Abstract
BackgroundOnly 55% of multidrug-resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular.ObjectivesTo explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge.MethodsBetween December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n = 10).ResultsSixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment.ConclusionIn this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation.Trial registrationSouth African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za)
Highlights
It is estimated that 457,000 people developed multidrugresistant tuberculosis (MDR-TB) in 2017 [1]
This paper reports on the (i) the feasibility of recruiting and retaining multidrug-resistant tuberculosis (MDR-TB) patients for a substance use intervention; (ii) preliminary information on the intervention’s substance use, mental health and TB outcomes; and (iii) participants’ perceptions of the acceptability of the intervention
14/40 recruited patients (33%) were excluded from the final analysis: 5 (13%) because they were discharged before the inpatient counselling intervention was completed, 3 (8%) because they were found not to have MDR-TB, 3 (8%) because they were lost to follow-up and 3 (8%) because they withdrew consent
Summary
It is estimated that 457,000 people developed multidrugresistant tuberculosis (MDR-TB) in 2017 [1]. Treatment-related factors resulting in poor adherence to MDR-TB therapy and high default rates include excessive pill burden, injectable drug delivery, prolonged treatment duration and treatment-related side effects. It has emphasised the need for a multisectoral approach to improving TB control, with one of its Sustainable Development Goals (SDGs) being to strengthen the prevention and treatment of substance use disorders including narcotic drug use, tobacco smoking and the harmful use of alcohol [1]. There is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular
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