Abstract
Screening, brief intervention, and referral to treatment (SBIRT) for risky substance use is infrequently included in routine healthcare in low-resourced settings. A SBIRT programme, adopted by the Western Cape provincial government within an alcohol harm reduction strategy, employed various implementation strategies executed by a diverse team to translate an evidence-based intervention into services at three demonstration sites before broader programme scale-up. This paper evaluates the implementation of this programme delivered by facility-based counsellors in South African emergency centres. Guided by the Consolidated Framework for Implementation Research, this mixed methods study evaluated the feasibility, acceptability, appropriateness and adoption of this task-shared SBIRT programme. Quantitative data were extracted from routinely collected health information. Qualitative interviews were conducted with 40 stakeholders in the programme's second year. In the first year, 13 136 patients were screened and 4 847 (37%) patients met criteria for risky substance use. Of these patients, 83% received the intervention, indicating programme feasibility. The programme was adopted into routine services and found to be acceptable and appropriate, particularly by stakeholders familiar with the emergency environment. These stakeholders highlighted the burden of substance-related harm in emergency centres and favourable patient responses to SBIRT. However, some stakeholders expressed scepticism of the behaviour change approach and programme compatibility with emergency centre operations. Furthermore, adoption was both facilitated and hampered by a top-down directive from provincial leadership to implement SBIRT, while rapid implementation limited effective engagement with a diverse stakeholder group. This is one of the first studies to address SBIRT implementation in low-resourced settings. The results show that SBIRT implementation and adoption was largely successful, and provide valuable insights that should be considered prior to implementation scale-up. Recommendations include ensuring ongoing monitoring and evaluation, and early stakeholder engagement to improve implementation readiness and programme compatibility in the emergency setting.
Highlights
The results show that SBIRT implementation and adoption was largely successful, and provide valuable insights that should be considered prior to implementation scale-up
Low- and middle-income countries (LMICs) have limited resources to prevent the harms associated with risky substance use [1, 2]
As in many low- and middle-income countries (LMICs), risky substance use is highly prevalent in South Africa, with 13% of adults meeting criteria for a lifetime substance use disorder and 43% of alcohol users reporting heavy episodic drinking [3, 4]
Summary
Low- and middle-income countries (LMICs) have limited resources to prevent the harms associated with risky substance use [1, 2]. As in many LMICs, risky substance use is highly prevalent in South Africa, with 13% of adults meeting criteria for a lifetime substance use disorder and 43% of alcohol users reporting heavy episodic drinking [3, 4] This modifiable risk factor contributes to South Africa’s quadruple burden of disease due to HIV and other infectious diseases, injuries and non-communicable diseases [5]. The World Health Organization (WHO) has supported the scale up of substance use screening, brief intervention, and referral to treatment (SBIRT) within healthcare services as a means of reducing risk of injury and other health consequences associated with risky substance use [6]. This paper evaluates the implementation of this programme delivered by facility-based counsellors in South African emergency centres
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