在莫桑比克（AUDIT-MZ），用于初级保健酒精使用筛查的酒精使用障碍识别测试（AUDIT）的有效性和项目反应理论特性。
Validity and item response theory properties of the Alcohol Use Disorders Identification Test for primary care alcohol use screening in Mozambique (AUDIT-MZ).
机构信息
Department of Global Health, University of Washington, Seattle, WA, USA.
Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Mozambique; Escola Paulista de Medicina, Universidade Federal de São Paulo, Departamento de Psiquiatria, Brazil.
出版信息
J Subst Abuse Treat. 2021 Aug;127:108441. doi: 10.1016/j.jsat.2021.108441. Epub 2021 Apr 28.
BACKGROUND
No validated tools exist to screen for substance use or dependence in Mozambique. The aim of this study was to validate the Alcohol Use Disorder Identification Test (AUDIT) for use in primary care settings in Mozambique.
METHODS
The study administered a final adapted Mozambican 10-item AUDIT (AUDIT-10-MZ) to 502 individuals from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary health care clinics in Sofala Province, Mozambique. The study evaluated the AUDIT-10-MZ against the MINI 5.0-MZ as a gold standard diagnostic tool.
RESULTS
Using the MINI 5.0-MZ, 16 (3.2%) of the sample tested positive for alcohol dependence and 3 (0.6%) tested positive for harmful alcohol use. The full AUDIT-10-MZ had acceptable internal consistency (α = 0.74); however, the shorter AUDIT-C-MZ had a higher alpha value than the full AUDIT screener (α = 0.79). The AUDIT-10-MZ performed well for screening in primary care, achieving areas under the receiver operating characteristic curves (AUROCs) of 0.94 (95% CI: 0.91, 0.96) for alcohol dependence. The AUDIT-C-MZ also performed well with an AUROC of 0.88 (95% CI: 0.80, 0.96) for alcohol dependence. Using a cut-off of ≥6, the AUDIT-10-MZ achieved a sensitivity of 68.8% and specificity of 92.0% for screening for alcohol dependence; a cut-off of ≥3 for the AUDIT-C-MZ achieved a sensitivity of 56.3% and specificity of 90.7%.
CONCLUSIONS
Both the AUDIT-10-MZ and AUDIT-C-MZ are valid instruments for screening for alcohol dependence in Mozambique. The AUDIT-C-MZ performed particularly well and providers could use it as a brief screener in primary care settings. Optimal cut-points will depend on weighing false positives and false negatives but could be employed at ≥ 6 or ≥ 7 for the AUDIT-10-MZ and at ≥ 2 or ≥ 3 for the AUDIT-C-MZ. Future implementation research is needed to examine how best to integrate screening for substance use or dependence in primary care settings in Mozambique and other similar LMICs.
背景
莫桑比克目前尚无用于筛查物质使用或依赖的经过验证的工具。本研究旨在验证酒精使用障碍识别测试（AUDIT）在莫桑比克初级保健环境中的适用性。
方法
该研究在莫桑比克索法拉省 3 家卫生部初级保健诊所的产前、产后和普通门诊咨询中，对 502 名个体进行了最终改编的莫桑比克 10 项 AUDIT（AUDIT-10-MZ）。该研究将 AUDIT-10-MZ 与 MINI 5.0-MZ 作为金标准诊断工具进行了评估。
结果
使用 MINI 5.0-MZ，样本中有 16 人（3.2%）检测出酒精依赖阳性，3 人（0.6%）检测出有害饮酒阳性。完整的 AUDIT-10-MZ 具有可接受的内部一致性（α=0.74）；然而，较短的 AUDIT-C-MZ 的α值高于完整的 AUDIT 筛查器（α=0.79）。AUDIT-10-MZ 在初级保健中的筛查效果良好，获得的接收器工作特征曲线（AUROC）面积为 0.94（95%CI：0.91，0.96），用于筛查酒精依赖。AUDIT-C-MZ 对酒精依赖的 AUROC 也为 0.88（95%CI：0.80，0.96）。使用≥6 的切点，AUDIT-10-MZ 对酒精依赖的筛查灵敏度为 68.8%，特异性为 92.0%；AUDIT-C-MZ 的切点为≥3，灵敏度为 56.3%，特异性为 90.7%。
结论
AUDIT-10-MZ 和 AUDIT-C-MZ 都是在莫桑比克筛查酒精依赖的有效工具。AUDIT-C-MZ 表现尤其出色，提供者可以在初级保健环境中使用它作为简短的筛查工具。最佳切点将取决于权衡假阳性和假阴性，但可以在 AUDIT-10-MZ 中使用≥6 或≥7，在 AUDIT-C-MZ 中使用≥2 或≥3。需要开展进一步的实施研究，以检验如何在莫桑比克和其他类似 LMIC 的初级保健环境中最好地纳入物质使用或依赖的筛查。
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