Table 1.
Study characteristics.
| Study | Country | Setting of recruitment | Sample (Number of S. randomized to conditions) | Individual or group format | Intervention facilitation and training a | Contents of intervention and control group(s) (main components of the alcohol-focused interventions in bold) | Duration per component/ session | No. of sessions | |
|---|---|---|---|---|---|---|---|---|---|
| Assanangkorn-chai et al. (101) | Thailand | Eight hospitals and health centers in Southern Thailand | n=747, 2% female, age range: 16–65, 61% aged 16–25 | Individual | BI: by co-author who had been trained in the technique Simple Advice (SA) by a research assistant |
TG |
MI
The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care (81) |
M=8.8 min, range 5–13 min (max. 15 min) | Single session |
| CG | Simple advice: P. received feedback on their ASSIST score and its meaning, they were simply advised to stop or reduce substance use | M=3.9 min, range 3–6 min | Single session | ||||||
| Babor et al. (79) | 6 LMICs: Bulgaria, Costa Rica, Kenya, Mexico, Former Sovjet Union, Zimbabwe | Combination of hospital settings, primary care clinics, work-sites and educational institutions | n=818
|
Individual | “Health advisors” hired for the study who received 10–20 h of training by the principle investigators according to written guidelines (standardized across centers) | TG1 |
Mainly behavioral techniques
Problem-Solving-Manual; strategies derived from the behavioral change model (106), consistent with principles of social learning theory and motivational psychology |
40 min | Single session |
| TG2 | Simple advice on reduction of alcohol consumption | 25 min | Single session | ||||||
| CG | 20 min health interview (WHO composite interview) | 20 min | Single session | ||||||
| Kalichman et al. (95) | South Africa | Urban STI-clinic in Cape Town | n=143 (15% female, age: M=28.75, SD=5.6) | Individual | 2 local bachelor degree-level counselors with minimal counseling experience outside the study protocol | TG |
MI + Intervention on HIV
Brief alcohol counseling model of the WHO tailored to the individual level of drinking (107) + HIV education component: facts about HIV-transmission and risk behaviors (not alcohol-related) |
60 min | Single session |
| CG | HIV education component (same as TG) | 20 min | Single session | ||||||
| Kalichman et al. (96) | South Africa | Informal alcohol serving establishments (“shebeens”) in a suburban township in Cape Town | n=353 (67% female, age: M=34.1, SD=10.5) | Group (8–10 same gender P. facilitated by 2 counselors) |
2 local bachelor degree-level counselors with minimal counseling experience outside the study protocol who received a 3-week training by project managers | TG |
MI + Intervention on HIV
Brief alcohol counseling model of the WHO tailored to the individual level of drinking (107) + HIV education component: facts about HIV-transmission and risk behaviors (not alcohol-related) |
180 min | Single session |
| CG | HIV education component (same as TG) | 60 min | Single session | ||||||
| L’Engle et al. (102) | Kenya | HIV prevention centers in Mombasa offering services for female sex workers | n=818 (all female, age: M=27.5, SD=6.6, range 18–54) | Individual | Nurse counselors who received training in motivational interviewing techniques | TG |
MI
WHO Brief Intervention for Hazardous and Harmful Drinking. A Manual for Use in Primary Care (80) + education on reproductive health |
20 min | 6 monthly sessions |
| CG | Nutrition intervention on nutritional needs for women and their children and women living with HIV | 20 min | 6 monthly sessions | ||||||
| Mertens et al. (97) b | South Africa | Public-sector clinic in Delft, a township in the Western Cape province | Original study: n=403 (52% female, age range: 18–24) | Individual | Primary care nurse practitioners who received a 3-day training by experienced practitioner and trainer | TG |
MI
Health Behavior Change: A Guide for Practitioners (108) + referral resource list for drinking and drug use |
10 min | Single session |
| CG | referral resource list for drinking and drug use | n/r | n/r | ||||||
| Nadkarni et al. (89) | India | 10 primary health centers in Goa | n=377 (all male, age: M=42.0, SD=11.4) | Individual | 11 lay counselors recruited from local community (at least secondary school education, selected after an interview, 2 week training, 6-month internship and testing through exam and performance in standardized role-plays) | TG |
MI + CBT-elements
Counseling for Alcohol Problems (109) + EUC (consultation with the Primary Health Center physician, provision of the AUDIT screening and of a contextualized version of the WHO Mental Health Gap Action Programme guidelines for harmful drinking) |
30–45 min per session (M=42.4 min, range: 40.9-43.7) | 1–4 weekly or fortnightly sessions (M=2.8 sessions, 95% CI 2.7–3.0) |
| CG | EUC: same as TG | n/r | n/r | ||||||
| Noknoy et al. (105) | Thailand | Primary care unit in rural Northeastern Thailand | n=117 (8.5% female, age: M=37.0, SD=10.0) | Individual | Nurses who received a single 6-hour training session | TG |
MI
