Browsing by Author "Morojele, Neo K"

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    The association betweeen psychopathology and substance use in young people
    (2011) Saban, Amina; Flisher, Alan J; London, Leslie; Morojele, Neo K
    The co-occurrence of problematic substance use and non-substance use psychopathology is very common in psychiatry, and is generally referred to as comorbidity. The phenomenon has been the subject of debate and widespread research, yet remains poorly understood. The thesis aimed to examine the association between psychopathology and substance use in young people in South African settings, to determine the nature and prevalence of comorbidity, and to identify sociodemographic factors that might influence the associations, as well as the influence of comorbidity on substance use treatment outcomes.
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    Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol
    (2014-09-12) Parry, Charles D; Morojele, Neo K; Myers, Bronwyn J; Kekwaletswe, Connie T; Manda, Samuel O; Sorsdahl, Katherine; Ramjee, Gita; Hahn, Judith A; Rehm, Jürgen; Shuper, Paul A
    Abstract Background Little research has examined whether alcohol reduction interventions improve antiretroviral therapy (ART) adherence and HIV treatment outcomes. This study assesses the efficacy of an intervention for reducing alcohol use among HIV patients on ART who are hazardous/harmful drinkers. Specific aims include adapting a blended Motivational Interviewing (MI) and Problem Solving Therapy (PST) intervention for use with HIV patients; evaluating the efficacy of the intervention for reducing alcohol consumption; and assessing counsellors’ and participants’ perceptions of the intervention. Methods/Design A randomised controlled trial will evaluate the intervention among ART patients in public hospital-based HIV clinics in Tshwane, South Africa. We will recruit patients who are HIV-positive, on ART for at least 3 months, and classified as harmful/hazardous drinkers using the AUDIT-3. Eligible patients will be randomly assigned to one of three conditions. Patients in the experimental group will receive the MI-PST intervention to reduce harmful/hazardous alcohol use. Patients in the equal-attention wellness intervention group will receive an intervention focused on addressing health risk behaviours. Patients in the control condition will receive treatment as usual. Participants will complete an interviewer-administered questionnaire at baseline and 3, 6 and 12 months post-randomisation to assess alcohol consumption, ART adherence, physical and mental health. We will also collect biological specimens to test for recent alcohol consumption, CD4 counts and HIV RNA viral loads. The primary outcome will be reduction in the volume of alcohol consumed. Secondary outcomes include reduction in harmful/hazardous use of alcohol, reduction in biological markers of drinking, increase in adherence rates, reductions in viral loads, and increases in CD4 T-cell counts. A process evaluation will ascertain counsellors’ and participants’ perceptions of the acceptability and effectiveness of the interventions. Discussion We have obtained ethical approval and approval from the study sites and regional and provincial health departments. The study has implications for clinicians, researchers and policy makers as it will provide efficacy data on how to reduce harmful/hazardous alcohol consumption among HIV patients and will shed light on whether reducing alcohol consumption impacts on HIV treatment adherence and other outcomes. Trial registration Pan African Clinical Trials Register Number: PACTR201405000815100 .
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    Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study
    (BioMed Central, 2018-12-05) Trangenstein, Pamela J; Morojele, Neo K; Lombard, Carl; Jernigan, David H; Parry, Charles D H
    Abstract Background There is limited information about the potential individual-level and contextual drivers of heavy drinking in South Africa. This study aimed to identify risk factors for heavy drinking in Tshwane, South Africa. Methods A household survey using a multi-stage stratified cluster random sampling design. Complete consumption and income data were available on 713 adults. Heavy drinking was defined as consuming ≥120 ml (96 g) of absolute alcohol (AA) for men and ≥ 90 ml (72 g) AA for women at any location at least monthly. Results 53% of the sample were heavy drinkers. Bivariate analyses revealed that heavy drinking differed by marital status, primary drinking location, and container size. Using simple logistic regression, only cider consumption was found to lower the odds of heavy drinking. Persons who primarily drank in someone else’s home, nightclubs, and sports clubs had increased odds of heavy drinking. Using multiple logistic regression and adjusting for marital status and primary container size, single persons were found to have substantially higher odds of heavy drinking. Persons who drank their primary beverage from above average-sized containers at their primary location had 7.9 times the odds of heavy drinking as compared to persons who drank from average-sized containers. Some significant associations between heavy drinking and age, race, and income were found for certain beverages. Conclusion Rates of heavy drinking were higher than expected giving impetus to various alcohol policy reforms under consideration in South Africa. Better labeling of the alcohol content of different containers is needed together with limiting production, marketing and serving of alcohol in large containers.
