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

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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.