Perceptions and experiences of patients attending an opioid substitution clinic in South Africa

Background

Opioid substitution therapy (OST) is endorsed as the recommended treatment for opioid use disorders. Opioid substitution therapy is not widely used in South Africa, so little is known about its perceived clinical utility in this setting. There is also a paucity of qualitative research that explores the subjective experiences of patients using OST.

Aim

To explore patients' perceptions and experiences attending a South African OST outpatient clinic (OST-OC).

Setting

The OST-OC at Stikland Psychiatric Hospital, Cape Town, South Africa.

Methods

We conducted a qualitative study using semi-structured interviews with eight participants who had been attending the OST-OC for at least 6 months. Transcripts were analysed using Atlas.ti software and thematic content analysis was used to identify themes.

Results

Patients stated that OST helped them to regain and maintain a stable lifestyle. Autonomy and agency, the therapeutic relationship and family support were perceived as contributing to successful patient outcomes. The preference for methadone and buprenorphine treatment depended on individual experiences. Patients valued kindness from staff members but reported that improved interactions with some nonclinical staff could better facilitate treatment. Challenges experienced included stigma and cost.

Conclusions

This study offers insights about OST that are pertinent to low- and middle-income countries. Reducing the cost of OST, collaborative decision-making between staff and patients, and a non-judgemental attitude by clinical staff were recognised as important factors for optimised service delivery.

Contribution

Understanding patients' experiences of OST in a South African setting will allow for future policy development for the treatment of opioid use disorders in similar settings locally and abroad.

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

Background

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.

Methods

We 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.

Results

Over 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.

Conclusions

This 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)

[2014 update in general internal medicine]

This article comments 9 original publications from year 2014 of interest for the primary care physician in the outpatient setting. The impact of diet such as nut consumption on health outcomes and mortality is developped, and the importance of dietary changes while taking statins is reminded. Red flags in low back pain and their predictive value are re-evaluated. An association between benzodiazepine use and Alzheimer dementia seems probable. New treatments for alcohol abuse, restless legs syndrome and type 2 diabetes are discussed. Finally, β-bloquers' effects on respiratory function in asthmatic patients are beeing reexamined.

[How to have a clear vision when considering all the different recommendations of moderate alcohol consumption?]

Although use of important amounts of alcohol has clearly been proven to have a negative health impact, large epidemiological studies show that a moderate quantity of alcohol might be beneficial in terms of total mortality, probably through cardiovascular protection. Many countries propose their own official recommandations with regard to moderate or low risk alcohol consumption. In this review, we compare some of these recommandations. Furthermore, risks and benefits of alcohol for the main groups of disease are analysed according to alcohol quantities and drinking patterns. Our final objective is to evaluate the small margin between potentially beneficial use of alcohol versus low risk use, and provide some practical recommandations for the physician advising an individual patient.

Exploring the comorbidity of anxiety and substance use disorders

Anxiety disorders and substance use disorders are highly comorbid, and such comorbidity complicates treatment and worsens prognosis. The mechanisms underlying the relationship between anxiety and substance use disorders are poorly understood. This paper reviews recent research attempting to explain these associations. Cognitive factors, such as attentional bias, expectancies, and anxiety sensitivity, appear to impact on the relation between anxiety and substance misuse. Temporality of the anxiety and substance use disorder may also indicate whether the substance use disorder is primary (anxiety may be a result of use) or secondary (substances may be used to self-medicate). Social phobia has been predominantly identified as a primary disorder preceding substance use, while the temporality of other anxiety and substance use disorders is less clear. The efficacy of concurrent treatment compared with separate treatment of either anxiety or substance use disorder is unclear and requires further research.

Substance misuse trends in South Africa

This paper, the first in a series related to the Joint European South African Research Network in Anxiety Disorders programme, examines substance use trends in South Africa. Alcohol remains the substance with the greatest burden of harm. Yet, trends vary by region, with for example methamphetamine being a major driver of psychiatric and substance abuse treatment demand in the Western Cape province. Heroin use is increasing in several provinces, where rapid intervention is required to avoid an epidemic. In particular, the state (the main funder of drug services) urgently needs to provide opioid substitution treatment. Apart from an inadequate number of treatment services, barriers to treatment are high. Barriers are predominantly cost, transport and resource related. Services are also impacted by a small and inadequately trained workforce and poor integration with mental health services. To adequately intervene with substance use disorders, South Africa needs an evidence-based policy and service planning framework that forges linkages with the mental health service system.

