Duke Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America.
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS Med. 2022 Apr 12;19(4):e1003961. doi: 10.1371/journal.pmed.1003961. eCollection 2022 Apr.
Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs.
In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated.
Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes.
Protocol Registry: PROSPERO CRD42017055549.
酒精使用导致的疾病和残疾在中低收入国家（LMICs）中不成比例地影响着人们。虽然已经证明各种干预措施可以减少高收入国家的酒精使用，但它们在 LMICs 中的效果尚未得到评估。本系统评价描述了目前在 LMICs 中针对患者的酒精干预措施的现有文献，并特别描述了评估 LMICs 中减少酒精使用的干预措施的临床试验。
根据 PRISMA，我们按照电子搜索策略进行了系统评价，该策略的时间范围为 1995 年 1 月 1 日至 2020 年 12 月 1 日。标题、摘要以及全文筛选和提取均由两人进行。对评估酒精相关结局的随机对照试验（RCT）进行了元汇总。我们搜索了以下电子数据库：PubMed、EMBASE、Scopus、Web of Science、Cochrane、WHO 全球卫生图书馆和 PsycINFO。符合纳入标准的文章评估了针对 LMICs 中酒精使用和酒精相关伤害的患者干预措施。没有根据语言排除任何研究。在筛选了 5036 篇文章后，有 117 篇文章符合纳入标准，其中 75 篇为 RCT。这些 RCT 中，93%是在 13 个中等收入国家进行的，而 7%是在 2 个低收入国家进行的。这些 RCT 评估了简短干预（24 种，定义为任何干预措施，从建议到咨询，每次治疗时间不到 1 小时，最多 4 次）、心理治疗或咨询（15 种，定义为与咨询师的互动时间长于简短干预或包括心理治疗成分）、健康促进和教育（20 种，定义为干预措施鼓励个人采取照顾自己健康的代理行为）或生物治疗（19 种，定义为以酒精使用障碍（AUD）的生物学功能为主要干预枢纽的干预措施），其中有 3 种混合干预类型。由于干预类型、结局测量和随访时间的高度异质性，我们没有进行荟萃分析来比较和对比研究，但对所有 75 项 RCT 研究进行了元汇总。评估最多且效果最一致的干预措施是简短干预；同样，在评估的各种干预措施中，最常用的是动机性访谈（MI）技术。
我们的综述表明，有许多针对患者的干预措施在 LMICs 中具有潜在的有效性，但需要进一步的研究来标准化干预措施、人群和结局测量，以准确评估其有效性。简短干预和 MI 技术是评估最多且对酒精相关结局影响最一致的干预措施。
方案注册：PROSPERO CRD42017055549。
