Brief Intervention to Reduce Substance Use in South African Primary Care

描述（由申请人提供）：这项药物健康服务申请是由一名新的研究者响应国家药物滥用研究所的项目公告PA-03-107“NIH探索性/发展性研究资助奖（R21）”和PA-05-139“药物和酒精滥用预防和治疗的健康服务研究”。本探索性研究考察了可行性，并采用随机对照试验来评估由执业护士提供的简短动机干预（BMI）在减少年轻人（18-24岁）危险药物和酒精使用方面的有效性。该干预是在一个新的环境和人群中进行的，该环境和人群是南非开普敦一家为医疗贫困居民服务的公共初级卫生保健诊所。BMI在欧洲和北美人群中得到了强有力的实证支持，南非的医学院正在广泛教授该方法。很少有研究检查医疗环境中药物使用的简短动机干预措施，而且没有在南非进行过研究。该研究利用并建立在美国和开普敦研究人员已建立的有效国际合作的基础上，该合作是在NIDA的南部非洲倡议下开始的，并引起了当地临床医生、管理人员和医学院的强烈兴趣。我们建议研究18-24岁年龄组，因为我们在这一人群中的流行病学研究发现，这一年龄组的毒品和酒精问题的风险很高，而这些问题又与艾滋病毒危险行为有关。该项目是及时的，因为甲基苯丙胺等毒品的使用在该国急剧增加。此外，该研究为了解其他国家（包括美国）繁忙的公共初级保健诊所的干预措施提供了重要贡献。根据结果，我们将修改干预措施以提高可行性和有效性，并向NIDA的国际合作PA提交R01，以进行更大规模的研究，可以根据种族，性别或其他亚组检查有效性。

DESCRIPTION (provided by applicant): This drug health services application by a new investigator responds to the National Institute on Drug Abuse's Program Announcements PA-03-107 the "NIH Exploratory/Developmental Research Grant Award (R21)" and PA-05-139 "Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse". This exploratory study examines feasibility and uses a randomized controlled trial to assess effectiveness of a Brief Motivational Intervention (BMI) delivered by nurse practitioners in reducing hazardous drug and alcohol use among young adults (aged 18-24 years) in a new setting and population-a public primary health care clinic serving medically indigent residents in Cape Town, South Africa. BMI has strong empirical support in European and North American populations and the methodology is being widely taught in medical schools in South Africa. There are very few studies examining Brief Motivational Interventions for drug use in medical settings, and none have been studied in South Africa. The study uses and builds on an established and effective international collaboration of researchers from the U.S. and Cape Town, begun under NIDA's Southern Africa Initiative, and has the strong interest of local clinicians, administrators, and the medical school. We propose to study the 18-24 year-old age group, because our epidemiological study in this population found that this age group was at high risk of drug and alcohol problems which in turn were linked to HIV risky behaviors. The project is timely as use of drugs, such as methamphetamine, are dramatically increasing in prevalence in the country. In addition, the study offers important contributions to understanding interventions for busy public primary care clinics in other countries, including the U.S. Informed by the results, we will modify the intervention to increase feasibility and effectiveness and submit an R01 under NIDA's International Collaborations PA to conduct a larger study which can examine effectiveness by race, gender, or other subgroups.