Treating South African Pregnant Women for Methamphetamine

• Methamphetamine practices [ Time Frame: 3 months after randomization ] [ Designated as safety issue: No ]
  Frequency of methamphetamine use in past 30 days measured by RRBA (WHC Revised Risk Behavior Assessment) and urine test
  
  
• Prenatal care [ Time Frame: At time of delivery ] [ Designated as safety issue: No ]
  Number of prenatal care visits measured by chart review of hospital record
  
  
• Length of hospital stay [ Time Frame: At time of delivery ] [ Designated as safety issue: No ]
  Length of hospital stay measured by chart review of hospital record
  
  

• Drug Use [ Time Frame: 3 months after randomization ] [ Designated as safety issue: No ]
  Frequency of opioid, cocaine, mandrax, marijuana, and self-report nicotine use in past 30 days measured by RRBA (WHC Revised Risk Behavior Assessment) and urine test
  
  
• Drug and alcohol use composite scores [ Time Frame: 3 months after randomization ] [ Designated as safety issue: No ]
  Drug and alcohol composite scores measured by the Addiction Severity Index
  
  
• Alcohol use [ Time Frame: 3 months after randomization ] [ Designated as safety issue: No ]
  Frequency of alcohol use in past 30 days measured by RRBA and breath test
  
  
• Sexual practices [ Time Frame: 3 months after randomization ] [ Designated as safety issue: No ]
  Frequency of unprotected sexual acts at last sexual encounter and in past 30 days measured by RRBA
  
  
• Birthweight [ Time Frame: At time of delivery ] [ Designated as safety issue: No ]
  Birthweight measured by chart review of hospital record
  
  
• Estimated gestational age [ Time Frame: At time of delivery ] [ Designated as safety issue: No ]
  Estimated gestational age measured by chart review of hospital record
  
  

Cape Town is a striking example of the need for women-specific substance abuse treatment, as it is experiencing a devastating level of methamphetamine use (7% of the adult population),especially among women of childbearing age. The use of methamphetamine (hereafter referred to as "meth") is higher in Cape Town than anywhere else in the country. Consequently, there has been a critical need to develop and test a woman-focused intervention that reduces meth use in a highly vulnerable population of South African women.

Since 2001, the Women's Health CoOp (WHC; PI Wechsberg; RO1s DA011609S; AA014488; HD058320) has successfully adapted an evidence-based intervention to reduce sex- and drug-risk behaviors in drug-using South African women. However, with a rapid rise in meth use, the Western Cape is experiencing a new drug epidemic. Ongoing study data (N=631 on 10/18/10; planned N=720) indicates that the WHC has had limited success in reducing the use of this among women. Alarmingly, among WHC participants, a greater proportion of pregnant than nonpregnant women reported using meth (n=24/26=92% v. n=238/356=67%; p=.01). These findings are underscored by a lack of a focused and intensive treatment for meth-using pregnant women who live in impoverished townships. Thus, this project responded to PA-09-021 International Research Collaboration on Drug Abuse and Addiction Research (R21) by developing treatment options for meth use among pregnant women and using the long collaboration between WHC staff and local treatment providers to develop our first project to treat meth use in pregnant women.

The goal of this project is to develop and initially evaluate an efficacious, comprehensive, culturally sensitive, women-centered model of care for pregnant South African women by adapting and refining PI Jones' Reinforcement-Based Treatment (RBT) model, at the same time integrating into it the HIV prevention components of Co-I Wechsberg's Women's Health CoOp (WHC) model, yielding an integrated treatment and prevention model, RBT+WHC.

Thus, the study will proceed by meeting two sequential aims: Aim 1. Adapt and pretest (N=20) a comprehensive drug abuse treatment model, RBT, into which will be integrated the evidence-based WHC HIV prevention model, in order to produce a comprehensive, culturally sensitive, woman-focused intervention for meth-using pregnant Coloured women, RBT+WHC. Aim 2. Conduct a small-scale randomized controlled trial (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 impact on maternal outcomes, including (a) meth 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.

The public health impact of this proposed project is far-reaching. RBT+WHC will fill a critical gap in substance use treatment research in a social structure where women are disproportionately disenfranchised from receiving healthcare compared with men. Furthermore, our initial study will lay the foundation for a full-scale RCT to examine the impact of RBT+WHC on an array of maternal and neonatal outcomes, within the population of pregnant Coloured as well as Black and White South African women. Finally, this study holds the promise of helping to improve the health of two generations of South Africans, meth-using women and their children.