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Bridget Spelke M, Okumu E, Perry NR, Blette BS, Paul R, Schiller CE, Ncheka JM, Kasaro MP, Price JT, Meltzer-Brody S, Stringer JSA, Stringer EM. Acceptability of a Randomized Trial of Anti-depressant Medication or Interpersonal Therapy for Treatment of Perinatal Depression in Women with HIV. AIDS Behav 2024; 28:1123-1136. [PMID: 38353877 PMCID: PMC10940463 DOI: 10.1007/s10461-023-04264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 03/16/2024]
Abstract
Postpartum depression (PPD) affects nearly 20% of postpartum women in Sub-Saharan Africa (SSA), where HIV prevalence is high. Depression is associated with worse HIV outcomes in non-pregnant adults and mental health disorders may worsen HIV outcomes for postpartum women and their infants. PPD is effectively treated with psychosocial or pharmacologic interventions; however, few studies have evaluated the acceptability of treatment modalities in SSA. We analyzed interviews with 23 postpartum women with HIV to assess the acceptability of two depression treatments provided in the context of a randomized trial. Most participants expressed acceptability of treatment randomization and study visit procedures. Participants shared perceptions of high treatment efficacy of their assigned intervention. They reported ongoing HIV and mental health stigma in their communities and emphasized the importance of social support from clinic staff. Our findings suggest a full-scale trial of PPD treatment will be acceptable among women with HIV in Zambia.
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Affiliation(s)
- M Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA.
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101.
| | - Eunice Okumu
- Social and Behavioral Science Core, Center for AIDS Research, University of North Carolina, Chapel Hill, USA
| | - Nzi R Perry
- Social and Behavioral Science Core, Center for AIDS Research, University of North Carolina, Chapel Hill, USA
| | - Bryan S Blette
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Ravi Paul
- Department of Psychiatry, University of Zambia School of Medicine, Lusaka, Zambia
| | - Crystal E Schiller
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
| | - J M Ncheka
- Department of Psychiatry, University of Zambia School of Medicine, Lusaka, Zambia
| | - Margaret P Kasaro
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
| | - Joan T Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
| | - Elizabeth M Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
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Pool M, Sorsdahl K, Myers B, van der Westhuizen C. The prevalence of and factors associated with depressive and anxiety symptoms during the COVID-19 pandemic among healthcare workers in South Africa. PLoS One 2024; 19:e0299584. [PMID: 38451982 PMCID: PMC10919616 DOI: 10.1371/journal.pone.0299584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Healthcare workers globally have experienced increased social and occupational stressors in their working environments and communities because of COVID-19 which has increased the risk of mental health concerns. This study aimed to explore the prevalence and correlates of depression and anxiety amongst healthcare workers during the COVID-19 pandemic in the Western Cape, South Africa. In addition, role-related stressors and coping strategies were explored. MATERIAL AND METHODS We conducted a cross-sectional survey of doctors and nurses working in public healthcare facilities across the Western Cape, South Africa. Participants completed the Generalized Anxiety Disorder-7 (GAD-7), the Center for Epidemiologic Studies Depression (CES-D), the Professional Quality of Life (PROQL-R-IV), and the Brief Coping Orientation to Problems Experienced (COPE-R) scales. Data were analysed using multivariable logistic regression analysis. RESULTS The sample comprised 416 health workers (303 nurses, 113 doctors). Almost 40% of the sample (n = 161) had CES-D scores suggestive of probable depression, and 45.9% (n = 186) had GAD-7 scores suggestive of anxiety. In the logistic regression model, the odds of probable depression were higher for female participants compared to men (OR = 2.26, 95% CI 1.00-5.10) and for participants who used behavioural disengagement as a coping strategy (OR = 1.50, 95% CI 1.14-1.97). More time spent working with COVID patients was associated with increased odds of having high levels of anxiety [OR = 1.13, 95% CI (1.02-1.25). Substance use (OR = 1.39, 95% CI 1.08-1.81), venting (OR = 1.31, 95% CI 1.01-1.70), and self-blame (OR = 1.42, 95% CI 1.08-1.87) were some of the coping strategies used by healthcare workers. High levels of secondary traumatic stress and burnout were found to increase the odds of both depression and anxiety. CONCLUSION Findings of this study suggest that there is a high prevalence of mental health issues among healthcare workers, and a critical need to focus on workplace mental health interventions to support these frontline workers.
