Community I-STAR Mozambique: Community Implementation of SBIRT using Technology for Alcohol use Reduction in Mozambique

危险饮酒（HD）是全球主要的公共卫生负担，具有很高的发病率和死亡率。 为了减少 HD，世界卫生组织建议采用筛查、简短干预、转诊治疗 (SBIRT)。手机 健康技术 (mHealth)，例如我们团队成员开发的 mSBIRT 应用程序，是一种很有前途的工具 社区卫生工作者 (CHW) 广泛、经济有效地提供基于证据的 HDS，因为 其提高保真度、有效性和可持续性的潜力。社区 I-STAR（实施 莫桑比克使用减少酒精使用技术的 SBIRT 包括三个阶段：1) mSBIRT 适应 – 已完成，2) 整群随机试验 – 正在进行中，以及 3) 扩大最具成本效益的试验 干预——在试验完成后开始。莫桑比克社区 I-STAR 将扩大成本- 适用于莫桑比克和其他中低收入国家的有效、可持续的计划和信息政策。 在 COVID-19 大流行初期，所有活动都被搁置。一旦我们能够重新开始活动， 大流行期间的社会限制要求改变培训的进行方式，以确保 安全。不再像原来那样在一个地点进行少量培训、大量学员培训 按照计划，我们必须以更少的学员人数进行更多的培训。培训师还必须 为了在农村地区培训（相同）数量的学员，需要从楠普拉市或马普托市出发更多次 按照最初的提议进行该项目。此外，2019 年 11 月，卫生部 (MoH) 聘请了 162 更多的社区卫生工作者在我们进行研究的地区工作。因此需要额外 228 个社区卫生工作者 需要接受培训，这也需要雇用更多的研究助理来提供所需的支持 诊所（和社区卫生工作者）级别。此外，截至目前，卫生部人员（例如社区卫生工作者）培训期间的每日津贴增加了三倍 11/2019。因此，培训预算远高于原计划，培训活动也 花费的时间比预期的要长，而且卫生部实施的变革也对我们的研究产生了财务影响。这个 行政补充申请资金用于支付尚未接受培训的 228 名社区卫生工作者的培训费用 获得检验假设所需的样本。本次行政补充申请 不建议更改该奖项的总体人类受试者/临床试验名称并保留 母公司奖项在最初奖项范围内的总体影响以及该项目将产生的可能性 在该领域产生持续、强大的影响。行政补助金将仅用于支付 由于 COVID-19 或无法承保的相关缓解措施而导致的意外费用增加 通过重新编制现有资金预算而不修改已批准项目的原始范围，并且不 旨在支持与新冠病毒相关的研究。因为我们即将开始该奖项的最后一年，没有 本补充文件中要求的资金，整个投资都面临风险。我们的请求代表了重大需求 寻求额外资金来支付这项投资的研究活动。

Hazardous drinking (HD) is a major public health burden worldwide with significant morbidity and mortality. To reduce HD, the WHO recommends using Screening, Brief Intervention, Referral to Treatment (SBIRT). Mobile health technology (mHealth), such as the mSBIRT app developed by members of our team, is a promising tool for widespread cost-effective delivery of evidence-based HDS by community health workers (CHWs) because of its potential to increase fidelity, effectiveness, and sustainability. Community I-STAR (Implementation of SBIRT using Technology for Alcohol use Reduction) Mozambique comprises three phases: 1) mSBIRT adaptation – completed, 2) a cluster-randomized trial – in progress, and 3) scale-up of the most cost-effective intervention – to be started after the trial is completed. Community I-STAR Mozambique will scale-up a cost- effective, sustainable program and inform policy applicable to Mozambique and other LMICs. Early in the COVID-19 pandemic, all activities were put on hold. Once we were able to restart activities, the social restrictions during the pandemic required changing how trainings needed to be conducted to ensure safety. Instead of conducting fewer number of trainings with large numbers of trainees in one site as originally planned, we had to conduct much more many trainings with smaller number of trainees. Trainers also had to travel more times from Nampula City or Maputo City to train the (same) number of trainees in rural areas required to conduct the project as originally proposed. Also, in November 2019, the Ministry of Health (MoH) hired 162 more CHWs to work within the districts where we are conducting the study. Therefore an additional 228 CHWs need to be trained, which also required hiring more research assistants to provide the support needed at the clinic (and CHW) level. Also, per diem costs during training of MoH personnel (e.g., CHWs) triplicated as of 11/2019. Therefore, the training budget was much higher than originally planned and training activities have taken longer than expected, and the changes instituted by the MoH also had a financial impact in our study. This administrative supplement requests funding to cover the costs of the training the yet to be trained 228 CHWs that are required to attain the sample needed to test the hypothesis. This administrative supplement application does not propose changes to the overall human subjects/clinical trial designation of the award and preserves the parent award’s overall impact within the original scope of the award and the likelihood that this project will exert a sustained, powerful influence on the field. The administrative supplement will be used only to cover the cost increases for unanticipated expenses due to COVID-19 or related mitigation efforts that could not be covered by re-budgeting existing funds without modifications to the original scope of the approved project and is not intended to support COVID-related research. Because we are about to begin the last year of the award, without the funds requested in this supplement, the entire investment is at risk. Our request represents a significant need for additional funds to cover the research activities of this investment.