Community Oriented Substance Use Programme in the City of Tshwane: A Cross-sectional Survey of Stakeholder Perceptions
Keywords:Harm reduction, drug use, South Africa, stakeholder perceptions, drug use disorder treatment
The City of Tshwane and University of Pretoria’s Community Oriented Substance Use Programme (COSUP) is an applied research intervention to address drug use-related harms in the city by using a harm reduction community-oriented primary care approach. This is a study of stakeholder perceptions of South Africa’s first publicly funded community-based harm reduction programme. In late 2021, purposively sampled respondents were surveyed using a cross-sectional survey. Electronically captured data were collected on respondent demographic characteristics, familiarity with COSUP and perceptions of COSUP’s effect on service users’ well-being, access to drug use services, family relationships, community integration, and on effective approaches to managing drug use. Frequencies and proportions were analysed as a total and by the degree of familiarity with COSUP, using descriptive statistics. Overall, 338 (93.1%) of the 363 stakeholders who consented to participate in the study had some familiarity with COSUP. Socio-demographically, 68.1% were female and over half (52.4%) were aged between 25–39 years. Most (70–80%) thought COSUP improved client well-being, family relationships and community re-integration. Most (80–84%) perceived COSUP to have increased service provider willingness to support people who use drugs, improved stakeholder networking and raised awareness of drug-related services. Most (76%) considered harm reduction to be the best approach to manage harmful drug use in the city. Stakeholders exposed to the work of COSUP perceive the intervention to be beneficial for individuals, families and service-providing organisations. Most favour a harm reduction approach to drug use and believe COSUP should be sustained and expanded.
Community Oriented Substance Use Programme (COSUP). 2020. “Phase 1 Performance and Review Report. 18 May 2016–30 June 2020.” Pretoria: University of Pretoria.
Community Oriented Substance Use Programme (COSUP). 2021. “2020/21 Annual Performance Report. Governance Meeting 23 July 2021.” Pretoria: University of Pretoria.
Dennis, F., T. Rhodes, and M. Harris. 2020. “More-than-Harm Reduction: Engaging with Alternative Ontologies of ‘Movement’ in UK Drug Services.” International Journal of Drug Policy 82: 102771. https://doi.org/10.1016/j.drugpo.2020.102771. DOI: https://doi.org/10.1016/j.drugpo.2020.102771
Department of Basic Education. 2013. “Guide to Drug Testing in South African Schools.” Pretoria. http://www.education.gov.za/Portals/0/Documents/Publications/DrugTestingGuide_FINAL_PRINT.pdf?ver=2014-07-18-150102-000.
Department of Basic Education, UNICEF, and Centre for Justice and Crime Prevention. 2016. “The National School Safety Framework.” Pretoria: South African National Department of Basic Education. https://eur-lex.europa.eu/legal-content/PT/TXT/PDF/?uri=CELEX:32016R0679&from=PT%0Ahttp://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:52012PC0011:pt:NOT.
Department of Social Development. 2013. “National Drug Master Plan 2013–2017.” Pretoria: Department of Social Development.
Department of Social Development. 2019. “National Drug Master Plan 4th Edition 2019–2024.” Cape Town: South African Government. https://www.gov.za/sites/default/files/gcis_document/202006/drug-master-plan.pdf.
Eligh, J. 2020. “A Shallow Flood. The Diffusion of Heroin in Eastern and Southern Africa.” Report. Geneva: Global Initiative Against Transnational Crime. https://globalinitiative.net/analysis/heroin-east-southern-africa/.