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Affiliation(s)
- Megan Pool
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Curtin enAble Institute, Curtin University, Perth, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Claire van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Parry CDH, Myers B, Londani M, Shuper PA, Janse van Rensburg C, Manda SOM, Nkosi S, Kekwaletswe CT, Hahn JA, Rehm J, Sorsdahl K, Morojele NK. Motivational interviewing and problem-solving therapy intervention for patients on antiretroviral therapy for HIV in Tshwane, South Africa: A randomized controlled trial to assess the impact on alcohol consumption. Addiction 2023; 118:2164-2176. [PMID: 37339811 PMCID: PMC10592292 DOI: 10.1111/add.16278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND AND AIMS Reduction of alcohol consumption is important for people undergoing treatment for HIV. We tested the efficacy of a brief intervention for reducing the average volume of alcohol consumed among patients on HIV antiretroviral therapy (ART). DESIGN, SETTING AND PARTICIPANTS This study used a two-arm multi-centre randomized controlled trial with follow-up to 6 months. Recruitment occurred between May 2016 and October 2017 at six ART clinics at public hospitals in Tshwane, South Africa. Participants were people living with HIV, mean age 40.8 years [standard deviation (SD) = 9.07], 57.5% female, and on average 6.9 years (SD = 3.62) on ART. At baseline (BL), the mean number of drinks consumed over the past 30 days was 25.2 (SD = 38.3). Of 756 eligible patients, 623 were enrolled. INTERVENTION Participants were randomly assigned to a motivational interviewing (MI)/problem-solving therapy (PST) intervention arm (four modules of MI and PST delivered over two sessions by interventionists) or a treatment as usual (TAU) comparison arm. People assessing outcomes were masked to group assignment. MEASUREMENTS The primary outcome was the number of standard drinks (15 ml pure alcohol) consumed during the past 30 days assessed at 6-month follow-up (6MFU). FINDINGS Of the 305 participants randomized to MI/PST, 225 (74%) completed the intervention (all modules). At 6MFU, retention was 88% for the control and 83% for the intervention arm. In support of the hypothesis, an intention-to-treat-analysis for the primary outcome at 6MFU was -0.410 (95% confidence interval = -0.670 to -0.149) units lower on log scale in the intervention group than in the control group (P = 0.002), a 34% relative reduction in the number of drinks. Sensitivity analyses were undertaken for patients who had alcohol use disorders identification test (AUDIT) scores ≥ 8 at BL (n = 299). Findings were similar to those of the whole sample. CONCLUSIONS In South Africa, a motivational interviewing/problem-solving therapy intervention significantly reduced drinking levels in HIV-infected patients on antiretroviral therapy at 6-month follow-up.
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Affiliation(s)
- Charles D. H. Parry
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilCape TownSouth Africa
- Department of PsychiatryUniversity of StellenboschCape TownSouth Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilCape TownSouth Africa
- Curtin enAble institute, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Division of Addiction Psychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Mukhethwa Londani
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilPretoriaSouth Africa
- Directorate of Research and InnovationTshwane University of TechnologyPretoriaSouth Africa
| | - Paul A. Shuper
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilCape TownSouth Africa
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Charl Janse van Rensburg
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa and Department of StatisticsUniversity of PretoriaPretoriaSouth Africa
| | - Samuel O. M. Manda
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa and Department of StatisticsUniversity of PretoriaPretoriaSouth Africa
| | - Sebenzile Nkosi
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilPretoriaSouth Africa
| | - Connie T. Kekwaletswe
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilPretoriaSouth Africa
| | - Judith A. Hahn
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Klinische Psychologie und PsychotherapieTechnische Universität Dresden, Klinische Psychologie & PsychotherapieDresdenGermany
- Department of International Health Projects, Institute for Leadership and Health ManagementInstitute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Neo K. Morojele
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilPretoriaSouth Africa
- Department of PsychologyUniversity of JohannesburgJohannesburgSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- School of Family Medicine and Public HealthUniversity of Cape TownCape TownSouth Africa
