Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study
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Abstract
Background: Only 55% of multidrug-resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular. Objectives: To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. Methods: Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants ( n = 10). Results: Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. Conclusion: In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. Trial registration: South African National Clinical Trials Register ( DOH-27-0315-5007 ) on 01/04/2015 ( http://www.sanctr.gov.za )
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Sample sizes for the quasi-experimental studies ranged from 39 to 973.
“for the quasi experimental studies from 39 [76] to 973 [77];”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [76]
The Results section (‘Patient flow and feasibility’; page unavailable) reports that 39 patients received at least one counselling session, supporting the figure cited for this study. It also says 40 patients were recruited, so 39 is the number treated, not the recruited sample size. The figure 973 is attached to a different citation and is not attributed to this paper. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn adult patients with multi-drug resistant TB in South Africa, depressive symptomatology improved, with the median (IQR) CES-D score significantly lower post intervention [23.5 (18-34) vs. 17 (13-22)].
“Depressive symptomatology improved, with the median (IQR) CES-D score significantly lower post intervention [23.5 (18–34) vs. 17 (13–22)].”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [76]
Results > Preliminary effects, Table 2, reports that the median (IQR) CES-D score fell from 23.5 (18–34) at baseline to 17 (13–22) at follow-up among 26 participants who completed the intervention. The cited passages do not report a statistical test establishing that this decrease was significant. The Discussion also cautions that the study had no comparison group and that other factors could explain the improvement. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn adult patients with multi-drug resistant TB in South Africa, there were also significant improvements in nicotine dependence, health status, functional impairment, psychological distress, readiness for change and perceived social support.
“There were also significant improvements in nicotine dependence, health status, functional impairment, psychological distress, readiness for change and perceived social support.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [76]
In adult patients with multi-drug resistant TB in South Africa, the ASSIST score decreased following the intervention (pre-intervention median (IQR) 17.5 (15-24) versus 6 (6-8)).
“The ASSIST score decreased following the intervention (pre-intervention median (IQR) 17.5 (15–24) versus 6 (6–8)).”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [76]
In adult patients with multi-drug resistant TB in South Africa, high levels of motivation for addressing substance use were reported by all patients, and patients reported positive experiences with the program, with consensus that the content, structure, and delivery were acceptable.
“High levels of motivation for addressing substance use were reported by all patients.Patients reported positive experiences with the program.There was consensus that the content, structure, and delivery of the program were acceptable.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [76]
Of the studies in which the duration of each session was provided, the amount of time spent across all sessions ranged from 15 minutes to 4 hours.
“Of the studies in which the duration of each session was provided, the amount of time spent across all sessions ranged from 15 minutes ([96] to 4 hours ([76] (Table 2).”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [76]
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Self-citation
- Authors
- Calligaro, G. L., de Wit, Z., Cirota, J., Orrell, C., Myers, B., Decker, S., Stein, D. J., Sorsdahl, K., & Dawson, R.
- Affiliations
- University of Cape Town (ZA)
- Institute of Infectious Disease and Molecular Medicine (ZA)
- South African Medical Research Council (ZA)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Dawson, Rodney
- ORCID
- Venue
- Pilot and Feasibility Studies
- Published
- 2021-01-19
- Volume
- 7
- Issue
- 1
- Pages
- 28-28
- ISSN
- 2055-5784 (ISSN-L)
- PMC
- PMC7814702
- OpenAlex
- W3115732575
- Cited by
- 15
- References
- 45
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 1 · 2022: 5 · 2021: 1
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Pilot and Feasibility Studies (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eSpace (Curtin University) (submittedVersion, cc-by)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Funders
- National Institute on Drug Abuse
- AIDS Clinical Trials Group
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Keywords
- multidrug-resistant tuberculosis, risky substance use, motivational interviewing, relapse prevention, brief psychotherapy, non-specialist health workers, counselors, medication adherence, depressive symptoms, psychological distress, functional disability, feasibility, acceptability, hospital discharge
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