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

危险性饮酒（HD）是世界范围内的一个主要公共卫生负担，具有显著的发病率和死亡率。的 与这一全球负担相关的预防和治疗差距要求采取有效的干预措施， 扩大规模，利用现有平台，并让决策者参与，随时准备应用和维持 随着时间的推移，证据知情的政策。为了减少HD，世卫组织建议使用筛查， 干预，转诊治疗（SBIRT）和心理健康差距行动计划指南（mhGAP）。 随着低收入和中等收入国家（LMIC）采用SBIRT和mhGAP进行社区HD服务， (HDS)因此，扩大规模的一个主要挑战是确保服务的有效性、忠实性和可持续性。移动的健康 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）广泛提供循证HDS的成本效益，因为其 提高忠诚度、有效性和可持续性的潜力。项目名称：Community I-STAR （利用减少酒精使用技术实施SBIRT）莫桑比克将利用以下措施： 莫桑比克卫生部现有的方案：（1）任务转移战略， （2）由CHW提供的WHO资助的癫痫社区计划; 以及（3）针对疟疾、肺炎和腹泻的移动健康计划（inSCALE -大规模创新， 社区访问和持久的影响）。这些目前正在运行的程序为使用mSBIRT奠定了基础 由社区卫生工作者在莫桑比克提供社区人道主义发展服务，并制定扩大政府资助的 社区HDS利用现有的人力资源。莫桑比克I-STAR社区由三个 阶段：1）mSBIRT适应，2）群集随机试验，3）最具成本效益的 干预在使mSBIRT适应莫桑比克的背景/文化的形成阶段之后，我们将进行2- 在12个地区进行的为期1年的整群随机、混合有效性-实施2型试验：6个地区随机化 接受mSBIRT和6到SBIRT常规培训和监督战略（SBIRT-CTS）， 社区卫生工作者提供的武器。在2年试验中显示出较高成本效益的手臂将扩大到 其他6个地区的12个“交叉”月。在整个试验和“交叉”放大过程中， 进程数据将补充定量评估，以审查执行情况、可持续性和扩大规模。 我们的方法重新定义了工作角色，而不需要新的人力资源，它符合卫生部的 致力于实施HDS。我们将使用循证实践（SBIRT）来a）建立以下能力： 完成可持续社区HDS实践的任务转移;以及B）使用实施工具来检查 评估两项SBIRT交付战略的实施情况和有效性，然后评估最大规模的 成本效益战略。莫桑比克社区I-STAR将扩大一个具有成本效益的可持续计划， 适用于莫桑比克和其他中低收入国家知情政策。

Hazardous drinking (HD) is a major public health burden worldwide with significant morbidity and mortality. The prevention and treatment gap associated with this global burden requires that efficacious interventions be scaled-up, leveraging existing platforms and participation of policy makers ready to apply and sustain evidence-informed policies over time. To reduce HD, the WHO recommends using Screening, Brief Intervention, Referral to Treatment (SBIRT) and the mental health Gap Action Programme guidelines (mhGAP). As low- and middle-income countries (LMIC) embrace SBIRT and mhGAP for community-based HD services (HDS), a main scale-up challenge is ensuring effectiveness, fidelity, and sustainability of services. 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. The proposed project, Community I-STAR (Implementation of SBIRT using Technology for Alcohol use Reduction) Mozambique, will leverage the following existing Mozambique Ministry of Health (MoH) programs: (1) a task-shifting strategy training psychiatric technicians (PsyTs) to use the mhGAP; (2) the WHO-funded epilepsy community program delivered by CHWs; and (3) an mHealth program for malaria, pneumonia, and diarrhea (inSCALE - Innovations at Scale for Community Access and Lasting Effects). These currently operating programs set the stage for the use of mSBIRT by CHWs to deliver community HDS in Mozambique and generate policy for scale-up of government-funded community HDS harnessing existing human resources. Community I-STAR Mozambique comprises three phases: 1) mSBIRT adaptation, 2) a cluster-randomized trial, and 3) scale-up of the most cost-effective intervention. After a formative phase to adapt mSBIRT to Mozambique’s context/culture, we will conduct a 2- year, cluster-randomized, hybrid effectiveness-implementation type 2 trial in 12 districts: 6 districts randomized to receive mSBIRT and 6 to an SBIRT Conventional Training and Supervision strategy (SBIRT-CTS), with both arms delivered by CHWs. The arm showing higher cost-effectiveness in the 2-year trial will be scaled up to the other 6 districts for 12 “cross-over” months. Throughout the trial and the “cross-over” scale-up, qualitative and process data will complement quantitative assessments to examine implementation, sustainability, and scale-up. Our approach redefines work roles without requiring new human resources, and it comports with the MoH’s commitment to implementing HDS. We will use evidence-based practices (SBIRT) to a) build capacity for complete task-shifting of sustainable community-HDS practices; and b) use implementation tools to examine implementation and effectiveness of two SBIRT delivery strategies followed by evaluation of scale-up of the most cost-effective strategy. Community I-STAR Mozambique will scale-up a cost-effective, sustainable program and inform policy applicable to Mozambique and other LMICs.