection on mindfulness • Evidence-Based Skill for Non-stigmatizing interactions: Confidentiality, Motivational Interviewing, Nonjudgmental Communication • Self-Care Skill: Identifying Values • Challenging situations: brainstorming difficult situations that may arise with patients and/or colleagues |
 Day #3 | • Welcome and reflection • Challenging situation: Roleplaying • Self-Care Skill: Balancing Values in Life • The value of supervision • Roleplay and rehearsal • Summary and reflection |
Supervisor characteristics | • Psychological counselor, registered with the Health Professions Council of South Africa (HPCSA) or Social Worker registered with the South African Council for Social Service Professions (SACSSP) • Conduct guided by the professional standards and ethics of the HPCSA/SACSSP |
Supervision structure | • In-person, group supervision • Up to an hour and a half in duration • Structured to include: Debriefing, Challenges to applying training content during patient-interactions, Refresher training: Brief skills rehearsal exercises or role playing to refresh training content and consolidate skills |