Abstract #156  -  The Western Cape Womens Health CoOp Study: Formative Research to Randomized Controlled Trial
Authors:   Presenting Author:   Ms. Felicia Browne - RTI International
Additional Authors:  Dr.  Wendee Wechsberg, Dr.  Bronwyn Myers, Ms.  Rachel Middlesteadt Ellerson, Ms. Tara Carney, Mr.  Nat Rodman,
Aim: The Western Cape Womens Health CoOp Study (WC-WHC) is an ongoing randomized controlled trial (RCT) reaching substance-using Black and Coloured women from township communities in Cape Town, South Africa. This NICHD-funded study tests the effectiveness of combining voluntary counseling and testing (VCT) with a woman-focused intervention (Women�s CoOp) to help women reduce their substance abuse, sexual risk, and victimization as compared with an equal-attention (nutrition) group at multiple follow-ups over a year. The intervention is built from an initial Womens CoOp study started in the United States which was found to be a best-evidence intervention by the Centers for Disease Control and Prevention and translated and adapted to African women in Gauteng, South Africa. The Womens CoOp was recently listed as a best practice study by the Womens and Gender HIV Compendium.
Method / Issue: The adaptation of the Womens CoOp intervention for WC-WHC involved extensive formative research, including focus group discussions, expert panel meetings, pretesting of the intervention and instrumentation, and a small NIDA-funded pilot study that demonstrated efficacy of the Womens CoOp intervention prior to the RCT. Women who enroll into the RCT are administered a questionnaire about demographics, alcohol and other drug use, sexual risk behaviors, and violence at baseline, 3-, 6-, 9-, and 12-month follow-ups. Biological testing for pregnancy, HIV, and alcohol and other drugs�methamphetamine, marijuana, cocaine, opiates, and Mandrax (methaqualone)is conducted at baseline, 6- and 12-month follow-ups. Women randomized to the woman-focused intervention participate in two sessions aimed at increasing knowledge and skills about substance abuse, HIV and other STIs, condoms, relationships and power, and communication.
Results / Comments: The findings from the formative and Phase I study provided valuable data regarding HIV risk behaviors specific to substance-using women in Cape Town. Differences were found between Black and Coloured women with regard to patterns of drug use and sexual risk. Similar positive outcomes were found when the intervention was administered in either individual or group formats. Additional study activities demonstrated: the importance of having trained data collectors administer the questionnaires as opposed to Audio Computer-Assisted Self-Interviewing (ACASI) to ensure cognitive understanding and data quality; the need to conduct HIV testing at the study site to limit breaches of confidentiality; and the importance of regular quality assurance review to avoid methodology drift. To date, 242 women have been screened and 167 women have been randomized into the Phase III study. Preliminary baseline findings indicate a high prevalence of recent use of methamphetamine (74%) and marijuana (59%), in addition to sexual risk behaviors. Additional baseline, 3-month and 6-month outcomes will be presented.
Discussion: More people live with HIV in South Africa than anywhere else in the world, and HIV/AIDS continues to disproportionately affect South African women. The intersection of alcohol and other drug use with sexual risk in this region has made these women particularly vulnerable to violence and HIV risk. Adapting and refining a gender-focused, best-evidence intervention that is intertwined with these risks is essential to reduce the burden of HIV/AIDS and victimization among childbearing women.
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