Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India.
Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India.
Alcohol. 2020 Feb;82:103-112. doi: 10.1016/j.alcohol.2019.08.006. Epub 2019 Aug 29.
Despite the increasing burden of alcohol dependence, treatment resources in low- and middle-income countries such as India are concentrated in poorly accessible tertiary care facilities. The aim of our study was to examine the feasibility and acceptability of lay health worker-delivered home-based packages of care for alcohol dependence. We conducted an uncontrolled treatment cohort with alcohol-dependent adult males recruited in primary and secondary care. Lay health workers delivered home-detoxification and/or relapse prevention counseling. Process data were analyzed using descriptive statistics. Eleven men with alcohol dependence received home detoxification and relapse prevention counseling, and 27 men received only relapse prevention counseling. Of the 11 receiving home detoxification, one participant re-started drinking; all the rest safely completed the home detoxification. During detoxification, the pulse, blood pressure, and temperature remained within the normal range and ataxia, dehydration, disorientation, and sleep normalized over the course of the detoxification. Of the 38 who entered relapse prevention treatment, 15 (39.5%) completed treatment or had a planned discharge. The mean number of sessions was 2.4 (SD = 1.3); those who had a planned discharge received an average of 3.7 (SD 0.5) sessions, and those who dropped out received an average of 1.4 (SD 0.8) sessions. There was no significant change in daily alcohol consumption and percentage days of heavy drinking (PDHD) between baseline and follow-up in the whole cohort. The SIP score reduced significantly in the whole cohort (24.5 vs. 15.0, p = 0.002), and also reduced when segregated by treatment settings, and type of treatment package received. With appropriate adaptations, our intervention warrants further research, as it has the potential to bridge the significant treatment gap for alcohol dependence in low- and middle-income countries.
尽管酒精依赖的负担不断增加，但在印度等中低收入国家，治疗资源集中在难以获得的三级保健设施中。我们的研究目的是检验针对酒精依赖患者提供由非专业卫生工作者上门护理的家庭护理包的可行性和可接受性。我们在初级和二级保健机构招募了成年酒精依赖男性，开展了一项非对照治疗队列研究。非专业卫生工作者上门提供脱毒和/或预防复发咨询。使用描述性统计分析处理数据。11 名男性接受了家庭脱毒和预防复发咨询，27 名男性仅接受了预防复发咨询。在接受家庭脱毒的 11 人中，1 人重新开始饮酒；其余人都安全地完成了家庭脱毒。在脱毒期间，脉搏、血压和体温保持在正常范围内，共济失调、脱水、定向障碍和睡眠在脱毒过程中恢复正常。在进入预防复发治疗的 38 人中，15 人（39.5%）完成了治疗或计划出院。平均治疗次数为 2.4（SD=1.3）；计划出院的患者平均接受了 3.7（SD 0.5）次治疗，而中途退出的患者平均接受了 1.4（SD 0.8）次治疗。整个队列的每日饮酒量和大量饮酒天数（PDHD）在基线和随访之间没有显著变化。整个队列的 SIP 评分显著降低（24.5 分比 15.0 分，p=0.002），在根据治疗环境和接受的治疗方案进行分层后，评分也显著降低。经过适当调整，我们的干预措施值得进一步研究，因为它有可能缩小中低收入国家酒精依赖治疗的巨大差距。
