Adapting a substance use screening and brief intervention for peer-delivery and for youth in Kenya.

Background: Substance use is a major problem among youth in sub-Saharan Africa, yet interventions that address this problem are scarce within the region. Screening and brief intervention is a cost-effective, efficacious, and easy to scale public health approach to addressing substance use problems. We conducted a pilot study to evaluate the feasibility of implementing a peer delivered screening and brief intervention program for youth in Kenya. The goal of this paper is to report on the process of adapting the Alcohol Smoking and Substance Involvement Screening Test for Youth- linked Brief Intervention (ASSIST-Y-linked BI) program for peer delivery and for the Kenyan context prior to the pilot. Methods: The adaptation process was led by a multi-disciplinary team comprised of psychiatrists, pediatricians, and psychologists. We utilized the ADAPT-ITT framework to adapt the ASSIST-Y-linked BI. The ADAPT-ITT framework consists of 8 phases including Assessment, Decision making, Adaptation, Production, Topical Experts, Integration, Training, and Testing the evidence-based intervention. Here, we report on phases 1-7 of the framework. The results of the pilot testing have been published elsewhere. Results: Overall, we made surface level adaptations to the ASSIST-Y-linked BI program such as simplifying the language to enhance understandability. We maintained the core components of the program i.e., Feedback, Responsibility, Advice, Menu of Options, Empathy, Self-efficacy (FRAMES). Conclusions: Our paper provides information which other stakeholders planning to implement the ASSIST-Y-linked BI for youth in sub-Saharan Africa, could use to adapt the intervention.

Feasibility and acceptability of a peer provider delivered substance use screening and brief intervention program for youth in Kenya.

BACKGROUND: Youth in sub-Saharan Africa are at high risk of substance use yet lack access to substance use interventions. The goal of this project was to evaluate the feasibility and acceptability of a peer-delivered, single-session substance use screening and brief intervention program for youth in Kenya. METHODS: This was a convergent parallel mixed methods study utilizing both quantitative and qualitative approaches. Two trained peer providers administered the screening and brief intervention program to 100 youth aged 15-24 years. To evaluate the implementation of the intervention, we collected quantitative and qualitative data. Feasibility and acceptability were quantitatively assessed using the Dissemination and Implementation Measures. Fidelity was assessed by rating all 100 audio-recorded sessions using a checklist. To obtain qualitative feedback on the intervention, we conducted five focus group discussions with 25 youths and six semi-structured interviews with two peer providers and four clinic leaders. The semi-structured interviews were guided by the Consolidated Framework for Implementation Research. Quantitative data was analyzed via descriptive statistics using STATA. Qualitative data was analyzed using thematic analysis with NVIVO. RESULTS: The lifetime prevalence of any substance use was 50%. The mean level of acceptability of the intervention from the perspective of the youth was 3.53 (SD 0.15), meaning that the youth found the intervention to be acceptable "a lot" of the time. Mean levels of implementation outcomes (acceptability, adoption, Acceptability, Appropriateness, Feasibility, Reach/access, Organizational climate, General leadership skills, and Sustainability) as rated by peer providers and clinic staff ranged between 2.61 ("a moderate amount") and 4.0 ("a lot"). In qualitative data, youth reported that the intervention was helpful and useful in enabling them to stop or reduce substance use. The peer providers felt that the intervention was easy to implement, while the clinic leaders felt that available resources were adequate, and that the intervention aligned well with the goals of the clinic. CONCLUSION: Our findings suggest that the peer-delivered screening and brief intervention program was perceived as acceptable to the youth and feasible to implement. TRIAL REGISTRATION: NCT04998045 Registration date: 10/08/2021.

Early Growth Performance of In Vitro Raised Melia volkensii Gürke Plantlets in Response to Beneficial Microorganisms under Semi-Arid Conditions.

Before in vitro propagated Melia volkensii plants can be used for mass planting, the transition phase to in vivo conditions needs to be better controlled because too many plants are lost during acclimatization and in the field. Two experiments were set up to evaluate the effects of biological agents on the establishment of M. volkensii in vitro plantlets. The biological agents consisted of Trichotech®, Bio-cure B®, Rhizatech®, Bacillus subtilis, a Trichoderma isolate and self-isolated native arbuscular mycorrhizal fungi (AMF). Regarding the latter, in soil from the nursery, the number of AMF spores increased from six spores to 400 per 100 g of soil using a trap culture, in which thirteen AMF morphotypes were identified and root colonization assessed through observation of hyphae, vesicles, coils and appressoria. The first experiment was set up in the greenhouse to investigate the efficacy of the biological agents on the hardening off. In the second, a field experiment was set up to study their effect on the early establishment of the plantlets in the field compared to seedlings. All biological agents significantly (p ≤ 0.05) improved in vitro plant survival and growth compared to the control. The highest plant height and number of leaves per plant were recorded in plants treated with Rhizatech®, Native AMF, Bio-cure B® and Trichoderma isolate. The treatments with Rhizatech®, Bio-cure B® and native mycorrhiza recorded a significantly wider stem. The root diameter of the plants treated with Rhizatech® and Bio-cure B® was the largest, but the plants inoculated with the native AMF had the longest roots. Moreover, the inoculated plants generally developed multiple secondary roots. After two months, AMF had clearly colonized the acclimatized plantlets. In the field experiment, the biologicals made no difference in survival rate but did produce a significantly larger leaf area after two months, with the largest leaves recorded with Rhizatech®, native AMF and Trichotech®. They also increased the quality index of the plants from 0.21 to 0.52. The performance of in vitro grown M. volkensii plants six months after planting in semi-arid conditions in Kiambere was better than that of seedlings. Inoculation of plants increased plant height and diameter. Thus, inoculation of biological agents is an efficient approach for improving the early growth of in vitro propagated M. volkensii plants.

"When my children see their father is sober, they are happy": A qualitative exploration of family system impacts following men's engagement in an alcohol misuse intervention in peri-urban Kenya.

Background: Men's alcohol misuse does not occur in a vacuum but has a cascade of consequences for families and children, with ties to violence, poor parenting, and poor partner and child mental health. Despite the intersection of individual and interpersonal problems associated with men's alcohol use, studies exploring the impact of men's completion of alcohol misuse treatment on family and family member outcomes are scarce. Here we begin to explore this question. Methods: We conducted qualitative interviews (N = 13) with female partners and children (8-17 years) of men with problem drinking who completed individual treatment targeting alcohol misuse, depressed mood, and family-focused efforts in Eldoret, Kenya. Interviews and thematic content analysis were guided by ecological-transactional systems theory. Results: Findings highlighted positive perceived changes for men, families, women and children that interacted together in a bi-directional pathway. Partners and children described men's reduced drinking, reduced spending, increased family-focused effort (e.g., coming home early), as well as increased emotion regulation, and openness to and communication with family. These changes were tied to perceived improvements in the couple and father-child relationship, including improved trust and time together, which were tied to improvements in women and children's emotional well-being (e.g., hope). Concurrently, reports noted men's increased effort to share money earned with the family which alleviated financial stress and helped ensure basic needs were met. Results aligned with the ecological transactional systems frame, with individuals in the family, family relationships, and economic climate each dynamically shaping each other. Conclusions: Although larger studies are needed, results provide promising signals regarding the potential downstream effects of individual treatment on family systems and members, which may in turn help maintain men's changes in drinking.