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

危险饮酒(HD)是世界范围内的主要公共卫生负担，发病率和死亡率都很高。 为了减少HD，世界卫生组织建议使用筛查、短暂干预、转诊治疗(SBIRT)。莫比尔县 健康技术(MHealth)，如我们团队成员开发的mSBIRT应用程序，是一个很有前途的工具 社区卫生工作者(CHW)广泛、经济高效地提供循证HDS，因为 它在提高保真度、有效性和可持续性方面的潜力。社区I-STAR(实施 使用减少酒精使用技术)莫桑比克由三个阶段组成：1)mSBIRT 适应-已完成，2)正在进行的群组随机试验，以及3)扩大最具成本效益的 干预--在试验结束后开始。社区i-star莫桑比克将扩大成本- 有效、可持续的方案，并为适用于莫桑比克和其他小岛屿发展中国家的政策提供信息。 在新冠肺炎大流行的早期，所有活动都被搁置。一旦我们能够重启活动， 大流行期间的社会限制要求改变需要进行培训的方式，以确保 安全。不是像最初那样在一个地点进行数量较少的培训，而是大量培训 计划好了，我们不得不用更少的学员进行更多的培训。教练员还必须 从楠普拉市或马普托市多次前往农村地区培训(相同)数量的受训人员 按照最初的提议进行这个项目。此外，在2019年11月，卫生部雇用了162名 让更多社工在我们进行研究的地区工作。因此，额外的228个CHW 需要接受培训，这还需要雇用更多的研究助理来提供所需的支持 临床(和CHW)水平。此外，卫生部人员(例如，CHW)培训期间的每日费用是#年的三倍 2019年11月。因此，培训预算比原计划高得多，培训活动 花费的时间比预期的要长，卫生部提出的变化在我们的研究中也产生了财务影响。这 行政补助金申请拨款以支付尚未接受培训的228名社区卫生工作者的培训费用 以获得检验该假说所需的样本。本行政副刊申请 不建议对奖项的总体人类受试者/临床试验指定进行更改，并保留 父奖项在原始奖项范围内的总体影响以及此项目将 在这一领域施加持续的、强大的影响。本行政副刊只适用于 新冠肺炎或相关缓解措施导致的无法覆盖的意外费用的成本增加 通过重新预算现有资金，而不修改已核准项目的原始范围 旨在支持与COVID相关的研究。因为我们即将开始最后一年的奖项，没有 这项补充要求的资金，整个投资都有风险。我们的请求代表着一种重要的需求 用于支付这项投资的研究活动的额外资金。

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.