Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary

• Published in: PLoS medicine 2022-04, Vol.19 (4), p.e1003961
• Main Authors: Staton, Catherine A, Vissoci, João Ricardo Nickenig, El-Gabri, Deena, Adewumi, Konyinsope, Concepcion, Tessa, Elliott, Shannon A, Evans, Daniel R, Galson, Sophie W, Pate, Charles T, Reynolds, Lindy M, Sanchez, Nadine A, Sutton, Alexandra E, Yuan, Charlotte, Pauley, Alena, Andrade, Luciano, Von Isenberg, Megan, Ye, Jinny J, Gerardo, Charles J
• Format: Article
• Language: English
• Subjects: Alcohol use; Alcoholism; Alcoholism - prevention & control; Bias; Biology and Life Sciences; Care and treatment; Clinical trials; Complications and side effects; Counseling; Demographic aspects; Developing Countries; Earth Sciences; Harm reduction; Health aspects; Health promotion; Humans; Income; Intervention; Low income groups; Medicine and Health Sciences; Meta-analysis; Patients; Poverty; Psychotherapy; Public health; Research and Analysis Methods; Social Sciences; Systematic review
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003961

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 poten