Brief psychotherapy administered by non-specialised health workers to address risky substance use in inpatients with multi-drug resistant tuberculosis: A feasibility and acceptability study
Background:
Only 55% of multi-drug 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 among MDR-TB patients in general, and on their delivery by non-specialist health workers in particular.
Objectives:
To 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.
Methods:
Between 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 four weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered three-months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n=10).
Results:
Sixty 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.
Conclusion:
In 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 registration: South African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za).
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Brief psychotherapy administered by non-specialised health workers to address risky substance use in inpatients with multi-drug resistant tuberculosis: A feasibility and acceptability study
Posted 18 Dec, 2020
On 19 Jan, 2021
On 17 Dec, 2020
On 05 Dec, 2020
On 05 Dec, 2020
On 05 Dec, 2020
Received 24 Nov, 2020
On 24 Nov, 2020
On 18 Nov, 2020
Received 15 Nov, 2020
On 11 Nov, 2020
Invitations sent on 10 Nov, 2020
On 22 Oct, 2020
On 21 Oct, 2020
On 21 Oct, 2020
On 13 Apr, 2020
On 12 Apr, 2020
On 12 Apr, 2020
On 11 Apr, 2020
Posted 16 Apr, 2020
On 28 Sep, 2020
Received 03 Sep, 2020
On 26 Aug, 2020
On 26 Aug, 2020
Received 22 Jul, 2020
On 20 Jul, 2020
Invitations sent on 28 May, 2020
On 14 May, 2020
On 13 May, 2020
On 13 May, 2020
Background:
Only 55% of multi-drug 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 among MDR-TB patients in general, and on their delivery by non-specialist health workers in particular.
Objectives:
To 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.
Methods:
Between 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 four weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered three-months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n=10).
Results:
Sixty 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.
Conclusion:
In 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 registration: South African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za).
Figure 1
Figure 1