Treating South African Pregnant Women for Methamphetamine

描述(由申请人提供)：背景：自2001年以来，妇女健康合作社(WHC)成功地采用了一种循证干预措施，以减少南非吸毒妇女的性行为和毒品危险行为。然而，开普敦的甲基苯丙胺使用量迅速上升，我们正在进行的研究结果表明，世界卫生组织在减少妇女使用甲基苯丙胺方面取得的成功有限。令人震惊的是，在WHC参与者中，报告使用冰毒的怀孕妇女比例高于未怀孕妇女(n=24/26=92%vs.n=238/356=67%；p=0.01)。此外，100%(n=31/31)的有色人种与60%(n=12/20)使用黑色物质的孕妇参与者报告在过去一个月中至少每周使用3次冰毒。对生活在贫困乡镇的使用甲基苯丙胺的孕妇缺乏重点和强化治疗，这突显了这些发现。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，此应用程序响应PA-09-021药物滥用和成瘾研究国际研究合作(R21)，重点开发孕妇使用甲基苯丙胺的治疗方案。拟议的首席调查员开发了一种有效的、可操作的条件化/社会学习理论驱动的全面药物滥用治疗模式，即强化治疗。RBT模式改善了美国使用兴奋剂的贫困非裔美国人孕妇的孕产妇和新生儿结局。因此，RBT是一种很有希望的治疗模式，可以补充赋权理论驱动的WHC艾滋病毒预防工作；它们共同可以有效地解决甲基苯丙胺的使用问题。项目目标：开发和初步评估一种有效的、全面的、对文化敏感的、以妇女为中心的南非有色人种怀孕妇女护理模式，方法是调整和完善RBT，同时将WHC艾滋病毒预防部分纳入其中，产生一种综合治疗和预防模式，即RBT+WHC。有两个连续的目标：目标1.调整和预测一个全面的药物滥用治疗模式--RBT，其中将整合基于证据的WHC艾滋病毒预防模式，产生RBT+WHC。目的2.对40名有色人种孕妇(N=40)进行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对产妇结局的可接受性、可行性和初步效果，包括(A)甲基苯丙胺的使用，(B)无保护性行为的频率，(C)产前护理就诊次数；以及新生儿结局，包括(D)住院时间，(E)出生体重，(F)分娩时的胎龄。公共健康影响：RBT+WHC模式将为填补妇女在物质使用治疗研究方面的空白奠定基础，在该地区，妇女特别被剥夺获得医疗保健的权利。这项拟议的研究还有望帮助改善两代南非人、有色人种妇女及其子女的健康。 公共卫生相关性：在南非妇女中，怀孕的有色人种妇女(混血血统的文化群体)最需要综合治疗，以减少甲基苯丙胺的使用和艾滋病毒的性和毒品危险行为，并改善产妇和新生儿的结局。这项研究的重点是适应和测试以妇女为中心的艾滋病毒预防和针对妊娠的药物滥用治疗的组合。这一创新的治疗模式将填补物质使用治疗研究的重要空白，并将有助于改善两代南非人的健康和福祉。

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. PUBLIC HEALTH RELEVANCE: Among South African women, pregnant Coloured women (a cultural grouping of mixed-race ancestry) are most in need of comprehensive treatment to reduce methamphetamine use and HIV sex- and drug-risk behaviors and to improve maternal and neonatal outcomes. This study focuses on adapting and testing the combination of women-centered HIV prevention and pregnancy-specific drug abuse treatment. This innovative treatment model will fill an important gap in substance use treatment research and will help to improve the health and well-being of two generations of South Africans.