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Cited by 21Substance Abuse Treatment and OutcomesMental Health Treatment and AccessHealth Policy Implementation Science

Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review

Open access
Mushi, Dorothy, Francis, Joel M., Moshiro, Candida, Hanlon, Charlotte, Teferra, Solomon·2022·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2022.822791PMC PMC8964495
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Abstract

Introduction: Alcohol use disorder (AUD) is among the leading cause of morbidity and mortality in sub-Saharan Africa. Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap. Integrating services for mental, neurological, and substance use disorders in general health care settings is among the recommended strategies to narrow this treatment gap. This scoping review aimed to map the available evidence on integration of AUD interventions in general health care settings in sub–Saharan Africa. Methods: We searched four databases (PubMed, PsycINFO, CINAHL, and Africa Wide Information) for publications up to December 2020. The search strategy focused on terms for alcohol use, alcohol interventions, and sub-Saharan African countries. Studies that reported AUD interventions in general health care settings in sub–Saharan Africa were eligible for inclusion. Over 3,817 potentially eligible articles were identified. After the removal of duplicates and screening of abstracts, 56 articles were included for full article review. Of these, 24 papers reporting on 22 studies were eligible and included in a narrative review. Results: Of the 24 eligible articles, 19 (80%) described AUD interventions that were being delivered in general health care settings, 3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities, and 2 (8%) studies reported on AUD interventions integrated into general health care settings. Conclusions: This review shows that there is limited evidence on the integration of AUD interventions in health care settings in sub-Saharan Africa. There is an urgent need for studies that report systematically on the development, adaptation, implementation, and evaluation of integrated AUD interventions in health care settings in sub-Saharan Africa.

AI snapshot

Written from the paper’s full text.

TL;DR

This scoping review maps evidence on integrating alcohol use disorder (AUD) interventions into general health care settings in sub-Saharan Africa and finds limited evidence, with only two studies reporting integration status. The authors call for systematic studies on development, adaptation, implementation, and evaluation of integrated AUD interventions in the region.

Key findings

  • Of 24 eligible articles, 19 (80%) described AUD interventions delivered in general health care settings, 3 (12%) described plans or programs for integrating AUD interventions, and 2 (8%) reported on AUD interventions integrated into general health care settings.
  • The review found only two studies that described and reported on the integration status of AUD interventions in general health care settings in sub-Saharan Africa.
  • Reported intervention types included motivational interviewing techniques (n = 15), identification of alcohol use (n = 8), cognitive behavior therapy (n = 3), risk/behavioral reduction counseling (n = 1), and problem-solving skills (n = 1).
  • Most included studies were randomized controlled trials (n = 15), followed by mixed-method designs (n = 7), cohort study (n = 1), and cross-sectional survey (n = 1); most were conducted in southern Africa (n = 12) and eastern Africa (n = 10).

Methods

  • Scoping review guided by Arksey and O’Malley’s framework and reported using PRISMA-ScR; integration was defined based on WHO technical report as AUD services/interventions integrated into the work of general health care workers in general health care settings.
  • Searched PubMed, PsycINFO, CINAHL, and Africa Wide Information from database inception to December 2020; included studies of any methodology reporting AUD interventions among people attending general health care facilities in sub-Saharan Africa, excluding specialist-setting studies and systematic reviews/meta-analyses.
  • From 6,415 citations, 2,598 duplicates were removed, 3,817 titles/abstracts were screened, 56 full articles were reviewed, and 24 papers reporting on 22 studies were included in a narrative review.

Limitations

  • The authors state they could not document policy-level examples of AUD integration and did not search gray literature, largely due to feasibility and concerns about online availability, URL/website stability, archiving, and inconsistent format/citation information.
  • The authors state it is likely that other examples of AUD integration in general health care exist but have not been reported and therefore could not be detected.
  • Evident from the text: most included studies could not be confirmed as integrated into services, only two studies reported integration status, and the included studies were concentrated in southern and eastern Africa, limiting regional coverage.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyt.2022.822791

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 59 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Of the 24 eligible articles, 3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities.

