Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Setting
2.3. Screening, Brief Intervention, and Referral to Treatment (SBIRT) Description
2.3.1. Screening
2.3.2. Brief Intervention
2.3.3. Referral/Treatment
2.4. Follow Up Care
2.5. Outcome Measures and Definitions
2.6. Data Collection and Analysis
2.7. Ethics
3. Results
3.1. Clinical and Demographic Characteristics Based on Substance-Use (SU) Screening
3.2. Substance Use Screening: Substances of Use and Risk Classification
3.3. Clinical and Demographic Characteristics Based on Highest Risk Classification
3.4. Rifampicin-Resistant Tuberculosis (RR-TB) Treatment Outcomes among Patients Screened for Substance Use Disorder within 2 Months of RR-TB Treatment Initiation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization (WHO). Global Tuberculosis Report 2021. Available online: https://www.who.int/publications/i/item/9789240037021 (accessed on 1 November 2021).
- Ahmad, N.; Ahuja, S.D.; Akkerman, O.W.; Alffenaar, J.C.; Anderson, L.F.; Baghaei, P.; Bang, D.; Barry, P.M.; Bastos, M.L.; Behera, D.; et al. Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment–2017. Lancet 2018, 392, 821–834. [Google Scholar] [CrossRef] [Green Version]
- Law, S.; Daftary, A.; O’Donnell, M.; Padayatchi, N.; Calzavara, L.; Menzies, D. Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: A systematic review. Eur. Respir. J. 2018, 53, 1801030. [Google Scholar] [CrossRef] [PubMed]
- Shean, K.; Streicher, E.; Pieterson, E.; Symons, G.; van Zyl-Smit, R.; Theron, G.; Lehloenya, R.J.; Padanilam, X.; Wilcox, P.; Victor, T.C.; et al. Drug-Associated Adverse Events and Their Relationship with Outcomes in Patients Receiving Treatment for Extensively Drug-Resistant Tuberculosis in South Africa. PLoS ONE 2013, 8, e63057. [Google Scholar] [CrossRef]
- Morris, M.D.; Quezada, L.; Bhat, P.; Moser, K.; Smith, J.; Perez, H.; Laniado-Laborin, R.; Estrada-Guzman, J.; Rodwell, T.C. Social, economic, and psychological impacts of MDR-TB treatment in Tijuana, Mexico: A patient’s perspective. Int. J. Tuberc. Lung Dis. 2013, 17, 954–960. [Google Scholar] [CrossRef]
- Isaakidis, P.; Rangan, S.; Pradhan, A.; Ladomirska, J.; Reid, T.; Kielmann, K. ‘I cry every day’: Experiences of patients co-infected with HIV and multidrug-resistant tuberculosis. Trop. Med. Int. Health 2013, 18, 1128–1133. [Google Scholar] [CrossRef]
- Gelmanova, I.; Keshavjee, S.; Golubchikova, V.; Berezina, V.; Strelis, A.; Yanova, G.; Atwood, S.; Murray, M. Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: Non-adherence, default and the acquisition of multidrug resistance. Bull. World Health Organ. 2007, 85, 703–711. [Google Scholar] [CrossRef]
- Holtz, T.H.; Lancaster, J.; Laserson, K.F.; Wells, C.D.; Thorpe, L.; Weyer, K. Risk factors associated with default from multidrug-resistant tuberculosis treatment, South Africa, 1999–2001. Int. J. Tuberc. Lung Dis. 2006, 10, 649–655. [Google Scholar]
- Baddeley, A. A Systematic Literature Review to Assess the Impact of Alcoholism on Tuberculosis Control and Strategies to Encourage Compliance Amongst Alcoholic TB Patients. Master’s Thesis, University of London, London, UK, 2008. [Google Scholar]
- Kendall, E.A.; Theron, D.; Franke, M.F.; Van Helden, P.; Victor, T.C.; Murray, M.B.; Warren, R.M.; Jacobson, K.R. Alcohol, Hospital Discharge, and Socioeconomic Risk Factors for Default from Multidrug Resistant Tuberculosis Treatment in Rural South Africa: A Retrospective Cohort Study. PLoS ONE 2013, 8, e83480. [Google Scholar] [CrossRef]
- Ngouleun, W.; Nya, P.C.B.; Pieme, A.C.; Telefo, P.B.; Williams, N.; Prosper, B.N.; Anatole, P.C.; Bruno, T.P. Risk assessment of hepatotoxicity among tuberculosis and human immunodeficiency virus/AIDS-coinfected patients under tuberculosis treatment. Int. J. Mycobacteriol. 2016, 5, 482–488. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization (WHO). Brief Intervention: The ASSIST-Linked Brief Intervention for Hazardous and Harmful Substance Use: Manual for Use in Primary Care. Available online: https://www.who.int/publications/i/item/the-assist-linked-brief-intervention-for-hazardous-and-harmful-substance-use (accessed on 1 November 2021).
