A Case Study of Illicit Substance Use Among Women Participating in an HIV Prevention Study (HPTN 084): Seke South CRS

A woman in smoke

The use of illicit drugs and alcohol use in young adults from our participant recruitment catchment areas has reached alarming levels, as reported by the Zimbabwe Civil Liberties and Drug Network (ZCLDN). It is estimated that 57% of young adults have experimented with or are involved in illicit substance use, and 40% of those seeking mental health services are young adults. This has not spared our study participants, and the major concern is that this affects their participation, especially adherence to using study products as directed. Most young people abusing drugs acquire HIV within the first 12 months of substance use initiation. Young Women and Adolescent Girls (YWAGs) involved in substance use have an increased likelihood of acquiring HIV. According to the ZCLDN, commonly used illicit substances are, marijuana, prescription drugs for mental health, crystal methamphetamine, prescription cough syrup, industrial ethanol, and chemicals from boiled diapers and television tubes.

It is important to understand the cases of substance and alcohol use experienced among research participants to determine the challenges and draft a mitigation plan. The outreach team looked at the triggers and clinical outcomes of illicit substance use among participants in an HPTN 084.  A history of illicit substance or alcohol use was not reported by all participants. The site inquired about substance use among participants by asking them to voluntarily report this behavior, or by clinically observing them. We investigated the types of illicit substances used by participants and assessed how they were affecting participation. Seven cases (out of 160) were recorded and followed-up, where 6 participants aged 21 – 30 self-reported the use of illicit substances or drugs to get high during the study, and 1 presented symptoms consistent with substance abuse but never admitted this use.  The most common illicit substances reported as used by participants were marijuana, crystal methamphetamine (“crystal meth, mutoriro or dombo’’) marijuana, and BronCleer Cough Syrup (“Bronco”).

Cough syrup & a tube used to burn Crystal Meth.
Cough syrup & a tube used to burn Crystal Meth.

Peer pressure, dysfunctional families, physical abuse, and rape were the tiggers for use among the participants, with peer pressure the most common. Participants often missed visits and exhibited the following clinical symptoms: psychosis, aggressive behaviour, wandering, schizophrenia, acute liver disease, swollen limbs, swollen legs, and Grade 3 unintentional weight loss. Medical records for all seven participants indicated mental health issues related to substance use. According to their clinical symptoms, participants were counselled and referred to appropriate service providers for professional help. Our interventions had mixed results: 3 participants received treatment, 1 reported successfully dealing with her issues, 1 refused the referral due to fear of hospitalization, 1 absconded referral, and the seventh participant never admitted substance use.

We continue to follow-up to learn more about the effects of substance use on study metrics, especially adherence and retention, and to support participants for effective protocol implementation.

Lydia Samaneka is the Community Educator & Charles Chasakara is the CTU Community Engagement Coordinator of the University of Zimbabwe Clinical Trials Research Centre (UZ-CTRC)/Seke South CRS in Harare, Zimbabwe.