    “3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities”
    Quote in the paperNot a substantial claim
  • Findingnone given

    There is a paucity of studies on integrated interventions for AUD in general health care settings in sub-Saharan Africa.

    “This review has highlighted the paucity of studies on integrated interventions for AUD in general health care settings in sub-Saharan Africa.”
    Quote in the paperSubstantial claim
  • Findingown data

    Of the 24 eligible articles, 19 (80%) described AUD interventions delivered in general health care settings.

    “Of the 24 eligible articles, 19 (80%) described AUD interventions that were being delivered in general health care settings”
    Quote in the paperSubstantial claim
  • Findingown data

    Only two of the 24 eligible studies reported on the integration status of AUD interventions in general health care settings in sub-Saharan Africa.

    “2 (8%) studies reported on AUD interventions integrated into general health care settings.”
    • Also stated in: § Discussion · plain
      “In this review, we found only two studies that described and reported on the integration status of AUD interventions in general health care settings in SSA (7, 57).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Peltzer, 2008, Evaluation of alcohol screening and brief intervention in routine practice of primary care nurses in Vhembe district, South Africa, Croat Med J. source

      Not checked in the free run.

    • cites [57] Cagle, 2017, Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi, Kenya, AIDS Care. source

      Not checked in the free run.

  • Findingcitation

    The included studies identified individual and structural bottlenecks for implementing integrated mental health services including AUD.

    “In addition, these studies identified individual and structural bottlenecks for implementing integrated mental health services including AUD (36, 38).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [36] Gureje, 2015, Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action program intervention guide, BMC Health Serv Res source

      Not checked in the free run.

    • cites [38] Petersen, 2016, Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan, Br J Psychiatry source

      Not checked in the free run.

  • May combine two claims. 15
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Findingcitation

    The included studies reported implementation strategies: engaging mental health stakeholders from inception, conducting sensitization workshops, training clinical staff, supervising decision support and supporting staff well-being, and leveraging available resources and existing systems.

    “The following implementation strategies were reported: (i) engaging mental health stakeholders from inception to enhance their ownership and commitment, (ii) conducting sensitization workshops (37, 38), (iii) training clinical staff (36–38), (iv) supervising decision support and supporting staff well-being (3–37, 59), and leveraging available resources and existing systems (36–38).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [37] Fekadu, 2016, Development of a scalable mental healthcare plan for a rural district in Ethiopia, Br J Psychiatry source

      Not checked in the free run.

    • cites [38] Petersen, 2016, Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan, Br J Psychiatry source

      Not checked in the free run.

    • cites [36] Gureje, 2015, Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action program intervention guide, BMC Health Serv Res source

      Not checked in the free run.

    • cites (3–37, 59)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of 3,817 screened citations, 56 were selected for full article review.

    “We screened titles and abstracts of 3,817 citations and identified 56 citations for full article review.”
    • Also stated in: § Methods · plain
      “After the removal of duplicates and screening of abstracts, 56 articles were included for full article review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most studies were of AUD interventions integrated within HIV care or services for other sexually transmitted diseases (n = 10), or in general clinical services (n = 10), with the remainder in emergency services (n = 3) and tuberculosis care/clinics (n = 1).

    “Most studies were of AUD interventions integrated within HIV care or services for other sexually transmitted diseases (n = 10), or in general clinical services (n = 10), with the remainder conducted in the context of emergency services (n = 3) and tuberculosis care/clinics (n = 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The search yielded 6,415 citations, of which 2,598 (40%) were duplicates.

    “The review yielded 6,415 citations, out of which 2,598 (40%) were duplicates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Integrated interventions for AUD in general health care settings included routine screening or inquiring about AUD (n = 1) and screening and brief intervention for AUD (n = 1).

    “This included routine screening or inquiring about alcohol use disorder (n = 1), and screening and brief intervention (SBI) for AUD (n = 1) (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most studies were implemented in the southern African region (n = 12) and eastern region (n = 10), with two studies in the central region and one in the western region.

