Research Triangle Institute (RTI International)
Dr. Hendree Jones, UNC Horizons, Obstetrics and Gynecology
Project Run Dates
4/1/2013 to 6/30/2013
Background: Since 2001, the Women’s Health Co-Op (WHC) has successfully adapted an evidence-based intervention to reduce sexual- and drug-risk behaviors in drug-using South African women. However, Cape Town, South Africa, has experienced a rapid rise in methamphetamine use, and findings from our ongoing study indicates that the WHC has had limited success in lessening its use among women. Alarmingly, among WHC participants, a greater proportion of pregnant than non-pregnant women reported using methamphetamine (95.5% v. 68.8%; p=.008). Among these pregnant women, 100% of the Coloured (mixed racial heritage) v. 66% of the Black pregnant women participants reported methamphetamine use. These findings are underscored by a lack of a focused and intensive treatment for methamphetamine-using pregnant women who live in impoverished townships. Thus, pregnant Coloured women are most in need of substance abuse treatment – and the target of the proposed study. Therefore, this proposal responds to PA-09-021 International Research Collaboration on Drug Abuse and Addiction Research (R21) by focusing on developing treatment options for methamphetamine abuse among pregnant women. The PI has developed an efficacious, operant conditioning/social-learning-theory-driven, comprehensive drug treatment model, Reinforcement-based Treatment (RBT). This RBT model has improved maternal and neonatal outcomes of impoverished African American stimulant-using pregnant women in the US. 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: 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, 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. Next, conduct a small-scale RCT with pregnant Coloured women (N=40) to determine the acceptability, feasibility, and initial efficacy of our 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 sexual 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: RBT+WHC 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 health care.