Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America (SCALA)

Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America

Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America

A quasi-experimental study will compare primary health care-based prevention and management of alcohol use disorder, operationalized by heavy drinking, in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives).

In the intervention municipalities, primary health care providers will receive ongoing training and support in undertaking screening and brief advice for heavy drinking. They will also receive community-based five adoption mechanisms and five support systems.

In the comparator municipalities, the primary health care providers will be given a summary card of screening and brief advice for heavy drinking, with no instruction

In intervention municipalities, primary health care centres and the providers working within them will receive training and a range of community support mechanisms.

The number of AUDIT-C positive patients that received oral advice or referral for advice to another provider in or outside the primary health care centre (PHCC), divided by the total number of adult consultations of the participating providers per provider and per PHCC

The proportion of patients screened will be calculated as the number of completed screens divided by the total number of consultations of all adult patients per participating provider, and averaged per participating PHCC

The proportion of patients advised will be calculated as the number of brief interventions delivered (received oral brief advice, and/or were referred to another provider in or outside the practice), divided by the total number of screen positives per participating provider and averaged per participating PHCC

Inclusion Criteria: Any fully trained medical practitioner, nurse or practice assistant Non-temporary employment contract Working in the selected primary health care centre Involved in medical and/or preventive care Exclusion Criteria: Not a fully trained medical practitioner, nurse or practice assistant Having a temporary employment contract Not working in the selected primary health care centre Not involved in medical and/or preventive care

Solovei A, Jane-Llopis E, Mercken L, Bustamante I, Kokole D, Mejia-Trujillo J, Medina Aguilar PS, Natera Rey G, O'Donnell A, Piazza M, Schmidt CS, Anderson P, de Vries H. Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption. Prev Sci. 2022 Feb;23(2):224-236. doi: 10.1007/s11121-021-01329-1. Epub 2022 Jan 15.

Anderson P, Manthey J, Llopis EJ, Rey GN, Bustamante IV, Piazza M, Aguilar PSM, Mejia-Trujillo J, Perez-Gomez A, Rowlands G, Lopez-Pelayo H, Mercken L, Kokole D, O'Donnell A, Solovei A, Kaner E, Schulte B, de Vries H, Schmidt C, Gual A, Rehm J. Impact of Training and Municipal Support on Primary Health Care-Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial. J Gen Intern Med. 2021 Sep;36(9):2663-2671. doi: 10.1007/s11606-020-06503-9. Epub 2021 Jan 19.