- World Health Organization (WHO). Management of Substance Dependence Review Series: A Systematic Review of Opioid Antagonists for Alcohol Dependence. Available online: https://www.who.int/substance_abuse/publications/en/opioid.pdf (accessed on 1 November 2021).
- Srisurapanont, M.; Jarusuraisin, N. Opioid antagonists for alcohol dependence. Cochrane Database Syst. Rev. 2005, 1, CD001867. [Google Scholar] [CrossRef]
- Cape Town City Health. City of Cape Town–2011 Census–Khayelitsha Health District. Available online: https://resource.capetown.gov.za/documentcentre/Documents/Maps%20and%20statistics/Khayelitsha%20Health%20District.pdf (accessed on 1 November 2021).
- Cox, H.; Hughes, J.; Daniels, J.; Azevedo, V.; McDermid, C.; Poolman, M.; Boulle, A.; Goemaere, E.; Van Cutsem, G. Community-based treatment of drug-resistant tuberculosis in Khayelitsha, South Africa. Int. J. Tuberc. Lung Dis. 2014, 18, 441–448. [Google Scholar] [CrossRef] [PubMed]
- University of Cape Town. A Mixed-Methods Study of the Nature and Extent of the Alcohol Trade in Khayelitsha—And Community Perceptions. Available online: https://movendi.ngo/wp-content/uploads/2020/04/khayelitsha_-_alcohol_trade_and_community_perceptions_report.pdf (accessed on 1 November 2021).
- Peltzer, K.; Phaswana-Mafuya, N. Drug use among youth and adults in a population-based survey in South Africa. S. Afr. J. Psychiatry 2018, 24, 1139. [Google Scholar] [CrossRef] [PubMed]
- Sinclair, J.D. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol. 2001, 36, 2–10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization (WHO). Definitions and Reporting Framework for Tuberculosis–2013 Revision. Available online: http://apps.who.int/iris/handle/10665/79199 (accessed on 1 November 2021).
- REDCap. Research Electronic Data Capture: REDCap. Available online: https://projectredcap.org/software/ (accessed on 1 November 2021).
- Jonas, D.E.; Garbutt, J.C.; Brown, J.M.; Amick, H.R.; Brownley, K.A.; Council, C.L.; Viera, A.J.; Wilkins, T.M.; Schwartz, C.; Richmond, E.M.; et al. Screening, Behavioral Counseling, and Referral in Primary Care to Reduce Alcohol Misuse. Comp. Eff. Rev. 2012, 64, 1–87. [Google Scholar]
- van der Westhuizen, C.; Malan, M.; Naledi, T.; Roelofse, M.; Myers, B.; Stein, D.J.; 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. [Google Scholar] [CrossRef]
- Madhombiro, M.; Kidd, M.; Dube, B.; Dube, M.; Mutsvuke, W.; Muronzie, T.; Zhou, D.T.; Derveeuw, S.; Chibanda, D.; Chingono, A.; et al. Effectiveness of a psychological intervention delivered by general nurses for alcohol use disorders in people living with HIV in Zimbabwe: A cluster randomized controlled trial. J. Int. AIDS Soc. 2020, 23, e25641. [Google Scholar] [CrossRef]
- Calligaro, G.L.; de Wit, Z.; Cirota, J.; Orrell, C.; Myers, B.; Decker, S.; Stein, D.J.; Sorsdahl, K.; Dawson, R. Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: A feasibility and acceptability study. Pilot Feasibility Stud. 2021, 7, 28. [Google Scholar] [CrossRef]