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Nguyen KA, Myers B, Abrahams N, Jewkes R, Mhlongo S, Seedat S, Lombard C, Garcia-Moreno C, Chirwa E, Kengne AP, Peer N. Symptoms of posttraumatic stress partially mediate the relationship between gender-based violence and alcohol misuse among South African women. Subst Abuse Treat Prev Policy 2023; 18:38. [PMID: 37349847 PMCID: PMC10288665 DOI: 10.1186/s13011-023-00549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The association of traumatic experiences with problematic alcohol use has been described, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol use. METHOD We analysed cross-sectional data from a sample of rape-exposed and non-rape-exposed women, living in KwaZulu-Natal, with self-reported data on alcohol misuse (AUDIT-C cut-off ≥ 3) and exposure to childhood maltreatment (CM), intimate partner violence (IPV), non-partner sexual violence (NPSV), other traumatic events, and mental ill-health. Logistic regression and multiple mediation models were used to test the mediation effects of symptoms of depression and PTSS on the association between abuse/trauma and alcohol misuse. RESULTS Of 1615 women, 31% (n = 498) reported alcohol misuse. Exposure to any CM (adjusted odds ratio (aOR): 1.59, 95% confidence interval (CI): 1.27-1.99), as well as to sexual, physical and emotional CM, were independently associated with alcohol misuse. Lifetime exposure to any IPV (aOR:2.01, 95%CI:1.59-2.54), as well as to physical, emotional and economic IPV, NPSV (aOR: 1.75, 95%CI: 1.32-2.33), and other trauma (aOR:2.08, 95%CI:1.62-2.66), was associated with alcohol misuse. Exposure to an increasing number of abuse types, and other traumatic events, was independently associated with alcohol misuse. PTSS partially mediated the associations of CM, IPV, NPSV and other trauma exposures with alcohol misuse (ps ≤ 0.04 for indirect effects), but depression symptoms did not. CONCLUSIONS These findings highlight the need for trauma-informed interventions to address alcohol misuse that are tailored to the needs of women who have experienced violence.
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Affiliation(s)
- Kim A. Nguyen
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505 and Durban, P.O. Box 19070, Tygerberg, 4091 South Africa
| | - Bronwyn Myers
- Mental Health, Alcohol, Substances, and Tobacco Research Unit, South African Medical Research Council, Cape Town, 7505 Substances South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102 Australia
| | - Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, 7505, 0001 South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925 South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, 7505, 0001 South Africa
- Office of the Executive Scientist, South African Medical Research Council, Cape Town, 7505 South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, 7505, 0001 South Africa
| | - Soraya Seedat
- SAMRC Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, 7505 South Africa
| | - Claudia Garcia-Moreno
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, 7505, 0001 South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, 2193 South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505 and Durban, P.O. Box 19070, Tygerberg, 4091 South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925 South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505 and Durban, P.O. Box 19070, Tygerberg, 4091 South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925 South Africa
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Brooke-Sumner C, Petersen-Williams P, Sorsdahl K, Kruger J, Mahomed H, Myers B. Strategies for supporting the implementation of a task-shared psychological intervention in South Africa's chronic disease services: qualitative insights from health managers' experiences of project MIND. Glob Health Action 2022; 15:2123005. [PMID: 36178292 PMCID: PMC9542686 DOI: 10.1080/16549716.2022.2123005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although evidence indicates that task-shared psychological interventions can reduce mental health treatment gaps in resource-constrained settings, systemic barriers have limited their widespread implementation. Evidence on how to sustain and scale such approaches is scant. This study responds to this gap by examining the experiences of South African health managers involved in the implementation of a task-shared counselling service for Project MIND. OBJECTIVES To qualitatively describe managers' experiences of implementing the MIND programme and their insights into potential strategies for supporting sustained implementation. METHODS Two focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with managers of urban and rural primary care facilities in the Western Cape province. All managers were female and 30-50 years old. FGDs and IDIs used an identical semi-structured topic guide to explore the experiences of the MIND programme and perceived barriers to sustained implementation. Normalisation process theory (NPT) guided the thematic analysis. RESULTS Four themes emerged that mapped onto the NPT constructs. First, managers noted that their relational work with staff to promote support for the intervention and reduce resistance was key to facilitating implementation. Second, managers emphasised the need for staff reorientation and upskilling to foster openness to mental health practice and for adequate time for quality counselling. Third, managers underscored the importance of strengthening linkages between the health and social service sectors to facilitate delivery of comprehensive mental health services. Finally, managers recommended ongoing monitoring of the service and communication about its impacts as strategies for supporting integration into routine practice. CONCLUSIONS Findings contribute to the emerging literature on strategies to support implementation of task-shared interventions in low- and middle-income countries. The findings highlight the leadership role of managers in identifying and actioning these strategies. Investing in managers' capacity to support implementation of psychological interventions is critical for scale-up of these mental health innovations.
