A novel brief treatment for methamphetamine use disorders in South Africa: a randomised feasibility trial

K Sorsdahl,J E Grant,D J Stein,S Richter,B Odlaug,Y Jacobs,R Kader,B Myers,S Pasche

doi:10.1186/s13722-020-00209-3

Abstract

BackgroundEffective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa. To address this gap, the purpose of this randomised feasibility trial was to determine the feasibility of delivering a six-session blended imaginal desensitisation, plus motivational interviewing (IDMI) intervention for adults with a MAUD.MethodsWe enrolled 60 adults with a MAUD and randomly assigned them 1:1 to the IDMI intervention delivered by clinical psychologists and a control group who we referred to usual care. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, were calculated. Follow-up interviews were conducted at 6 weeks and 3 months post-enrollment.ResultsOver 9 months, 278 potential particiants initiated contact. Following initial screening 78 (28%) met inclusion criteria, and 60 (77%) were randomised. Thirteen of the 30 participants assigned to the treatment group completed the intervention. Both psychologists were highly adherent to the intervention, obtaining a fidelity rating of 91%. In total, 39 (65%) participants completed the 6-week follow-up and 40 (67%) completed the 3-month follow-up. The intervention shows potential effectiveness in the intention-to-treat analysis where frequency of methamphetamine use was significantly lower in the treatment than in the control group at both the 6 week and 3-month endpoints. No adverse outcomes were reported.ConclusionsThis feasibility trial suggests that the locally adapted IDMI intervention is an acceptable and safe intervention as a brief treatment for MAUD in South Africa. Modifications to the study design should be considered in a fully powered, definitive controlled trial to assess this potentially effective intervention.Trial registration The trial is registered with the Pan African Clinical Trials Registry (Trial ID: PACTR201310000589295)

Highlights

Effective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa
This paper has been written in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement: extension to randomised pilot and feasibility trials [27] and the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist [28]
There were no refusals and concerns from participants regarding randomisation and project staff reported confidence in the randomisation and blinding process, as the follow-up assessment was conducted by an individual who did not work at the hospital where the intervention sessions were being conducted

Summary

Introduction

Effective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa. To address this gap, the purpose of this randomised feasibility trial was to determine the feasibility of delivering a six-session blended imaginal desensitisation, plus motivational interviewing (IDMI) intervention for adults with a MAUD. Substance use disorders represent a major public health problem, both globally and in South Africa. MA use has been associated with neurocognitive impairment, interpersonal violence and risk of HIV acquisition and transmission [9, 10], two key drivers of South Africa’s burden of disease

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