- Wennerstrom, A.; Hargrove, L.; Minor, S.; Kirkland, A.L.; Shelton, S.R. Integrating Community Health Workers Into Primary Care to Support Behavioral Health Service Delivery. J. Ambul. Care Manag. 2015, 38, 263–272. [Google Scholar] [CrossRef] [Green Version]
- Necho, M.; Tsehay, M.; Seid, M.; Zenebe, Y.; Belete, A.; Gelaye, H.; Muche, A. Prevalence and associated factors for alcohol use disorder among tuberculosis patients: A systematic review and meta-analysis study. Subst. Abus. Treat. Prev. Policy 2021, 16, 2. [Google Scholar] [CrossRef]
- Mohr-Holland, E.; Reuter, A.; Hughes, J.; Daniels, J.; Beko, B.; Makhanda, G.; De Avezedo, V.; Kock, Y.; Cox, H.; Furin, J.; et al. Correspondence regarding “Delamanid for rifampicin-resistant tuberculosis: A retrospective study from South Africa”. Eur. Respir. J. 2020, 56, 2000837. [Google Scholar] [CrossRef]
- Shin, S.; Livchits, V.; Connery, H.S.; Shields, A.; Yanov, S.; Yanova, G.; Fitzmaurice, G.M.; Nelson, A.K.; Greenfield, S.F. Tomsk Tuberculosis Alcohol Working Group Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia. Addiction 2013, 108, 1387–1396. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Total n = 333 | Not Screened n = 205 | Screened n = 128 | p-Value | |
---|---|---|---|---|
Male | 195 (58.6) | 117 (57.1) | 78 (60.9) | 0.49 |
Median Age, years | 34 (28–42) | 34 (28–42) | 35 (29–43) | 0.58 |
Age Category, years | ||||
<20 | 19 (5.7) | 10 (4.9) | 9 (7.0) | |
20–29 | 87 (26.1) | 58 (28.3) | 29 (22.7) | |
30–39 | 119 (35.7) | 72 (35.1) | 47 (36.7) | |
40–49 | 66 (19.8) | 38 (18.5) | 28 (21.9) | |
≥50 | 42 (12.6) | 27 (13.2) | 15 (11.7) | 0.69 |
Disease classification | ||||
Xpert MTB/RIF unconfirmed | 34 (10.2) | 25 (12.2) | 9 (7.0) | |
Rifampicin-mono resistance | 77 (23.1) | 53 (25.9) | 24 (18.8) | |
MDR including injectable resistance | 191 (57.4) | 113 (55.1) | 78 (60.9) | |
MDR plus fluroquinolone resistance | 31 (9.3) | 14 (6.8) | 17 (13.3) | 0.051 |
Previous TB treatment history None | 143 (42.9) | 90 (43.9) | 53 (41.4) | |
Previous 1st line TB treatment | 162 (48.7) | 96 (46.8) | 66 (51.6) | |
Previous 2nd line TB treatment | 28 (8.4) | 19 (9.3) | 9 (7.0) | 0.64 |
Disease Site | ||||
Pulmonary TB | 314 (94.3) | 194 (94.6) | 120 (93.8) | |
Extra-Pulmonary TB | 19 (5.7) | 11 (5.4) | 8 (6.3) | 0.74 |
Site of Treatment initiation | 288 (86.5) | 167 (81.5) | 121 (94.5) | |
Primary Health Care Facility Hospital | 45 (13.5) | 38 (18.5) | 7 (5.5) | 0.001 * |
HIV Positive | 226 (67.9) | 138 (67.3) | 88 (68.8) | 0.79 |
Median CD4 count | 79 (28–239) ^ | 73 (24–217) ^ | 102 (35–247) ^ | 0.30 |
On Antiretroviral Therapy | 218 (96.5) | 132 (95.7) | 86 (97.7) | 0.38 |
Total Screened n = 128 | No-/Low-Risk SU n = 45 | Moderate-/High-Risk SU n = 83 | p-Value | |
---|---|---|---|---|
Male | 78 (60.9) | 14 (31.1) | 64 (77.1) | <0.001 * |
Median Age, years | 35 (29–43) | 34 (25–47) | 35 (30–42) | 0.64 |
