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

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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.