Treating South African Pregnant Women for Methamphetamine

描述（申请人提供）：背景：自2001年以来，妇女健康合作社（WHC）成功地采用了循证干预措施，以减少南非吸毒妇女的性和毒品风险行为。然而，开普敦的甲基苯丙胺使用率迅速上升，我们正在进行的研究结果表明，世界卫生中心在减少妇女使用这种药物方面取得的成功有限。令人震惊的是，在WHC参与者中，报告使用冰毒的孕妇比例高于非孕妇（n=24/26= 92% v. n=238/356= 67%; p= 0.01）。此外，100%（n=31/31）的有色人种与60%（n=12/20）的使用黑色物质的怀孕参与者报告在过去一个月内每周至少使用3次冰毒。这些发现强调了缺乏一个集中和密集的治疗甲基苯丙胺使用孕妇谁住在贫困乡镇。因此，怀孕的有色人种妇女最需要药物滥用治疗，因此她们是拟议研究的目标。因此，本申请响应PA-09-021药物滥用和成瘾研究国际研究合作（R21），重点是开发孕妇使用甲基苯丙胺的治疗方案。拟定的主要研究者开发了一种有效的、操作性条件反射/社会学习理论驱动的综合药物滥用治疗模式，即基于强化的治疗（RBT）。RBT模式改善了美国贫困的非裔美国兴奋剂使用孕妇的孕产妇和新生儿结局。因此，RBT是一种很有前途的治疗模式，可以补充授权理论驱动的WHC艾滋病毒预防工作;它们可以有效地解决甲基苯丙胺的使用问题。项目目标：通过调整和完善区域性行为疗法，同时将妇女健康中心的艾滋病毒预防部分纳入其中，形成一个综合治疗和预防模式，即区域性行为疗法+妇女健康中心，制定并初步评价一个有效、全面、对文化敏感、以妇女为中心的南非有色人种孕妇护理模式。有两个连续的目标：目标1。调整和预先测试一个综合药物滥用治疗模式，即RBT，其中将纳入循证的WHC艾滋病毒预防模式，产生RBT+WHC。目标2.对有色人种孕妇（N=40）进行一项小规模随机对照试验，以确定RBT+WHC模式相对于心理教育控制条件的可接受性、可行性和初步疗效，其对孕产妇结局的影响包括（a）甲基苯丙胺的使用，（B）无保护性行为的频率，以及（c）产前护理访视的次数;和新生儿结局，包括（d）住院时间，（e）出生体重和（f）分娩时胎龄。公共卫生影响：RBT+WHC模式将为填补该地区妇女药物使用治疗研究的空白奠定基础，在该地区，妇女特别被剥夺了接受医疗保健的权利。拟议的研究还有望帮助改善两代南非人，有色妇女及其子女的健康。

DESCRIPTION (provided by applicant): Background: Since 2001, the Women's Health CoOp (WHC) has successfully adapted an evidence-based intervention to reduce sex- and drug-risk behaviors in drug-using South African women. However, Cape Town has experienced a rapid rise in methamphetamine use, and the findings from our ongoing study indicate that the WHC has had limited success in reducing the use of this drug among women. Alarmingly, among WHC participants, a greater proportion of pregnant than nonpregnant women reported using meth (n=24/26=92 percent v. n=238/356=67 percent; p=.01). Further, 100 percent (n=31/31) of the Coloured versus 60 percent (n=12/20) of the Black substance-using pregnant participants reported at least 3 times/week meth use in the past month. These findings are underscored by a lack of a focused and intensive treatment for methamphetamine-using pregnant women who live in impoverished townships. Consequently, pregnant Coloured women are most in need of substance abuse treatment, and thus are they are the target of the proposed study. Therefore, this application responds to PA-09-021 International Research Collaboration on Drug Abuse and Addiction Research (R21) by focusing on developing treatment options for methamphetamine use among pregnant women. The proposed Principal Investigator has developed an efficacious, operant conditioning/social-learning-theory-driven, comprehensive drug abuse treatment model, Reinforcement-Based Treatment (RBT). The RBT model has improved maternal and neonatal outcomes of impoverished African American stimulant-using pregnant women in the United States. Thus, RBT is a promising treatment model to complement the empowerment-theory-driven WHC HIV prevention efforts; and together, they can effectively address methamphetamine use. Project Goal: To develop and initially evaluate an efficacious, comprehensive, culturally sensitive, women-centered model of care for pregnant South African Coloured women by adapting and refining RBT and at the same time integrating into it the WHC HIV prevention components, yielding an integrated treatment and prevention model, RBT+WHC. There are two sequential aims: Aim 1. Adapt and pretest a comprehensive drug abuse treatment model, RBT, into which will be integrated the evidence-based WHC HIV prevention model, yielding RBT+WHC. Aim 2. Conduct a small-scale RCT with pregnant Coloured women (N=40) to determine the acceptability, feasibility, and initial efficacy of the RBT+WHC model relative to a psycho-educational control condition in terms of their respective impacts on maternal outcomes, including (a) methamphetamine use, (b) frequency of unprotected sex acts, and (c) number of prenatal care visits; and neonatal outcomes, including (d) length of hospital stay, (e) birth weight, and (f) gestational age at delivery. Public Health Impact: The RBT+WHC model will lay the foundation for filling a void in substance use treatment research for women in a region where they are especially disenfranchised from receiving healthcare. The proposed study also holds the promise of helping to improve the health of two generations of South Africans, Coloured women and their children.