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. 2022 Jan 31;7(2):21.
doi: 10.3390/tropicalmed7020021.

Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa

Anja Reuter  1 , Buci Beko  1 , Boniwe Memani  1 , Jennifer Furin  2 , Johnny Daniels  1 , Erickmar Rodriguez  1 , Hermann Reuter  3 , Lize Weich  4 , Petros Isaakidis  5 , Erin von der Heyden  6 , Yulene Kock  7 , Erika Mohr-Holland  1   5
Affiliations

Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa

Anja Reuter et al. Trop Med Infect Dis. .

Abstract

Substance use (SU) is associated with poor rifampicin-resistant tuberculosis (RR-TB) treatment outcomes. In 2017, a SBIRT (SU screening-brief intervention-referral to treatment) was integrated into routine RR-TB care in Khayelitsha, South Africa. This was a retrospective study of persons with RR-TB who were screened for SU between 1 July 2018 and 30 September 2020 using the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Here we describe outcomes from this program. Persons scoring moderate/high risk received a brief intervention and referral to treatment. Overall, 333 persons were initiated on RR-TB treatment; 38% (n = 128) were screened for SU. Of those, 88% (n = 113/128) reported SU; 65% (n = 83/128) had moderate/high risk SU. Eighty percent (n = 103/128) reported alcohol use, of whom 52% (n = 54/103) reported moderate/high risk alcohol use. Seventy-seven persons were screened for SU within ≤2 months of RR-TB treatment initiation, of whom 69%, 12%, and 12% had outcomes of treatment success, loss to follow-up and death, respectively. Outcomes did not differ between persons with no/low risk and moderate/high risk SU or based on the receipt of naltrexone (p > 0.05). SU was common among persons with RR-TB; there is a need for interventions to address this co-morbidity as part of "person-centered care". Integrated, holistic care is needed at the community level to address unique challenges of persons with RR-TB and SU.

Keywords: ASSIST; RR-TB; SBIRT; brief intervention; integrated care; loss-to-follow-up; person-centered care; substance use.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Rifampicin-resistant tuberculosis substance-use intervention flow diagram (Screening, Brief Intervention and Referral to Treatment Model). This intervention could be implemented by doctors, nurses, or trainer lay counselors at primary health care facility.
Figure 2
Figure 2
Substance-use screening outcomes among persons initiated on RR-TB treatment from July 2018-September 2020. * TIK= crystal methamphetamines.
See this image and copyright information in PMC

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