Implementing Evidence-Based Alcohol Interventions in a Resource-Limited Setting: Novel Delivery Strategies in Tomsk, Russia

Sonya S Shin,Adrianne K Nelson,Hilary S Connery,Charmaine S Lastimoso,Sergey P Mishustin,Sergey A Yanov,Shelly F Greenfield,Galina V Yanova,Viktoriya Livchits

doi:10.3109/10673229.2012.649121

Abstract

Effective implementation of evidence-based interventions in “real-world” settings can be challenging. Interventions based on externally valid trial findings can be even more difficult to apply in resource-limited settings, given marked differences—in provider experience, patient population, and health systems—between those settings and the typical clinical trial environment. Under the auspices of the Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis Patients (IMPACT) study, a randomized, controlled effectiveness trial, and as an integrated component of tuberculosis treatment in Tomsk, Russia, we adapted two proven alcohol interventions to the delivery of care to 200 patients with alcohol use disorders. Tuberculosis providers performed screening for alcohol use disorders and also delivered naltrexone (with medical management) or a brief counseling intervention either independently or in combination as a seamless part of routine care. We report the innovations and challenges to intervention design, training, and delivery of both pharmacologic and behavioral alcohol interventions within programmatic tuberculosis treatment services. We also discuss the implications of these lessons learned within the context of meeting the challenge of providing evidence-based care in resource-limited settings. (Harv Rev Psychiatry 2012;20:58–67.)

Highlights

Alcohol use disorders (AUDs) are undertreated in the United States and worldwide, despite their high medical costs, social consequences, and role in the incidence and severity of other diseases—in particular, diseases of poverty
Initial efforts of the Working Group focused on identifying evidencebased interventions (EBIs) that could be readily applied as part of TB care
We sought an intervention that would focus on medication adherence and on goal setting to reduce alcohol consumption, but that maintained a clear distinction from brief counseling interventions (BCIs) by avoiding both counseling that used problem-solving methods and the style and techniques of motivational interviewing

Summary

Introduction

Alcohol use disorders (AUDs) are undertreated in the United States and worldwide, despite their high medical costs, social consequences, and role in the incidence and severity of other diseases—in particular, diseases of poverty. Alcohol dependence is an established cause of 12 of the 20 leading global causes of death.[2,3]

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Results

Conclusion