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

• Published in: Tropical medicine and infectious disease 2022-01, Vol.7 (2), p.21
• Main Authors: Reuter, Anja, Beko, Buci, Memani, Boniwe, Furin, Jennifer, Daniels, Johnny, Rodriguez, Erickmar, Reuter, Hermann, Weich, Lize, Isaakidis, Petros, von der Heyden, Erin, Kock, Yulene, Mohr-Holland, Erika
• Format: Article
• Language: English
• Subjects: Alcohol use; ASSIST; Clinical outcomes; Clinics; Drug therapy; integrated care; Intervention; loss-to-follow-up; Medical records; Medical referrals; Patients; person-centered care; RR-TB; substance use; Tuberculosis
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed7020021

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% ( = 128) were screened for SU. Of those, 88% ( = 113/128) reported SU; 65% ( = 83/128) had moderate/high risk SU. Eighty percent ( = 103/128) reported alcohol use, of whom 52% ( = 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 ( > 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.