Parallel group individually randomised controlled trial (RCT) with stratified (by severity of drinking problem) randomisation into intervention and control arms. Aim is to test the effectiveness and cost-effectiveness of Coordinated Care for Alcohol Problems (CCAP) for the whole spectrum of drinking problems in primary care in Goa, India. Primary outcome is the drinking outcome of percentage days abstinent (PDA) at three months post randomisation. Secondary outcomes include drinking outcomes (PDA at six- and 12- months post-randomisation; percentage days heavy drinking (PDHD), intensity of drinking and remission) and drinking related outcomes (e.g., injuries, violence) at three-, six- and 12- months post- randomisation. Participants will include consenting adult (\>18 years) men with drinking problems attending Primary Healthcare Centres (PHCs) and Community Healthcare Centres (CHCs) in Goa and have drinking problems defined as scoring \>8 on the Alcohol Use Disorder Identification Test (AUDIT). CCAP is a multi-component evidence-informed complex intervention package for coordinating treatment for all levels of problem drinking (hazardous, harmful, dependent). For hazardous drinking, it includes Mobile based Brief Intervention Treatment (M-BIT), which is a mobile-messaging brief intervention delivered via WhatsApp over eight weeks using multimedia content including contextually relevant messages, images and videos. For harmful drinking, it includes Counselling for Alcohol Problems Plus (CAP+) which is Counselling for Alcohol Problems (CAP), an evidence-based brief psychological treatment, integrated with strategies to enhance treatment engagement (entry into and completion). For dependent drinking, it includes Community Orientated Treatment for Alcohol Dependence (CONTAD) which is supervised home-detoxification over a week followed by a psychological treatment to prevent relapse, both integrated with treatment engagement strategies. CAP+ and CONTAD will be delivered in the community by non-specialist health workers (NSHW).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
1,022
Hazardous drinking: The content of the intervention includes seven themes: health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and relapse prevention. Participants will receive texts and video-based messages building their awareness about drinking and associated harms. Harmful drinking: CAP has three phases which are delivered in one to four sessions over six to eight weeks by NSHWs. Each session lasts between 30 to 45 minutes. The content is delivered through motivational interviewing with additional behavioural and cognitive components. CAP+ will include treatment engagement strategies integrated into CAP. Dependent drinking: Home detoxification will be supervised by a doctor and monitored by the NSHW and a designated carer (e.g. spouse) for the patient at their home-setting. The counselling sessions are delivered by NSHWs, over 4-8 weeks and lasting 30-60 minutes each.
Hazardous drinking: An information sheet/brochure with information on alcohol consumption, associated risks, and tips to manage and reduce drinking. Harmful drinking: CAP psychological brief treatment delivered by trained NSHWs (described above in detail). Dependent drinking: Hospital-based detoxification delivered in secondary or tertiary care.
Percentage days abstinent (PDA) [Parent trial]
Proportion of days abstinent in the past two weeks measured using the Timeline Follow Back (TLFB)
Time frame: 3 months post randomisation
Pattern of drinking [Sub-group A Hazardous drinking]
Number of heavy drinking days in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Treatment completion [Sub-group B Harmful Drinking]
Proportion of consented participants who go on to complete treatment defined as planned discharge which would be one of the following 1. Received all sessions as per protocol 2. Discharge by mutual agreement between NSHW and participant on achievement of treatment goals 3. Referral out of the study
Time frame: Through the period of intervention delivery, an average of 3 months
Intensity of drinking [Sub-group C Dependent drinking]
Units of alcohol consumed in the past week measured using the TLFB
Time frame: 3 months post randomisation
Percentage days abstinent (PDA) [Parent trial]
Proportion of days abstinent in the past two weeks measured using the Timeline Follow
Time frame: 6 months post randomisation
Percentage days abstinent (PDA) [Parent trial]
Proportion of days abstinent in the past two weeks measured using the Timeline Follow
Time frame: 12 months post randomisation
Consequences of alcohol use [Parent trial]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 3 months post randomisation
Consequences of alcohol use [Parent trial]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 6 months post randomisation
Consequences of alcohol use [Parent trial]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 12 months post randomisation
Food security [Parent trial]
Improvement of food security as measured using Food Insecurity Experience Scale
Time frame: 12 months post randomisation
