title: Implementation of Cognitive-Behavioral Substance Abuse Treatment in Sub-Saharan Africa: Treatment Engagement and Abstinence at Treatment Exit.
abstract: OBJECTIVE
  This study documented the treatment cascade for engagement in care and abstinence at treatment exit as well as examined correlates of these outcomes for the first certified Matrix Model® substance abuse treatment site in Sub-Saharan Africa.
  
  
  METHODS
  This retrospective chart review conducted at a resource-limited community clinic in Cape Town, South Africa, assessed treatment readiness and substance use severity at treatment entry as correlates of the number of sessions attended and biologically confirmed abstinence at treatment exit among 986 clients who initiated treatment from 2009-2014. Sociodemographic and clinical correlates of treatment outcomes were examined using logistic regression, modeling treatment completion and abstinence at treatment exit separately.
  
  
  RESULTS
  Of the 2,233 clients who completed screening, approximately 44% (n = 986) initiated treatment. Among those who initiated treatment, 45% completed at least four group sessions, 30% completed early recovery skills training (i.e., at least eight group sessions), and 13% completed the full 16-week program. Approximately half (54%) of clients who provided a urine sample had negative urine toxicology results for any substance at treatment exit. Higher motivation at treatment entry was independently associated with greater odds of treatment completion and negative urine toxicology results at treatment exit.
  
  
  CONCLUSIONS
  Findings provide initial support for the successful implementation the Matrix Model in a resource-limited setting. Motivational enhancement interventions could support treatment initiation, promote sustained engagement in treatment, and achieve better treatment outcomes.
authors.affiliation: Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Cape Town, South Africa.
authors.forename: Hetta
authors.initials: H
authors.lastname: Gouse
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America.|Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jessica F
authors.initials: JF
authors.lastname: Magidson
authors.affiliation: City of Cape Town Health. Substance Abuse, Cape Town, South Africa.
authors.forename: Warren
authors.initials: W
authors.lastname: Burnhams
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America.
authors.forename: Jocelyn E
authors.initials: JE
authors.lastname: Remmert
authors.affiliation: South African Medical Research Council, Alcohol Tobacco and Other Drug Research Unit, Cape Town, South Africa.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Myers
authors.affiliation: Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Cape Town, South Africa.
authors.forename: John A
authors.initials: JA
authors.lastname: Joska
authors.affiliation: School of Nursing, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy* / Q000652:urine; D016896:Treatment Outcome; D055815:Young Adult
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