Feasibility and Acceptability of a Substance Use Screening and Brief Intervention for Youth Living With HIV in Kenya
Condition: Substance Use; Substance Use Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Youth living with HIV in Kenya frequently use substances and this negatively affects their
      mental health as well as viral suppression.

      The goal of this study is to evaluate the feasibility and acceptability of a peer-delivered
      substance use screening and brief intervention for these youth.
    

Detailed description: 
      Globally, youth are disproportionately affected by substance use. In sub-Saharan Africa
      (SSA), an estimated 41% of youth have used at least one substance in their lifetime. Youth
      Living with HIV (YLH) have not been spared. In a study conducted in Kenya, 33% and 46% of
      youth attending a HIV clinic reported harmful patterns of alcohol and illicit substance use
      respectively. Substance use among YLH has been associated with negative outcomes including
      antiretroviral therapy (ART) non-adherence, neurocognitive deficits, poor virologic control
      and depression. Unfortunately, YLH in SSA lack access to substance use interventions. A study
      conducted by Parcesepe et al reported that only 37% of HIV adolescent sites in select LMICs
      offered any substance use screening and interventions.

      The World Health Organization (WHO) recommends screening and brief intervention (SBI) in
      primary healthcare for identification and early intervention for substance use. Primary
      healthcare workers in LMICs are however often unable to implement SBI due to heavy workload.
      Peers represent a potential means through which SBI may be delivered in adolescent HIV
      settings and presents a number of advantages. First, peer support systems are well
      established in many adolescent HIV clinics in sub-Saharan Africa. Secondly, by drawing upon
      their shared experiences as youth living with HIV, the peers can provide empathic support to
      the adolescents.

      Few studies have evaluated implementation of peer-delivered SBI for adolescents. Available
      studies have been conducted in high-income countries. To our knowledge, no study has
      evaluated implementation of peer-delivered SBI among YLH. Our project seeks to fill this gap
      by evaluating the feasibility and acceptability of a peer-delivered SBI for YLH in Kenya.
      This project is in line with: (i) Kenyan Ministry of Health guidelines for delivery of
      adolescent and youth friendly services which lists substance use counseling as an essential
      service, and (ii) United Nations Programme on HIV/AIDS (UNAIDS) Fast-track target 95-95-95,
      which requires that by 2030, 95% of people on ART be virally suppressed (12) as well as
      target 3.5 of the Sustainable Development Goals (SDGs) which requires that governments
      strengthen the treatment and prevention of substance abuse. Data from this study will set the
      stage for full-efficacy trials and ultimately to scale-up efforts to other LMICs.
    

Intervention name(s): Screening and brief intervention for substance use
Intervention type(s): Behavioral
Intervention description(s): Screening will be done using the WHO Alcohol Smoking and Substance Involvement Screening Test (ASSIST). The brief intervention will be delivered based on ASSIST risk scores: low risk - verbal positive reinforcement and brief advice on harmful consequences of substance use (ii) moderate risk - brief motivational interviewing (BMI) (iii) high risk - BMI and referral to child psychiatry out-patient clinic. The BMI will be delivered in a single session (approximately 15 minutes) using Feedback Listen Options model (15): (i) providing feedback on screening results (ii) exploring pros and cons of substance use, enquiring about importance of change (iii) exploring options for change.
Intervention model: Single Group Assignment
Intervention model description: All eligible youth will be screened for substance use and assigned to the intervention based on level of substance use risk. Immediately after the intervention they will rate the acceptability of the intervention. After enrollment is over, peers, clinic staff and youth will be asked to give feedback (qualitative and quantitative) on the feasibility and acceptability of the intervention.
Masking: None (Open Label)
Primary purpose: Prevention