Patient Preference and Adherence (Oct 2018)
Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women
Abstract
Bronwyn Myers,1,2 Tara Carney,1,2 Felicia A Browne,3 Wendee M Wechsberg3–6 1Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, Cape Town, South Africa; 2Division of Addiction Psychiatry, Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; 3Substance Use and Gender Research (SUGAR) Program, RTI International, Research Triangle Park, NC, USA; 4Department of Public Health, Health Policy and Administration, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA; 5Department of Psychology, North Carolina State University, Raleigh, NC, USA; 6Department of Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC, USA Purpose: To develop a trauma-informed substance use and sexual risk reduction intervention for young South African women at risk of HIV.Patients and methods: Guided by the ADAPT-ITT framework for intervention development, we selected four focus groups (n=26) to assess the service needs and preferences of trauma-exposed young women (aged 18–25 years) who use substances. We used findings to develop a needs-based and contextually appropriate intervention. In addition four focus groups (n=30) were selected to explore potential service users’ views of this intervention and recommendations for improving acceptability and appeal. Expert stakeholders were also consulted.Results: Young women described therapeutic, self-care, and social support needs for coping with traumatic experiences and reducing substance- and sexual-related risks for HIV and further trauma. To address these needs, we expanded the Women’s Health Co-Operative (WHC; an evidence-based HIV prevention program) to include trauma-related psychoeducation; cognitive-behavioral strategies for coping with the emotional impact of trauma, stress, and substance use craving; social support strategies; and self-care components to help young women create a life with purpose. This novel and expanded six-session group-based intervention is called the trauma-informed WHC. Focus group participants and expert stakeholders viewed the trauma-informed WHC as highly relevant and acceptable. They provided recommendations for modifications to the intervention structure and reformatting of intervention materials to enhance the intervention’s appeal and the feasibility of reaching and retaining young women in the program.Conclusion: Engaging women as potential service users in the process of developing a trauma-informed substance use and sexual risk reduction intervention helped identify service needs not commonly addressed in trauma-informed substance use interventions but critical for recovery and local relevance. It also enhanced the acceptability and appeal of the intervention. While potentially acceptable, the trauma-informed WHC requires feasibility testing before establishing its efficacy in a larger trial. Keywords: participatory approach, ADAPT-ITT, mental health, substance use, HIV