    “Most of the studies were implemented in the southern African region (n = 12) and eastern region (n = 10), with two studies conducted in the central region, and one in the western region.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of 56 full articles, 32 were excluded because they did not report AUD interventions or reported AUD interventions from settings other than general health care.

    “Of these, we excluded 32 articles that did not report on AUD interventions or reported on AUD interventions from settings other than general health care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most studies were published from 2010 to 2020 (n = 20), three from 2000 to 2010, and one before 2000.

    “Most studies were published from the years 2010 to 2020 (n = 20), while three studies were reported from the years 2000 to 2010. Only one study was published before the year 2000.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most included studies were randomized controlled trials (n = 15), followed by mixed-method study designs (n = 7), cohort study design (n = 1), and cross-sectional survey (n = 1).

    “Most of the studies were randomized controlled trials (n = 15), followed by mixed-method study designs (n = 7), cohort study design (n = 1), and cross-sectional survey (n = 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Programs for integrated AUD interventions included district mental health plans (n = 2) and a program intervention guide (n = 1) for integrated mental health services that included AUD.

    “This included district mental health plans (n = 2) and a program intervention guide (n = 1) for integrated mental health services that included AUD (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    AUD is often not detected by health care providers in sub-Saharan Africa, contributing to a wide treatment gap.

    “Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap.”
    • Also stated in: § Introduction · hedged
      “Even though the magnitude and factors associated with AUD are substantial, AUD appears to be rarely detected by health care providers (11) leading to a wide treatment gap (9, 11–13).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [11] Rathod, 2016, Treatment contact coverage for probable depressive and probable alcohol use disorders in four low- and middle-income country districts: the PRIME cross-sectional community surveys, PLoS ONE source

      Not checked in the free run.

    • cites [9] Zewdu, 2019, Treatment gap, help-seeking, stigma and magnitude of alcohol use disorder in rural Ethiopia, Subst Abuse Treat Prev Policy. source

      Not checked in the free run.

    • cites [12] Luitel, 2017, Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal, PLoS ONE source

      Not checked in the free run.

    • cites [13] Kohn, 2004, The treatment gap in mental health care, Bull World Health Organ.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study was guided by Arksey and O'Malley's scoping review methodological framework.

    “This study was guided by Arksey and O'Malley's (39) scoping review methodological framework.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Arksey, 2005, Scoping studies: towards a methodological framework, Int J Soc Res Methodol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study team followed the PRISMA-ScR checklist and explanation.

    “Furthermore, the study team followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation (40).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Tricco, 2018, PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation, Ann Int Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Interventions for AUD have been reported in various general health care settings in sub-Saharan Africa, including HIV or sexually transmitted disease services, antenatal and postnatal care, tuberculosis care, and inpatient and outpatient care.

    “In SSA, interventions for AUD have been reported in various general health care settings (3, 17–27), including services for people with HIV or other sexually transmitted diseases (9, 10, 13–16, 18, 21), antenatal and postnatal care (19, 27–29), care for people with tuberculosis (30, 31), inpatient and outpatient care (20, 26, 32–35).”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [3] Parry, 2016, Heavy alcohol use in patients on highly active antiretroviral therapy: What responses are needed?, S Afr Med J. source

      Not checked in the free run.

    • cites [17] Jaquet, 2017, Alcohol use, viral hepatitis, and liver fibrosis among HIV-positive persons in West Africa: a cross-sectional study, J Int AIDS Soc. source

      Not checked in the free run.

    • cites [18] Soboka, 2014, Alcohol use disorders and associated factors among people living with HIV who are attending services in southwest Ethiopia, BMC. source

      Not checked in the free run.

    • cites [19] Sania, 2017, Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study, BMJ Open source

      Not checked in the free run.

    • cites [20] Bhana, 2017, Characteristics and correlates of alcohol consumption among adult chronic care patients in North West Province, South Africa, S Afr Med J source

      Not checked in the free run.