Age Category, years | ||||
<20 20–29 30–39 40–49 | 9 (7.0) 29 (22.7) 47 (36.7) 28 (21.9) | 5 (11.1) 13 (28.9) 11 (24.4) 6 (13.3) | 4 (4.8) 16 (19.3) 36 (43.4) 22 (26.5) | |
>=50 | 15 (11.7) | 10 (22.2) | 5 (6.0) | 0.006 * |
Time to SU screening | ||||
<=2 months | 77 (60.2) | 32 (71.1) | 45 (54.2) | |
>2 months | 51 (39.8) | 13 (28.9) | 38 (45.8) | 0.062 |
Disease classification | ||||
Xpert MTB/RIF unconfirmed Rifampicin-mono resistance MDR including injectable resistance | 9 (7.0) 24 (18.8) 78 (60.9) | 3 (6.7) 8 (17.8) 25 (55.5) | 6 (7.2) 16 (19.3) 53 (63.9) | |
MDR plus fluroquinolone resistance | 17 (13.3) | 9 (20.0) | 8 (9.6) | 0.43 |
Previous TB treatment history | ||||
None Previous 1st line TB treatment | 53 (41.4) 66 (51.6) | 21 (46.7) 20 (44.4) | 32 (38.6) 46 (55.4) | |
Previous 2nd line TB treatment | 9 (7.0) | 4 (8.9) | 5 (6.0) | 0.48 |
Disease Site | ||||
Pulmonary TB | 120 (93.8) | 42 (93.3) | 78 (94.0) | |
Extra-pulmonary TB | 8 (6.3) | 3 (6.7) | 5 (6.0) | 0.89 |
Site of Treatment initiation | ||||
Primary Health Care Facility | 121 (94.5) | 41 (91.1) | 80 (96.4) | |
Hospital | 7 (5.5) | 4 (8.9) | 3 (3.6) | 0.21 |
HIV Positive | 88 (68.8) | 29 (64.4) | 59 (71.1) | 0.44 |
Median CD4 count | 102 (35–247) ^ | 100 (35–238) | 107 (38–257) ^ | 0.95 |
On Antiretroviral Therapy | 86 (97.7) | 27 (93.1) | 59 (100.0) | 0.041 * |
Overall n = 77 n (%) | No-/Low-Risk SU n = 32 n (%) | Moderate/High Risk n = 45 n (%) | |
---|---|---|---|
Treatment Success | 53 (68.8) | 21 (65.6) | 32 (71.1) |
Loss to Follow-up | 9 (11.7) | 2 (6.2) | 7 (15.6) |
Died | 9 (11.7) | 5 (15.6) | 4 (8.9) |
Failed by Treatment | 3 (3.9) | 3 (9.4) | 0 (0) |
Not Evaluated | 3 (3.9) | 1 (3.1) | 2 (4.4) |
Overall n = 33 n (%, Column) | Did not Receive Naltrexone n = 22 | Received Naltrexone n = 11 | |
---|---|---|---|
Treatment Success | 23 (69.7) | 16 (72.7) | 7 (63.6) |
Loss to Follow-up | 6 (18.2) | 4 (18.2) | 2 (18.2) |
Died | 2 (6.1) | 1 (4.5) | 1 (9.1) |
Not Evaluated | 2 (6.1) | 1 (4.5) | 1 (9.1) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Reuter, A.; Beko, B.; Memani, B.; Furin, J.; Daniels, J.; Rodriguez, E.; Reuter, H.; Weich, L.; Isaakidis, P.; von der Heyden, E.; et al. Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa. Trop. Med. Infect. Dis. 2022, 7, 21. https://doi.org/10.3390/tropicalmed7020021
Reuter A, Beko B, Memani B, Furin J, Daniels J, Rodriguez E, Reuter H, Weich L, Isaakidis P, von der Heyden E, et al. Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa. Tropical Medicine and Infectious Disease. 2022; 7(2):21. https://doi.org/10.3390/tropicalmed7020021
Chicago/Turabian StyleReuter, Anja, Buci Beko, Boniwe Memani, Jennifer Furin, Johnny Daniels, Erickmar Rodriguez, Hermann Reuter, Lize Weich, Petros Isaakidis, Erin von der Heyden, and et al. 2022. "Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa" Tropical Medicine and Infectious Disease 7, no. 2: 21. https://doi.org/10.3390/tropicalmed7020021