Harker, N., W. C. Lucas, R. Laubscher, S. Dada, B. Myers, and C. D. H. Parry. 2020. “Is South Africa Being Spared the Global Opioid Crisis? A Review of Trends in Drug Treatment Demand for Heroin, Nyaope and Codeine-related Medicines in South Africa (2012–2017).” International Journal of Drug Policy 83: 102839. https://doi.org/10.1016/j.drugpo.2020.102839. DOI: https://doi.org/10.1016/j.drugpo.2020.102839
Hawk, M., R. W. S. Coulter, J. E. Egan, S. Fisk, M. R. Friedman, M. Tula, and S. Kinsky. 2017. “Harm Reduction Principles for Healthcare Settings.” Harm Reduction Journal 14 (1): 70. https://doi.org/10.1186/s12954-017-0196-4. DOI: https://doi.org/10.1186/s12954-017-0196-4
Jürgens, R., J. Csete, J. J. Amon, S. Baral, and C. Beyrer. 2010. “People Who Use Drugs, HIV, and Human Rights.” The Lancet 376 (9739): 475–85. https://doi.org/10.1016/S0140-6736(10)60830-6. DOI: https://doi.org/10.1016/S0140-6736(10)60830-6
Keeney, E., and R. Saucier. 2010. “Lowering the Threshold: Models of Accessible Methadone and Buprenorphine Treatment.” New York: Open Society Institute. https://www.opensocietyfoundations.org/publications/lowering-threshold#publications_download.
Marcus, T. S., J. Heese, A. Scheibe, S. Shelly, S. X. Lalla, and J. F. Hugo. 2020. “Harm Reduction in an Emergency Response to Homelessness during South Africa’s Covid-19 Lockdown.” Harm Reduction Journal 17 (1): 60. https://doi.org/10.1186/s12954-020-00404-0. DOI: https://doi.org/10.1186/s12954-020-00404-0
Nutt, D. J., L. A. King, and L. D. Phillips. 2010. “Drug Harms in the UK: A Multicriteria Decision Analysis.” The Lancet 376: 1558–65. https://doi.org/10.1016/S0140-6736(10)61462-6. DOI: https://doi.org/10.1016/S0140-6736(10)61462-6
Paquette, C. E., S. B. Daughters, and K. Witkiewitz. 2022. “Expanding the Continuum of Substance Use Disorder Treatment: Nonabstinence Approaches.” Clinical Psychology Review 91. https://doi.org/10.1016/j.cpr.2021.102110. DOI: https://doi.org/10.1016/j.cpr.2021.102110
Pauly, B. 2008. “Harm Reduction through a Social Justice Lens.” International Journal of Drug Policy 19 (1): 4–10. https://doi.org/10.1016/j.drugpo.2007.11.005. DOI: https://doi.org/10.1016/j.drugpo.2007.11.005
Peltzer, K., and N. Phaswana-Mafuya. 2018. “Drug Use among Youth and Adults in a Population-based Survey in South Africa.” South African Journal of Psychiatry 24 (1): 1–6. https://doi.org/10.4102/sajpsychiatry.v24i0.1139. DOI: https://doi.org/10.4102/sajpsychiatry.v24i0.1139
Scheibe, A., S. Howell, A. Müller, M. Katumba, B. Langen, L. Artz, and M. Marks. 2016. “Finding Solid Ground: Law Enforcement, Key Populations and Their Health and Rights in South Africa.” Journal of the International AIDS Society 19 (4 Suppl 3): 1–6. https://doi.org/10.7448/IAS.19.4.20872. DOI: https://doi.org/10.7448/IAS.19.4.20872
Scheibe, A., S. Shelly, A. Versfeld, S. Howell, and M. Marks. 2017. “Safe Treatment and Treatment of Safety: Call for a Harm-Reduction Approach to Drug-Use Disorders in South Africa.” South African Health Review 20: 197–204.
Scheibe, A., K. Young, L. Moses, R. L. Basson, A. Versfeld, C. W. Spearman, M. W. Sonderup, et al. 2019. “Understanding Hepatitis B, Hepatitis C and HIV among People Who Inject Drugs in South Africa : Findings from a Three-City Cross-Sectional Survey.” Harm Reduction Journal 16 (28): 1–11. DOI: https://doi.org/10.1186/s12954-019-0298-2
Scheibe, A., S. Shelly, J. Hugo, M. Mohale, S. Lalla, W. Renkin, N. Gloeck, et al. 2020a. “Harm Reduction in Practice: The Community Oriented Substance Use Programme in Tshwane.” African Journal of Primary Health Care and Family Medicine 12 (1): 1–6. https://doi.org/10.4102/phcfm.v12i1.2285. DOI: https://doi.org/10.4102/phcfm.v12i1.2285
Scheibe, A., S. Shelly, T. Gerardy, Z. von Homeyer, A. Schneider, K. Padayachee, S. B. Naidoo, et al. 2020b. “Six-month Retention and Changes in Quality of Life and Substance Use from a Low-threshold Methadone Maintenance Therapy Programme in Durban, South Africa.” Addiction Science and Clinical Practice 15 (13): 1–11. https://doi.org/10.1186/s13722-020-00186-7. DOI: https://doi.org/10.1186/s13722-020-00186-7
Scheibe, A., N. Gloeck, E. Madela-Mntla, W. Renkin, S. Shelly, S. X. Lalla, L. Kroukamp, S. de Beer, and J. Hugo. 2021. “Towards Housing First and Harm Reduction: Lessons Learnt from Addressing Opioid Dependence and Homelessness in Tshwane during the Covid-19 Pandemic.” South African Health Review: 17–28. https://www.hst.org.za/publications/South%20African%20Health%20Reviews/Chapter23_SAHR21_04022022_OD.pdf.