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Affiliation(s)
- Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - Petal Petersen-Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - James Kruger
- Metro Health Services, Western Cape Government: Health, Bellville Health Park, Cape Town, South Africa
| | - Hassan Mahomed
- Metro Health Services, Western Cape Government: Health, Bellville Health Park, Cape Town, South Africa
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- CONTACT Bronwyn Myers Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town7501, South Africa
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Bitew T, Keynejad R, Myers B, Honikman S, Sorsdahl K, Hanlon C. Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia. Pilot Feasibility Stud 2022; 8:202. [PMID: 36085054 PMCID: PMC9461178 DOI: 10.1186/s40814-022-01166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. METHODS We employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a 'theatre test', leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. RESULTS In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women's engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women's emotions to address PHC staff training needs, leading to the final version (version 4.0). CONCLUSION Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings.
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Affiliation(s)
- Tesera Bitew
- Department of Psychology, Injibara University, Institute of Educational and Behavioural Sciences, Injibara, Ethiopia.
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.
| | - Roxanne Keynejad
- Section of Women's Mental Health, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Bronwyn Myers
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simone Honikman
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Health Service and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Sikkema KJ, Rabie S, King A, Watt MH, Mulawa MI, Andersen LS, Wilson PA, Marais A, Ndwandwa E, Majokweni S, Orrell C, Joska JA. ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial. Trials 2022; 23:680. [PMID: 35982485 PMCID: PMC9386207 DOI: 10.1186/s13063-022-06655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. Methods This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). Discussion This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.
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Affiliation(s)
- K J Sikkema
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - S Rabie
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A King
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M I Mulawa
- Duke University School of Nursing and Duke Global Health Institute, Durham, NC, USA
| | - L S Andersen
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Present Address, University of Copenhagen, Copenhagen, Denmark
| | - P A Wilson
- Department of Psychology, University of California, Los Angeles, USA
| | - A Marais
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - E Ndwandwa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - S Majokweni
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - C Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Lemma A, Minichil W, Salelew E, Tadesa J, Kerebih H, Nigussie K, Demilew D, Shumet S. University students’ help seeking intention for depression from health professionals; a cross sectional study. PLoS One 2022; 17:e0271392. [PMID: 35830383 PMCID: PMC9278731 DOI: 10.1371/journal.pone.0271392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
To assess University students’ intention to seek help for depression from health professional and associated factors among University of Gondar students, Northwest, Ethiopia.
Methods
An institution-based cross-sectional study was conducted among 487 students. Multistage sampling technique was used to select study participants. Self-administered questionnaire was employed to collect the data. General help seeking questionnaire with major depressive disorder case vignette was used to assess students’ intention to seek help for depression. The collected data was analyzed using SPSS version 20. Simple and multiple linear regression analysis were performed to identify factors for intention to seek help for depression. Association was described by using adjusted unstandardized β coefficient along with 95% confidence interval. Finally, P-values < 0.05 in adjusted analysis were taken as a cut off for significant association.
Results
The mean score of intention to seek help from health professionals was 3.84 (±0.76)with a range of (1 “very unlikely” to 5 “very likely”). About 67.8% of the study participants would seek help from health professionals if they would have depressive symptoms which was depicted in the case vignette. In the multiple linear regression analyses, student age (unstandardized ß = 0.07, 95% CI: (0.05, 0.10)), good attitude towards seeking professional help (ß = 0.03, 95% CI: (0.02, 0.04)) were factors positively associated with intention to seek help.
Conclusion
The current study showed that more than three-fifth of the study participants reported they were likely or very likely to seek help for depression from health professionals. Increased age and favorable attitude were factors associated with intention to seek help for depression. Working on awareness creation and attitude change towards depression would be necessary to increase students’ intention to seek help for depression from health professional.
