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.
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.