Pattern of drinking [Parent trial]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Pattern of drinking [Parent trial]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Pattern of drinking [Parent trial]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Intensity of drinking [Parent trial]
Grams ethanol consumed per drinking day in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Intensity of drinking [Parent trial]
Grams ethanol consumed per drinking day in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Intensity of drinking [Parent trial]
Grams ethanol consumed per drinking day in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Remission [Parent trial]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 3 months post randomisation
Remission [Parent trial]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 6 months post randomisation
Remission [Parent trial]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 12 months post randomisation
System-level costs [Parent trial]
Economic costs in WHO six building blocks for delivering the interventions measured using inventory form for collecting system-level economic costs of delivering interventions (finance records and individuals involved in delivery of interventions)
Time frame: Monthly, during the period of implementation
Out-of-pocket costs 1 [Parent trial]
Out-of-pocket costs for receiving general medical care and the related non-medical costs (e.g.: time loss, travel, etc) measured using Client Service Receipt Inventory form for collecting costs to patients who receive CCAP interventions
Time frame: 3 months post randomisation
Out-of-pocket costs 1 [Parent trial]
Out-of-pocket costs for receiving general medical care and the related non-medical costs (e.g.: time loss, travel, etc) measured using Client Service Receipt Inventory form for collecting costs to patients who receive CCAP interventions
Time frame: 6 months post randomisation
Out-of-pocket costs 1 [Parent trial]
Out-of-pocket costs for receiving general medical care and the related non-medical costs (e.g.: time loss, travel, etc) measured using Client Service Receipt Inventory form for collecting costs to patients who receive CCAP interventions
Time frame: 12 months post randomisation
Out-of-pocket costs 2 [Parent trial]
Out-of-pocket costs for receiving CCAP interventions (e.g.: time loss, travel, etc) using survey form for receiving the CCAP interventions to patients who receive CCAP interventions
Time frame: 3 months post randomisation
Out-of-pocket costs 2 [Parent trial]
Out-of-pocket costs for receiving CCAP interventions (e.g.: time loss, travel, etc) using survey form for receiving the CCAP interventions to patients who receive CCAP interventions
Time frame: 6 months post randomisation
Out-of-pocket costs 2 [Parent trial]
Out-of-pocket costs for receiving CCAP interventions (e.g.: time loss, travel, etc) using survey form for receiving the CCAP interventions to patients who receive CCAP interventions
Time frame: 12 months post randomisation
Disability [Parent trial]
Standardised disability scores used to estimate Quality-Adjusted Life Years (QALYs) using the WHO Disability Assessment Scale (WHODAS)
Time frame: 3 months post randomisation
Disability [Parent trial]
Standardised disability scores used to estimate Quality-Adjusted Life Years (QALYs) using the WHO Disability Assessment Scale (WHODAS)
Time frame: 6 months post randomisation
Disability [Parent trial]
Standardised disability scores used to estimate Quality-Adjusted Life Years (QALYs) using the WHO Disability Assessment Scale (WHODAS)
Time frame: 12 months post randomisation
Pattern of drinking [Sub-group A Hazardous drinking]
Number of heavy drinking days in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Pattern of drinking [Sub-group A Hazardous drinking]
Number of heavy drinking days in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Intensity of drinking [Sub-group A Hazardous drinking]
Grams ethanol consumed per drinking day in past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Intensity of drinking [Sub-group A Hazardous drinking]
Grams ethanol consumed per drinking day in past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Intensity of drinking [Sub-group A Hazardous drinking]
Grams ethanol consumed per drinking day in past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Remission [Sub-group A Hazardous drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 3 months post randomisation
Remission [Sub-group A Hazardous drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 6 months post randomisation
Remission [Sub-group A Hazardous drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 12 months post randomisation
Percentage days abstinent (PDA) [Sub-group A Hazardous drinking]
Proportion of days abstinent in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Percentage days abstinent (PDA) [Sub-group A Hazardous drinking]
Proportion of days abstinent in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Percentage days abstinent (PDA) [Sub-group A Hazardous drinking]