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Affiliation(s)
- Alemu Lemma
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Woredaw Minichil
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Endalamaw Salelew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Jinenus Tadesa
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Habtamu Kerebih
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- * E-mail:
| | - Demeke Demilew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Belus JM, Regenauer KS, Hutman E, Rose AL, Burnhams W, Andersen LS, Myers B, Joska JA, Magidson JF. Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100035. [PMID: 36845899 PMCID: PMC9948858 DOI: 10.1016/j.dadr.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/15/2021] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
Introduction Despite efforts to detect and treat problematic substance use (SU) among people living with HIV (PLWH) in South Africa, integration of HIV and SU services is limited. We sought to understand whether PLWH and problematic SU were: (a) routinely referred to SU treatment, a co-located Matrix clinic, (b) used SU treatment services when referred, and (c) the individual amount spent on SU. Methods Guided by the RE-AIM implementation science framework, we examined patient-level quantitative screening and baseline data from a pilot clinical trial for medication adherence and problematic SU. Qualitative data came from semi-structured interviews with HIV care providers (N = 8), supplemented by patient interviews (N = 15). Results None of the screened patient participants (N = 121) who were seeking HIV care and had problematic SU were engaged in SU treatment, despite the freely available co-located SU treatment program. Only 1.5% of the enrolled patient study sample (N = 66) reported lifetime referral to SU treatment. On average, patients with untreated SU spent 33.3% (SD=34.5%) of their monthly household income on substances. HIV care providers reported a lack of clarity about the SU referral process and a lack of direct communication with patients about patients' needs or interest in receiving an SU referral. Discussion SU treatment referrals and uptake were rare among PLWH reporting problematic SU, despite the high proportion of individual resources allocated to substances and the co-located Matrix site. A standardized referral policy between the HIV and Matrix sites may improve communication and uptake of SU referrals.
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Affiliation(s)
- Jennifer M. Belus
- Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland,University of Basel, Basel, Switzerland,University of Maryland, Department of Psychology, College Park, MD, USA,Corresponding author at: Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4051, Switzerland.
| | | | - Elizabeth Hutman
- University of Maryland, School of Public Health, College Park, MD, USA
| | - Alexandra L. Rose
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Warren Burnhams
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - Lena S. Andersen
- University of Copenhagen, Global Health Section, Department of Public Health, Copenhagen, Denmark
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa,University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
| | - John A. Joska
- University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
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10
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Myers B, Koch JR, Johnson K, Harker N. Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. Addict Sci Clin Pract 2022; 17:8. [PMID: 35109915 PMCID: PMC8812030 DOI: 10.1186/s13722-022-00289-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nadine Harker
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
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11
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Myers B, Lombard C, Joska JA, Abdullah F, Naledi T, Lund C, Petersen Williams P, Stein DJ, Sorsdahl KR. Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa. AIDS Behav 2021; 25:3758-3769. [PMID: 33876383 PMCID: PMC8560660 DOI: 10.1007/s10461-021-03263-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.
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Affiliation(s)
- B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa.
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - F Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - T Naledi
- Dean's Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C Lund
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - P Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - D J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council's Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - K R Sorsdahl
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
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12
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Myers B, Browne FA, Carney T, Kline T, Bonner CP, Wechsberg WM. The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11403. [PMID: 34769920 PMCID: PMC8582840 DOI: 10.3390/ijerph182111403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/03/2022]
Abstract
Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Felicia A Browne
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tracy Kline
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Wendee M Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
- Maternal and Child Health Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27529, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27703, USA
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13
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Myers B, Carney T, Rooney J, Malatesta S, White LF, Parry CDH, Bouton TC, Ragan EJ, Horsburgh CR, Warren RM, Jacobson KR. Alcohol and Tobacco Use in a Tuberculosis Treatment Cohort during South Africa's COVID-19 Sales Bans: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5449. [PMID: 34069737 PMCID: PMC8161406 DOI: 10.3390/ijerph18105449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND South Africa temporarily banned alcohol and tobacco sales for about 20 weeks during the COVID-19 lockdown. We described changes in alcohol and tobacco consumption after implementation of these restrictions among a small number of participants in a tuberculosis treatment cohort. METHOD The timeline follow-back procedure and Fägerstrom test for nicotine dependence was used to collect monthly alcohol and tobacco use information. We report changes in heavy drinking days (HDD), average amount of absolute alcohol (AA) consumed per drinking day, and cigarettes smoked daily during the alcohol and tobacco ban compared to use prior to the ban. RESULTS Of the 61 participants for whom we have pre-ban and within-ban alcohol use information, 17 (27.9%) reported within-ban alcohol use. On average, participants reported one less HDD per fortnight (interquartile range (IQR): -4, 1), but their amount of AA consumed increased by 37.4 g per drinking occasion (IQR: -65.9 g, 71.0 g). Of 53 participants who reported pre-ban tobacco use, 17 (32.1%) stopped smoking during the ban. The number of participants smoking >10 cigarettes per day decreased from 8 to 1. CONCLUSIONS From these observations, we hypothesize that policies restricting alcohol and tobacco availability seem to enable some individuals to reduce their consumption. However, these appear to have little effect on the volume of AA consumed among individuals with more harmful patterns of drinking in the absence of additional behavior change interventions.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Jennifer Rooney
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Samantha Malatesta
- Department of Biostatistics, School of Public Health, Boston University, MA 02119, USA; (S.M.); (L.F.W.)
