Young South African Women on Antiretroviral Therapy Perceptions of a Psychological Counselling Program to Reduce Heavy Drinking and Depression

Abstract

Young women in South Africa remain most at risk for HIV infection. Several factors contribute to the high incidence rate in this population, including hazardous drinking and depression. Addressing common mental disorders (CMDs) such as depression and alcohol use disorders is key to effective HIV treatment. We explored the experiences and perceptions of young South African women on antiretroviral therapy (ART) of a lay health worker (LHW)-delivered psychosocial intervention based on motivational interviewing (MI) and problem-solving therapy (PST) to reduce heavy drinking and depression. We conducted 27 in-depth interviews with young women (aged 18–35) recruited from 16 primary care clinics in the Western Cape province of South Africa. Discussion topics included young women’s life experiences leading to their enrollment in the program, their perceptions of the counselling sessions and the quality of their interaction with the counsellor. Qualitative data were analyzed using a framework approach. The findings highlighted the impact adverse life experiences and stressful life circumstances have on young women’s use of alcohol and symptoms of depression and the effect this has on ART adherence. The findings suggest that women found the intervention components that helped them develop strategies for coping with their past experiences, managing current life stressors, and regulating negative thoughts and emotions most beneficial. Taken together, these findings confirm the acceptability of LHW-delivered MI-PST counselling for this population, but suggest that the relevance of the MI-PST intervention for this highly vulnerable population could be further enhanced by including a focus on psychological trauma.

Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study

“…In this study the caring, supportive style of the counsellors was central to patients’ positive perception of the SBIRT service. While few other studies have included SBIRT recipients in evaluation research and interrogated the style of the counsellor, some studies report SBIRT recipients appreciating being able to speak with a non-judgemental SBIRT provider [ 25 , 39 ]. Although we didn’t examine the association between recipients’ perception of the counselling relationship and outcome, there is evidence from other studies that counsellor empathy and collaboration is associated with better client outcomes [ 48 , 49 ].…”

“…This cost-saving approach is particularly attractive in LMIC settings, such as South Africa, for tackling widespread public health issues [ 21 ]. While SBIRT programmes using a task-sharing approach employing nurses or social workers have been found to be effective and acceptable to patients in healthcare settings, few studies have explored patient experiences and the acceptability of community health worker or facility-based counsellor-delivered SBIRT [ 22 – 25 ]. Although patient involvement is increasingly recognised as an important, effective strategy in improving the quality of healthcare services [ 26 ], SBIRT implementation studies have focused mainly on uptake amongst healthcare providers and managers, with patient outcome data often limited to substance use screening tool scores [ 27 , 28 ].…”

“Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

“…Implementing screening and brief alcohol reduction interventions on scale, therefore, will require alternative delivery agents. Although not examined here, other South African studies have demonstrated the feasibility, acceptability, and effectiveness of using community health workers to conduct screening and brief alcohol reduction interventions [27][28][29]-provided these non-professional providers have adequate training and support.…”

“…Participants who reported alcohol cessation as their behavioral change goal reflected that the intervention was helpful for alcohol reduction efforts but not sufficient for cessation goals. In previous studies using MI-PST, the counselling sessions were delivered over a four to six-week period and comprised four separate counselling occasions, each spaced at least a week apart (see [25][26][27][28][29]). This gave participants multiple opportunities to put their problem-solving skills into practice and to review these efforts with their counsellor at their next session.…”

“…The intervention included motivational elements to build readiness for alcohol behavior change and PST content to help patients cope with life stressors, deal with negative emotions, and accept problems that cannot be solved without relying on alcohol as an avoidant coping strategy [23,24]. There is evidence that the combination of these two approaches is acceptable and effective for reducing hazardous alcohol use in South African patient populations [25][26][27][28][29].…”