Brief Intervention to Reduce Substance Use in South African Primary Care

描述(申请人提供)：这项由一位新的调查员提出的药物健康服务申请是对国家药物滥用研究所的计划公告PA-03-107“NIH探索/发展研究资助奖(R21)”和PA-05-139“预防和治疗药物和酒精滥用的健康服务研究”的回应。这项探索性研究考察了可行性，并使用随机对照试验来评估在新的环境和人口中由护士从业者实施的简短动机干预(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--这是一家为南非开普敦医疗贫困居民提供服务的公共初级保健诊所。BMI在欧洲和北美人群中有很强的实证支持，这种方法正在南非的医学院广泛教授。很少有研究考察在医疗环境中对药物使用的简短激励干预，南非也没有研究过。这项研究利用并建立了来自美国和开普敦的研究人员在NIDA南部非洲倡议下开始的既定和有效的国际合作，并引起了当地临床医生、管理人员和医学院的浓厚兴趣。我们建议研究18-24岁的年龄组，因为我们在这一年龄段的流行病学研究发现，这一年龄段的人面临着药物和酒精问题的高风险，而这反过来又与艾滋病毒的危险行为有关。该项目很及时，因为毒品的使用，如甲基苯丙胺，在该国的流行率正在急剧上升。此外，这项研究为了解包括美国在内的其他国家繁忙的公共初级保健诊所的干预措施提供了重要贡献。了解到这一结果后，我们将修改干预措施，以提高可行性和有效性，并根据NIDA的国际合作PA提交R01，以进行一项更大规模的研究，以检查种族、性别或其他亚组的有效性。

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.