PRACT: A Pragmatic Randomized Adaptive Clinical Trial to Investigate Controlling Alcohol related harms in a Low-Income Setting; Emergency Department Brief Interventions in Tanzania

摘要 在低收入和中等收入国家，酒精的使用正在迅速增加，在这些国家，酒精的价格低廉，容易获得， 监管不力，几乎没有资源专门用于促进安全饮酒。像许多其他受限的 资源环境，在#年的乞力马扎罗地区没有治疗设施或上瘾从业者 坦桑尼亚。对于这种情况下的许多人来说，他们只在紧急情况下才寻求治疗，比如急性受伤。从我们的 初步工作，我们已经看到30%的受伤患者在急诊科就诊 报告过量饮酒，并有再次受伤的风险。基于动机的简短干预 访谈框架已被证明可以减少饮酒和与酒精相关的危害。我们已经翻译了 并改编了一个简短的酒精干预词，以适应坦桑尼亚的上下文和斯瓦希里语，称为“Punguza” Pombe Kua Afya Yako(PPKAY)/为您的健康减少酒精。本项目将对此进行评估 莫希乞力马扎罗基督教医疗中心受伤患者的护理干预， 坦桑尼亚。通过使用创新的适应性临床试验方法，我们将加快开发MOST 将这种干预措施整合到临床护理中的有效方法。到这个项目结束时，我们将确定 最有效的简短干预组成部分，并能够描述干预的整体效果。 此外，我们将标准化适应性试验方法，以革命临床试验的科学性 低资源环境下的行为科学。

ABSTRACT Alcohol use is rapidly increasing in low- and middle-income countries, where it is inexpensive, readily available, poorly regulated, and there are few resources devoted to promoting safe alcohol use. Like many other limited resource settings, there are no treatment facilities or addiction practitioners in the Kilimanjaro region of Tanzania. For many in this setting, they only seek care after an emergency like an acute injury. From our preliminary work, we have seen that 30% of injury patients presenting for care in the Emergency Department report excess alcohol use and are at risk of a repeat injury. A Brief Intervention based on a motivational interviewing framework has been shown to reduce alcohol use and alcohol-related harms. We have translated and adapted a Brief Intervention for alcohol to the Tanzanian context and Swahili language called “Punguza Pombe Kwa Afya Yako (PPKAY)/ Reduce Alcohol for Your Health.” This project will evaluate this intervention in injury patients presenting for care at the Kilimanjaro Christian Medical Center in Moshi, Tanzania. By using innovative adaptive clinical trial methods, we will expedite the development of the most effective way to integrate this intervention into clinical care. By the end of this project, we will have identified the most effective brief intervention components and be able to characterize the intervention’s effect overall. Additionally, we will standardize adaptive trial methods to revolutionize the science of clinical trials for behavioral sciences in low-resource settings.