| | - Laura F. White
- Department of Biostatistics, School of Public Health, Boston University, MA 02119, USA; (S.M.); (L.F.W.)
| | - Charles D. H. Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Department of Psychiatry, Stellenbosch University, Tygerberg 7505, South Africa
| | - Tara C. Bouton
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Elizabeth J. Ragan
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Charles Robert Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
- Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, MA 02119, USA
| | - Robin M. Warren
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Tuberculosis Research, Stellenbosch University, Tygerberg 7505, South Africa;
| | - Karen R. Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
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14
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van der Westhuizen C, Malan M, Naledi T, Roelofse M, Myers B, Stein DJ, Lahri S, Sorsdahl K. Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study. Addict Sci Clin Pract 2021; 16:31. [PMID: 33980314 PMCID: PMC8117325 DOI: 10.1186/s13722-021-00239-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs). Methods This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes. Results Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings. Conclusions This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.
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Affiliation(s)
- Claire van der Westhuizen
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Megan Malan
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
| | - Tracey Naledi
- Public Health Medicine Division, University of Cape Town, Cape Town, South Africa
| | | | - Bronwyn Myers
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, SA MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Sa'ad Lahri
- Department of Emergency Medicine, University of Cape Town, Cape Town, South Africa.,Khayelitsha Hospital Emergency Services, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
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15
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"Moving Forward with Life": Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165706. [PMID: 32784613 PMCID: PMC7459709 DOI: 10.3390/ijerph17165706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Background: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.
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Song X, Wang S, Wang R, Xu H, Jiang Z, Li S, Zhang S, Wan Y. Mediating Effects of Specific Types of Coping Styles on the Relationship between Childhood Maltreatment and Depressive Symptoms among Chinese Undergraduates: The Role of Sex. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093120. [PMID: 32365812 PMCID: PMC7246430 DOI: 10.3390/ijerph17093120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Abstract
Although childhood maltreatment is known to be associated with depressive symptoms, few studies have investigated the mediating effect of different types of coping styles on this association. It is unknown whether the impacts vary by sex. We investigated the mediating effects of different coping styles on the relationship between childhood maltreatment and depressive symptoms among Chinese undergraduates, as well as the role of sex in the mediated pathways. A total of 7643 college freshmen and sophomores (5665 females, 1978 males; 4215 freshmen, 3428 sophomores; mean age, 19.67 years) from two colleges in China completed a standard questionnaire on the details of childhood maltreatment, depressive symptoms, and coping styles. Childhood maltreatment was significantly correlated with all coping styles and depressive symptoms studied (p < 0.001). Problem solving, self-blame, help seeking, problem avoidance, and rationalization mediated the relationship between childhood maltreatment and depressive symptoms. The estimated ratio of the effect of childhood maltreatment on the occurrence of depressive symptoms can be explained by the mediation of problem solving, self-blame, help seeking, problem avoidance, and rationalization, which accounted for 15.1%, 25.6%, 7.4%, 1.6% and 1.6% of the total effect, respectively. Sex differences were found to have mediating effects on coping styles in terms of the relationship between childhood maltreatment and depressive symptoms. The findings illustrate the need to focus on coping styles and to employ sex-specific methods to effectively help college students reduce depressive symptoms associated with childhood maltreatment.
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Affiliation(s)
- Xianbing Song
- Department of Human Anatomy, Histology & Embryology, Anhui Medical College, Hefei 230032, China;
| | - Shanshan Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (S.W.); (H.X.); (Z.J.); (S.L.); (S.Z.)
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei 230032, China
| | - Rui Wang
- Information Technology Office, Anqing Medical College, Anqing 246052, China;
| | - Huiqiong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (S.W.); (H.X.); (Z.J.); (S.L.); (S.Z.)
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei 230032, China
| | - Zhicheng Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (S.W.); (H.X.); (Z.J.); (S.L.); (S.Z.)
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei 230032, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (S.W.); (H.X.); (Z.J.); (S.L.); (S.Z.)
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei 230032, China
| | - Shichen Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (S.W.); (H.X.); (Z.J.); (S.L.); (S.Z.)
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei 230032, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (S.W.); (H.X.); (Z.J.); (S.L.); (S.Z.)
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei 230032, China
- Correspondence:
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