Brief Intervention to Reduce Substance Use in South African Primary Care

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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.