Motivational Enhancement Therapy (MET): originally developed as a brief four-session adaptation of Motivational Interviewing in Project MATCH (53) |
15 min | 3 sessions: on day 1, 2 weeks and 6 weeks after baseline assessment |
| CG | assessment only | n/r | Single session | ||||||
| Omeje et al. (87) | Nigeria | Infectious disease clinics at 10 community health centers, hospitals & HIV service centers in Enugu State, Nigeria | n=124 (31.45% female, age: M=33.76, SD=2.16, range: 27–56) | Group (sample split into 6 subgroups, no. of P. per sub-group n/r) |
University personnel (the study authors), formally trained as counselors and psychologists and expertise in the principles and practice of Rational Emotive Behavior Therapy theory | TG |
Rational emotive health therapy
Rational emotive health therapy Treatment Manual for Alcohol Use Disorder [RTMAUD; (110)] |
50 min | 20 sessions held twice per week for 10 consecutive weeks |
| CG | waitlist | - | - | ||||||
| Pal et al. (100) | India | Recruitment within participants of an earlier community-based study (house-to-house survey) | n=90 (all male, age: M=29.7, SD=9.89) | Individual | 1 local health worker (social service officer) who delivered both intervention and control conditions (training: n/r) | TG |
MI
Brief Intervention: A Manual for Practice (111) based on “Feedback, Responsibility, Advice, Menu, Empathy and Self-Efficacy” as critical elements of BI [FRAMES; (52)] |
45 min | 2 sessions separated by a 3–5-d gap |
| CG | Simple advice (SA): empathic expression of concern based on consequences, with an advice to cut down or stop alcohol use | 5 min | Single session | ||||||
| Papas et al. (112) | Kenya | HIV outpatient clinic in Eldoret, Western Kenya | n=75 (men and women, gender rate n/r, age: M=37.1, SD=8.4,) | Group (12–15 same gender P.) |
2 para-professionals meeting certification procedures after trainee program who received 175 and 300 h, respectively, of total training/supervision prior to trial | TG |
CBT-based intervention
Systematic cultural adaptation of cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in Western Kenya (113) |
90 min | 6 weekly sessions |
| CG | routine medical care provided in the HIV-outpatient clinic | n/r | n/r | ||||||
| Peltzer et al. (93) | South Africa | 42 primary health care clinics in the three provinces with the highest tuberculosis caseload | n=1196 (26% female, age: M=36.7, SD=10.9) | Individual | Lay HIV counselors (to implement the intervention) and nurses (to assist when necessary) from the study clinics who received formal training (lay counselors 3 d, nurses 2 d) | TG |
MI
No manual specified; Information-Motivation-Behavioral Skills (IMB) Model (114) was used to guide alcohol reduction intervention |
15–20 min | 2 sessions: on day 1 and within one month after baseline evaluation |
| CG | P. received a health education leaflet on responsible drinking | - | - | ||||||
| Pengpid et al. (103) | South Africa | Outpatients of a hospital in Gauteng, Northern South Africa | n=392 (27.6% female, age: M=35.6, SD=n/r) | Individual | Research assistant counselors who received 5 d of training (role playing and general skills training techniques; research assistants were observed in role-play demonstrations until performance criteria are met) | TG |
MI
No manual specified; Information-Motivation-Behavioral Skills (IMB) Model (114) was used to guide alcohol reduction intervention |
20 min | Single session |
| CG | P. received a health education leaflet on responsible drinking (no feedback on alcohol-screening) | - | - | ||||||
| Pengpid et al. (104) | Thailand | Four district hospitals in Nakhon Patthom province | n=206 (0.5 % female, age: M=36.8, SD=11.0) | Individual | Research counselors with a university degree in a health related background who received 4 d of training (practical approach, mainly addressed issues deemed essential for implementation of BI in clinic operations) | TG |
MI
BI (integrative for both alcohol and tobacco use): The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care (81) and Brief intervention for heavy drinking smokers by Kahler et al. [treatment provider training manual (115)] |
n/r | 3 sessions within a period of 3 weeks |
| CG1 | BI (alcohol use only): (81) | n/r | 3 sessions within a period of 3 weeks | ||||||
| CG2 | BI (tobacco use only): (115) | n/r | 3 sessions within a period of 3 weeks | ||||||
| Rendall-Mkosi et al. (94) | South Africa | Rural area in the Western Cape province (farms and six primary care clinics) | n=165 (all female, age: M=29.8, range: 18–44) | Individual | Locally recruited and trained lay counselors |
TG |
MI
Manual developed by the CHOICES (Changing High-risk Alcohol Use and Improving Contraception Effectiveness Study) Intervention Research Group (116) + Provision of information pamphlet on FAS prevention and woman’s health |
n/r | 5 sessions over 2 months |
| CG1 | Group-based life-skills training intervention: arm not completed due to logistic problems and poor adherence to the intervention | - | - | ||||||
| CG2 | Provision of information pamphlet (same as TG) | - | - | ||||||
