A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: A randomised trial of the Women’s Health CoOp
Wechsberg, W., Jewkes, R., Novak, S., Kline, T., Myers, B., Browne, F. A., ... Parry, C. (2013). A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: A randomised trial of the Women’s Health CoOp. BMJ Open, 3, e002622. DOI: 10.1136/bmjopen-2013-002622
Objective To assess the impact of the Women's Health CoOp (WHC) on drug abstinence among vulnerable women having HIV counselling and testing (HCT).
Design Randomised trial conducted with multiple follow-ups.
Setting 15 communities in Cape Town, South Africa.
Participants 720 drug-using women aged 18–33, randomised to an intervention (360) or one of two control arms (181 and 179) with 91.9% retained at follow-up.
Interventions The WHC brief peer-facilitated intervention consisted of four modules (two sessions), 2?h addressing knowledge and skills to reduce drug use, sex risk and violence; and included role-playing and rehearsal, an equal attention nutrition intervention, and an HCT-only control.
Primary outcome measures Biologically confirmed drug abstinence measured at 12-month follow-up, sober at last sex act, condom use with main and casual sex partners, and intimate partner violence.
Results At the 12-month endpoint, 26.9% (n=83/309) of the women in the WHC arm were abstinent from drugs, compared with 16.9% (n=27/160) in the Nutrition arm and 20% (n=31/155) in the HCT-only control arm. In the random effects model, this translated to an effect size on the log odds scale with an OR of 1.54 (95% CI 1.07 to 2.22) comparing the WHC arm with the combined control arms. Other 12-month comparison measures between arms were non-significant for sex risk and victimisation outcomes. At 6-month follow-up, women in the WHC arm (65.9%, 197/299) were more likely to be sober at the last sex act (OR1.32 (95% CI 1.02 to 1.84)) than women in the Nutrition arm (54.3%, n=82/152).
Conclusions This is the first trial among drug-using women in South Africa showing that a brief intervention added to HCT results in greater abstinence from drug use at 12?months and a larger percentage of sexual activity not under the influence of substances.
Trial registration number NCT00729391 ClinicalTrials.gov