Factors associated with retention in alcohol and other drug treatment among disadvantaged communities in Cape Town, South Africa

OBJECTIVE

Retention in alcohol and other drug (AOD) treatment is strongly associated with positive outcomes. To design interventions to improve outcomes, it is therefore important to uncover the factors contributing to treatment retention. To date, South African AOD research has not examined the factors associated with retention among disadvantaged communities. This study aimed to address this gap by exploring client-level factors associated with retention in AOD treatment.

METHOD

Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in disadvantaged communities in the Cape Town metropolitan area who had accessed AOD treatment in 2006.

RESULTS

Multiple regression analyses revealed that race, therapeutic alliance, abstinence-specific social support, and anxiety were significant partial predictors of treatment retention. Black African participants spent significantly fewer days in treatment than "Coloured" individuals.

CONCLUSIONS

Findings point to the need to improve treatment retention among Black African clients specifically. For clients from poor South African communities, treatment retention rates can be improved by increasing abstinence-specific social support, improving perceptions of AOD treatment, and strengthening the counselor-client therapeutic alliance.

Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

Background

Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries. This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa.

Methods

Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in poor communities in Cape Town, South Africa who had accessed substance abuse treatment in 2006.

Results

Multiple regression analyses revealed that therapeutic alliance, treatment perceptions, abstinence-specific social support, and depression were significant partial predictors of treatment completion.

Conclusions

Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i) improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii) strengthening clients' abstinence-oriented social networks and, iii) strengthening the counselor-client therapeutic alliance.

Characterization of Poly(l-lysine)-graft-Poly(ethylene glycol) Assembled Monolayers on Niobium Pentoxide Substrates Using Time-of-Flight Secondary Ion Mass Spectrometry and Multivariate Analysis

Control of protein adsorption onto solid surfaces is a critical area of biomaterials and biosensors research. Application of high performance surface analysis techniques to these problems can improve the rational design and understanding of coatings that control protein adsorption. We have used static time-of-flight secondary ion mass spectrometry (TOF-SIMS) to investigate several poly(L-lysine)-graft-poly(ethylene glycol) (PLL-g-PEG) adlayers adsorbed electrostatically onto negatively charged niobium pentoxide (Nb(2)O(5)) substrates. By varying the PEG graft ratio (i.e., the number of lysine monomers per grafted PEG chain) and the molecular weights of the PLL and PEG polymers, the amount of protein adsorption can be tailored between 1 and 300 ng/cm(2). Detailed multivariate analysis using principal component analysis (PCA) of the positive and negative ion TOF-SIMS spectra showed changes in the outermost surface of the polymer films that were related to the density and molecular weight of the PEG chains on the surface. However, no significant differences were noted due to PLL molecular weight, despite observed differences in the serum adsorption characteristics for adlayers of PLL-g-PEG polymers with different PLL molecular weights. From the PCA results, multivariate peak intensity ratios were developed that correlated with the thickness of the adlayer and the enrichment of the PEG chains and the methoxy terminus of the PEG chains at the outermost surface of the adlayer. Furthermore, partial least squares regression was used to correlate the TOF-SIMS spectra with the amount of protein adsorption, resulting in a predictive model for determining the amount of protein adsorption on the basis of the TOF-SIMS spectra. The accuracy of the prediction of the amount of serum adsorption depended on the molecular weight of the PLL and PEG polymers and the PEG graft ratio. The combination of multivariate analysis and static TOF-SIMS provides detailed information on the surface chemistry and insight into the mechanism for protein resistance of the coatings.

[Quality management: definition and concept]

BACKGROUND

The topic "quality" has gained importance during recent years due to increasing interest of the society, insurances, governmental institutions and, last not least, those who are involved in health care themselves.

DEFINITIONS

The terms and notions, which mostly are adopted from the industry, are not at all self-explaining. Clarifications not only serve to avoid misinterpretations. The efficiency and power of the underlying concepts can not be recognized without introduction into the proper terminology.