| Segatto et al. (88) | Brazil | Three general emergency rooms in Southeastern Brazil | n=175 (17% female, age: M=21.8, SD=2,6 range: 16–25) | Individual | TG: senior psychologist previously trained according to the MI principles CG: 3 trained psychology-students (minimum Bachelor-level) |
TG |
MI
No manual specified; Intervention based on: preparing people to change addictive behavior (117) + educational brochure (same as CG) |
45 min | Single session |
| CG | Provision of a brochure on the risks of alcohol consumption and possible ways to consider reduction, was read by P. and discussed with facilitator | max. 5 min | Single session | ||||||
| Sheikh et al. (90) | Zambia | Chainama Hills Hospital in Lusaka | n=114 (3,5% female, age range: 18–53) | P. with at least one relative | 1 psychosocial counselor (training: n/r) |
TG |
MI + relative as co-therapist
WHO mhGAP Intervention Guide for Alcohol Problems (118) + relative as co-therapist (tasks: providing alternative activities to drinking, help P. to attend follow-up appointments, tell P. to remain abstinent, report to study team if they see signs of relapse) + detoxification with diazepam and vitamin supplem. |
20 min | Single session |
| CG | detoxification with diazepam and vitamin supplem. | – | – | ||||||
| Shin et al. (92) | Russia | Tomsk Oblast Tuberculosis Services | n=196 (18% female, age: M=40.1, SD=11.2) | Individual | TB physicians who received BI-training (including theoretical framework, specific cultural adaptations, videos of mock MI-sessions; competency assessed using role-plays), training on naltrexone, including the administration, dosing, side-effect management and contraindications | TG1 |
MI
Helping Patients who drink too much: A Health Practitioner’s Guide (119) adapted to the local context and modified to be implemented in routine TB Services |
10–15 min within the standard 45–60-min TB appointm. | 6 monthly sessions |
| TG2 | Administration of Naltrexone (NTX; daily single dose of 50 mg for 6 months) paired with focused intervention (no MI) | 5–10 min within the standard 45–60-min TB appointm. | 6 monthly sessions | ||||||
| TG3 |
MI
TG1 + TG2 |
15–25 min within the standard 45–60-min TB appointm. | 6 monthly sessions | ||||||
| CG | TAU: standard referral to and a narcologist only | standard 45–60-min TB appointm. | 6 monthly sessions | ||||||
| Sorsdahl et al. (98) b | South Africa | Emergency department in Cape Town | n=335 (34.5% female, age: M=28, range 18–75) | Individual | 5 peer counselors who received 18 h of training in MI by a MI-certified trainer (incl. proficiency testing), 3 half-day booster trainings to limit intervention drift, 12 h of training in Problem Solving Therapy (incl. proficiency testing), further training e.g. in substance use and associated risks | TG1 |
MI
The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care (81) |
20 min | Single session |
| TG2 |
MI + CBT elements
The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care (81) + Problem Solving Therapy (PST; CBT-approach, no manual specified) |
20 min per MI-session/45–60 min per PST-session | Single session MI + 4 weekly sessions of PST | ||||||
| CG | psychoeducation only (brochure providing information on the effects of substance use) | - | - | ||||||
| Wandera et al. (99) | Uganda | Clinic for Infectious Diseases within a public hospital in Kampala | n=337 (34.4% female, age range: 32–46) | Individual | Counselors (minimum bachelor’s degree) with >5 years of experience in HIV (but not alcohol) counseling who received training workshop on treatment administration (including role-play exercises) as well as a treatment manual | TG |
MI
MI (no manual specified) + Standard Positive Prevention counseling (SPP; education on HIV including risks of alcohol use and encouragement to reduce alcohol intake) |
30–60 min | Single session |
| CG | SPP: same as in TG | 10–30 min | Single session | ||||||
| Witte et al. (91) | Mongolia | National AIDS Foundation in Ulaanbaatar, within services for female sex workers | n=166 (all female, age: 9.6% <25 years) | Group (6–8 women) |
Female facilitators who received a standardized training | TG |
MI
MI (no MI-manual specified) + HIV sexual risk reduction (HIV-SRR) intervention adapted from a relationship-based HIV/STD prevention program for heterosexual couples (120), incl. alcohol use as a contributing factor to sexual risk |
90 min | 4 weekly sessions +2 additional MI-sessions |
| CG1 | HIV-SSR (same as TG) | 90 min | 4 weekly sessions | ||||||
| CG2 | wellness promotion (focus on relaxation, the importance of exercise and a healthy diet) | 90 min | 4 weekly sessions | ||||||
a
were information was available, number and professional background of facilitators as well as duration/intensity of training were reported.
b
for quantitative analyses, a subsample has been obtained from the author. The characteristics listed here describe the full sample as reported within the publication.
BI, brief intervention; CG, control group; TG, treatment group; EUC, enhanced usual care; TAU, treatment as usual; n/r, not reported; P, participant(s); STI, sexually transmitted infections.