Proportion of days abstinent in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Pattern of drinking [Sub-group A Hazardous drinking]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Pattern of drinking [Sub-group A Hazardous drinking]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Pattern of drinking [Sub-group A Hazardous drinking]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Treatment entry [Sub-group B Harmful drinking]
Proportion of consented participants who receive at least one session of counselling
Time frame: 3 months post randomisation
Treatment entry [Sub-group B Harmful drinking]
Proportion of consented participants who receive at least one session of counselling
Time frame: 6 months post randomisation
Treatment entry [Sub-group B Harmful drinking]
Proportion of consented participants who receive at least one session of counselling
Time frame: 12 months post randomisation
Percentage days abstinent (PDA) [Sub-group B Harmful drinking]
Proportion of days abstinent in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Percentage days abstinent (PDA) [Sub-group B Harmful drinking]
Proportion of days abstinent in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Percentage days abstinent (PDA) [Sub-group B Harmful drinking]
Proportion of days abstinent in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Pattern of drinking [Sub-group B Harmful drinking]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Pattern of drinking [Sub-group B Harmful drinking]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Pattern of drinking [Sub-group B Harmful drinking]
Percentage days heavy drinking (PDHD) in the past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Intensity of drinking [Sub-group B Harmful drinking]
Grams ethanol consumed per drinking day in past two weeks measured using the TLFB
Time frame: 3 months post randomisation
Intensity of drinking [Sub-group B Harmful drinking]
Grams ethanol consumed per drinking day in past two weeks measured using the TLFB
Time frame: 6 months post randomisation
Intensity of drinking [Sub-group B Harmful drinking]
Grams ethanol consumed per drinking day in past two weeks measured using the TLFB
Time frame: 12 months post randomisation
Remission [Sub-group B Harmful drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 3 months post randomisation
Remission [Sub-group B Harmful drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 6 months post randomisation
Remission [Sub-group B Harmful drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 12 months post randomisation
Consequences of alcohol use [Sub-group B Harmful drinking]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 3 months post randomisation
Consequences of alcohol use [Sub-group B Harmful drinking]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 6 months post randomisation
Consequences of alcohol use [Sub-group B Harmful drinking]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 12 months post randomisation
Food security [Sub-group B Harmful drinking]
Improvement of food security as measured using Food Insecurity Experience Scale
Time frame: 12 months post randomisation
Intensity of drinking [Sub-group C Dependent drinking]
Units of alcohol consumed in the past week measured using TLFB
Time frame: 6 months post randomisation
Intensity of drinking [Sub-group C Dependent drinking]
Units of alcohol consumed in the past week measured using TLFB
Time frame: 12 months post randomisation
Consequences of alcohol use [Sub-group C Dependent drinking]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 3 months post randomisation
Consequences of alcohol use [Sub-group C Dependent drinking]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 6 months post randomisation
Consequences of alcohol use [Sub-group C Dependent drinking]
Physical, social, intrapersonal and interpersonal consequences of alcohol use measured using the Short Inventory of Problems (SIP)
Time frame: 12 months post randomisation
Food security [Sub-group C Dependent drinking]
Improvement of food security as measured using Food Insecurity Experience Scale
Time frame: 12 months post randomisation
Remission [Sub-group C Dependent drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 3 months post randomisation
Remission [Sub-group C Dependent drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 6 months post randomisation
Remission [Sub-group C Dependent drinking]
Alcohol Use Disorder Identification Test (AUDIT) score \<8
Time frame: 12 months post randomisation
Treatment entry [Sub-group C Dependent drinking]
Proportion of consented participants who receive at least one session of counselling
Time frame: Through the period of intervention delivery, an average of 3 months
Treatment completion [Sub-group C Dependent drinking]
Proportion of consented participants who go on to complete treatment defined as planned discharge which would be one of the following 1. Received all sessions as per protocol 2. Discharge by mutual agreement between NSHW and participant on achievement of treatment goals 3. Referral out of the program
Time frame: Through the period of intervention delivery, an average of 3 months
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