Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa.

Hermann Reuter,Johnny Daniels,Petros Isaakidis,Erika Mohr-Holland,Lize Weich,Erin von der Heyden,Jennifer Furin,Yulene Kock,Anja Reuter,Buci Beko,Boniwe Memani,Erickmar Rodriguez

doi:10.3390/tropicalmed7020021

Abstract

Substance use (SU) is associated with poor rifampicin-resistant tuberculosis (RR-TB) treatment outcomes. In 2017, a SBIRT (SU screening-brief intervention-referral to treatment) was integrated into routine RR-TB care in Khayelitsha, South Africa. This was a retrospective study of persons with RR-TB who were screened for SU between 1 July 2018 and 30 September 2020 using the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Here we describe outcomes from this program. Persons scoring moderate/high risk received a brief intervention and referral to treatment. Overall, 333 persons were initiated on RR-TB treatment; 38% (n = 128) were screened for SU. Of those, 88% (n = 113/128) reported SU; 65% (n = 83/128) had moderate/high risk SU. Eighty percent (n = 103/128) reported alcohol use, of whom 52% (n = 54/103) reported moderate/high risk alcohol use. Seventy-seven persons were screened for SU within ≤2 months of RR-TB treatment initiation, of whom 69%, 12%, and 12% had outcomes of treatment success, loss to follow-up and death, respectively. Outcomes did not differ between persons with no/low risk and moderate/high risk SU or based on the receipt of naltrexone (p > 0.05). SU was common among persons with RR-TB; there is a need for interventions to address this co-morbidity as part of “person-centered care”. Integrated, holistic care is needed at the community level to address unique challenges of persons with RR-TB and SU.

Highlights

Rifampicin-resistant tuberculosis (RR-TB) affects half a million people each year and is associated with a high rate of morbidity and mortality [1]
Persons were considered eligible for the cohort study if they were initiated on rifampicin-resistant tuberculosis (RR-TB) treatment during that time period and if they underwent an initial screening for Substance use (SU) at any time during the treatment
333 persons were initiated on RR-TB treatment, of whom

Summary

Introduction

Rifampicin-resistant tuberculosis (RR-TB) affects half a million people each year and is associated with a high rate of morbidity and mortality [1]. There have been recent therapeutic improvements leading to better treatment outcomes, global success rates are just over 61% [2]. Treatment for RR-TB is characterized by a long duration and high pill burden, and multiple patients are unable to adhere to this grueling therapy or complete the prescribed course of treatment [3–6]. People who stop taking treatment early or who miss more than 8 weeks of therapy are given an outcome of Loss to Follow-Up (LTFU). Rates of LTFU vary considerably between settings and are driven by multiple factors, including the use of alcohol and other substances [7–9]. Substance-use disorder (SUD) is a common co-morbid condition among people living with RR-TB. It is a risk for poor treatment outcomes, including LTFU [10]. Substance use (SU) complicates other aspects of RR-TB treatment including overlapping toxicities with TB treatment [11], increased experiences of stigma, and lack of access to SU treatment given the infectious nature of RR-TB

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