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    Psychosocial factors associated with early booking and frequency of antenatal care (ANC) visits in a rural and urban setting in south Africa
    (2014) Muhwava, Lorrein Shamiso; London, Leslie; Morojele, Neo K
    Late antenatal care (ANC) booking remains the trend in most countries in sub- Saharan Africa despite the known benefits of early booking. Infrequent, poor and no antenatal care are among the most frequent patient-related avoidable factors and missed opportunities identified for many cases of maternal death in South Africa. Whilst most country guidelines recommend that a woman initiates antenatal care (ANC) within the first 16 weeks of pregnancy and the Basic Antenatal Care (BANC) approach recommends at least 4 visits during pregnancy, this has not translated into practice amongst women in South Africa. Disparities in timing of initiation of antenatal care and frequency of attendance exist between countries and between rural and urban settings within a country. Previous studies have identified demographic factors, physical access to health facilities, parity, lack of health education, relationships with health care providers and misconceptions of antenatal care (ANC) as factors influencing timing of ANC booking. Psychosocial factors have been found to also play an important role in timing and frequency of attendance to antenatal care. Strong social capital and social support were identified as protective factors against late ANC initiation and inadequate attendance whilst substance use, experiencing negative feelings about the pregnancy, misconceptions about antenatal care, poor mental health were mostly associated with poor ANC attendance. In the literature, partner characteristics and cultural and religious beliefs were associated with both early and late ANC initiation depending on the specific factors investigated. Research on the associations between psychosocial factors and antenatal care attendance is currently quite limited and fairly new and in addition, some psychosocial factors may not be associated with timing of initiation but may have an effect on the frequency of attendance of follow-up visits. The aim of the study was to examine the association between psychosocial factors and ANC booking to determine whether psychosocial factors (particularly substance use, feelings about pregnancy, social capital, social support, cultural beliefs, mental health perceptions, self-esteem and partner characteristics) were associated with not only timing of initiation of antenatal care but also frequency of attendance of antenatal care visits during a previous pregnancy among women in an urban and rural location in South Africa.
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    Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study
    (2019-12-16) Egbe, Catherine O; Londani, Mukhethwa; Parry, Charles D H; Myers, Bronwyn; Shuper, Paul A; Nkosi, Sebenzile; Morojele, Neo K
    Abstract Background People living with HIV (PLWH) who drink alcohol and use tobacco are particularly vulnerable to tobacco-induced diseases due to an already compromised immune system. This study investigated the prevalence and factors associated with tobacco use (cigarette and snuff) among PLWH who drink heavily. Methods Participants (n = 623) on antiretroviral therapy for HIV who reported heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C were recruited from six hospitals in Gauteng Province, South Africa. The Fagerström test was used to assess nicotine dependence. Chi Square tests and modified Poisson regression analyses were conducted to identify factors associated with tobacco use. Results Almost half of the participants reported ever smoking (44.0%; CI: 40.1–47.9) and about a quarter reported ever using snuff (25.5%; CI: 22.2–29.1). Current smokers and current snuff users comprised 27.3% (CI: 23.9–30.9) and 19.1% (CI: 16.2–22.3) of all participants respectively. Among current smokers, 37.9% (CI: 30.8–45.3) were moderately/highly dependent on nicotine. Current ‘any tobacco product users’ (ATPU: use cigarettes or snuff) were 45.4% (CI: 41.5–49.3) while 1.0% (CI: 0.4–2.0) currently used cigarettes and snuff. Adjusted regression analyses showed that, compared to males, females were less at risk of being: ever smokers (Relative Risk Ratio [RRR] = 0.33; CI: 0.27–0.41), current smokers (RRR = 0.18; CI: 0.12–0.25), and ATPU (RRR = 0.75; CI: 0.63–0.89) but were more at risk of ever snuff use (RRR = 5.23; CI: 3.31–8.25), or current snuff use (RRR = 26.19; CI: 8.32–82.40) than males. Ever snuff users (RRR = 1.32; CI: 1.03–1.70), current snuff users (RRR = 1.40; CI: 1.03–1.89) and ATPU (RRR = 1.27; CI: 1.07–1.51) were more at risk of reporting significant depressive symptoms. We found no significant associations between smoking status and years on ART and viral load. Conclusion There is a high prevalence of cigarette and snuff use among PLWH who drink heavily. Tobacco use cessation interventions tailored specifically for this population and according to their tobacco product of choice are urgently needed given their vulnerability to ill-health.