Seddon, T. 2020. “Prescribing Heroin: John Marks, the Merseyside Clinics, and Lessons from History.” International Journal of Drug Policy 78 (September 1981): 102730. https://doi.org/10.1016/j.drugpo.2020.102730. DOI: https://doi.org/10.1016/j.drugpo.2020.102730
Shelly, S., I. Broughton, A. Mcbide, Z. van Hofmeyer, N. Medeiros, C. van Staden, and D. Oosthuizen. 2017. “Every Single Person Looks at Us Bad.” Cape Town: South African Network of People Who Use Drugs. http://www.stepupprojectsouthafrica.org/.
South African Government, and South African National AIDS Council. 2017. “Let Our Actions Count. South African National Strategic Plan on HIV, TB and STIs 2017–2022. Summary.” Pretoria: SANAC. https://sanac.org.za/about-sanac/the-national-strategic-plan/.
Statistics South Africa. 2011. City of Tshwane. “Statistics by Place.” Pretoria: Statistics South Africa. Accessed March 15, 2023. https://www.statssa.gov.za/?page_id=1021&id=city-of-tshwane-municipality.
Tlali, M., A. Scheibe, Y. Ruffieux, M. Cornell, A. E. Wettstein, M. Egger, M-A. Davies, G. Maartens, L. F. Johnson, and A. D. Haas. 2022. “Diagnosis and Treatment of Opioid-Related Disorders in a South African Private Sector Medical Insurance Scheme: A Cohort Study.” International Journal of Drug Policy 109 (0): 103853. https://doi.org/10.1016/j.drugpo.2022.103853. DOI: https://doi.org/10.1016/j.drugpo.2022.103853
University of California San Francisco, Anova Health Institute, and National Institute for Communicable Diseases. 2018. “Brief Report of the TipVal Study: An Integrated Bio-Behavioral Surveillance Survey among People Who Inject Drugs.” San Francisco: UCSF.
UNAIDS. 2022. “Key Population Atlas.” Accessed June 6, 2023. https://kpatlas.unaids.org/.
UNODC. 2015. “Afghan Opiate Trafficking through the Southern Route.” Vienna: UNODC. https://www.unodc.org/documents/islamicrepublicofiran/publications/sp1/Afghan_opiate_trafficking_southern_route_2015.pdf.
UNODC. 2022a. Book 2. “World Drug Report.” Vienna: UNODC. https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2022.html.
UNODC. 2022b. Book 3. “World Drug Report.” Vienna: UNODC. https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2022.html.
WHO. 2009. “Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence.” Geneva: WHO.
WHO. 2019. “Opioid Use Disorders.” ICD11. 2019. Accessed May 28, 2023. https://icd.who.int/browse11/l-m/en#/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1120716949.
WHO and UNODC. 2020. “International Standards for the Treatment of Drug Use Disorders.” Vienna and Geneva: UNODC and WHO. https://doi.org/10.18356/0489b59b-en. DOI: https://doi.org/10.18356/0489b59b-en
WHO. 2022. “Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention, Diagnosis, Treatment and Care for Key Populations.” Geneva: WHO. https://www.who.int/publications/i/item/9789240052390.
Zinberg, N. E. 1984. Drug, Set and Setting: The Basis for Controlled Intoxicant Use. New Haven: Yale University Press.
How to Cite