南非对弱势女性进行药物使用、性行为风险和暴力预防的简短干预：妇女健康合作社的随机试验。

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.

机构信息

Substance Abuse Treatment Evaluations and Intervention Research, RTI International, Durham, North Carolina, USA.

出版信息

BMJ Open. 2013 May 28;3(5):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.

目的

评估妇女健康合作社（WHC）对接受艾滋病毒咨询和检测（HCT）的易感染艾滋病毒的女性戒毒的影响。

设计

多随访的随机试验。

地点

南非开普敦的 15 个社区。

参与者

720 名年龄在 18-33 岁之间的吸毒女性，随机分为干预组（360 人）和两个对照组之一（181 人和 179 人），随访时保留率为 91.9%。

干预措施

WHC 简短的同伴促进干预包括四个模块（两个疗程），2 小时的课程，旨在减少吸毒、性风险和暴力的知识和技能；包括角色扮演和排练、同等关注营养干预以及仅 HCT 对照组。

主要结局指标

12 个月随访时通过生物检测确认的药物戒断，最后一次性行为清醒，与主要和偶然性伴侣使用避孕套，以及亲密伴侣暴力。

结果

在 12 个月的研究终点，WHC 组中有 26.9%（n=83/309）的女性戒毒，而营养组为 16.9%（n=27/160），仅 HCT 对照组为 20%（n=31/155）。在随机效应模型中，这在对数几率标度上的效应大小为 OR 1.54（95% CI 1.07 至 2.22），与联合对照组相比，WHC 组的效果更好。其他 12 个月的手臂比较结果对于性风险和受害结果均无显著性差异。在 6 个月的随访中，WHC 组（65.9%，197/299）的女性在最后一次性行为中清醒的可能性更大（OR1.32（95% CI 1.02 至 1.84））比营养组（54.3%，n=82/152）。

结论

这是南非首次在吸毒女性中进行的试验，表明在 HCT 基础上增加简短干预可使吸毒者在 12 个月时更有可能戒除药物，并且有更大比例的性行为不受物质影响。

试验注册号

NCT00729391 ClinicalTrials.gov。