South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

中文翻译：

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“无聊不是一件好事”：在资源有限的南非HIV护理环境中，将行为激活与药物使用相适应。

南非是全球艾滋病毒/艾滋病负担最大的国家。在南非，滥用毒品十分普遍，会干扰HIV治疗的依从性和病毒抑制作用，但在HIV护理中并未得到常规治疗。需要开展更多的研究来调整可扩展的循证疗法，以便将药物用于南非的艾滋病毒治疗。行为激活（BA）最初是作为一种有效的抑郁症治疗方法而开发的，现已在中低收入国家/地区用于治疗抑郁症，并在高收入人群中用于药物滥用。但是，迄今为止，在低收入和中等收入国家中使用BA进行物质使用的研究还很有限。在ADAPT-ITT框架的指导下，本研究试图使BA治疗适应南非艾滋病毒治疗中的物质使用。我们在郊区中的两个诊所中，对中度/重度物质使用和可检测到的病毒载量的患者（n = 19），HIV护理提供者和药物使用治疗师（n = 11）进行了半结构化的个人访谈，涉及不同的角色和学科开普敦地区。我们评估了患者和提供者/治疗师对BA治疗模型的适当性的观点，并寻求有关异烟叶酸翻译的BA治疗成分的反馈。参与者确定了无聊在促进物质使用中的核心作用，并认为BA治疗模型非常合适。参与者将教堂和宗教习俗，体育活动以及院子/家务劳动确定为相关的无毒活动。这些发现将在这种情况下为适应BA治疗的药物使用和HIV药物依从性提供信息。