    • cites [21] Wandera, 2015, Alcohol consumption among HIV-infected persons in a large urban HIV clinic in Kampala Uganda: a constellation of harmful behaviors, PLoS ONE source

      Not checked in the free run.

    • cites [22] Medley, 2014, Alcohol use and its association with HIV risk behaviors among a cohort of patients attending HIV clinical care in Tanzania, Kenya, and Namibia, AIDS Care source

      Not checked in the free run.

    • cites [23] Martinez, 2008, Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in Southwest Uganda, AIDS Behav source

      Not checked in the free run.

    • cites [24] Hahn, 2014, Decreases in self-reported alcohol consumption following HIV counseling and testing at Mulago Hospital, Kampala, Uganda, BMC Infect Dis source

      Not checked in the free run.

    • cites [25] Kalichman, 2007, HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in cape town, South Africa, J Acquir Immune Defic Syndr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the WHO report, treatment coverage for AUD is low and national alcohol policies are scarce in sub-Saharan Africa.

    “In that WHO report, treatment coverage for AUD is low and national alcohol policies are scarce in SSA.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2018

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The strategies identified to facilitate implementation of AUD components of integrated mental health care include methods to improve detection, support decision making, improve staff wellbeing, and ensure proper program management and supportive supervision.

    “These strategies included methods to improve detection, support decision making, improve staff wellbeing, and ensure proper program management and supportive supervision (36–38).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [36] Gureje, 2015, Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action program intervention guide, BMC Health Serv Res source

      Not checked in the free run.

    • cites [37] Fekadu, 2016, Development of a scalable mental healthcare plan for a rural district in Ethiopia, Br J Psychiatry source

      Not checked in the free run.

    • cites [38] Petersen, 2016, Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan, Br J Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    It is likely that other examples of integration of AUD interventions in general health care exist but have not been reported and therefore could not be detected by this scoping review.

    “It is likely that other examples of integration of AUD interventions in general health care exist but have not been reported and, therefore, could not be detected by this scoping review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two reviewers independently screened titles and abstracts and then full articles, with disagreements resolved by joint discussion.

    “Two reviewers (DM and JF) independently screened the titles and abstracts of citations identified through the search strategy, and thereafter full articles, to select studies that met inclusion criteria. Disagreements between the screeners were resolved by a joint discussion, without the need for the involvement of senior co-investigators.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A pre-tested data extraction form was used, pre-tested with five articles.

    “A pre-tested data extraction form was used to extract the information needed for this review. A pre-test was conducted with five articles to assess if all the required information would be captured.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The review's findings align with a previous review on strategies to facilitate integrated care for people with alcohol problems.

    “These findings align with a previous review on strategies to facilitate integrated care for people with alcohol problems (63).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Savic, 2017, Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review, Subst Abuse Treat Prev Policy source

      Not checked in the free run.

20 of 20

  • The paper relies on this without support.

    AUD is among the leading causes of morbidity and mortality in sub-Saharan Africa.

    “Alcohol use disorder (AUD) is among the leading cause of morbidity and mortality in sub-Saharan Africa.”

  • The paper relies on this without support.

    Evidence on the integration of AUD interventions into general health care settings in sub-Saharan Africa has not been synthesized.

    “However, evidence on the integration of AUD interventions into general health care settings has not been synthesized.”

  • The paper relies on this without support.

    No previous review on integration of interventions for people with AUD attending general health care facilities in sub-Saharan Africa had been conducted.

    “The rationale for this was that no previous review on integration of interventions for people with AUD attending general health care facilities in SSA had been conducted.”

  • The paper relies on this without support.

    Older studies would still have potential relevance.

    “We also anticipated that older studies would still have potential relevance.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • This finding is similar to those reported in two scoping reviews conducted to map literature on BIs in Africa, both of which found that most of the research had been conducted in Southern and Eastern Africa.

    “This finding is similar to those reported in two scoping reviews conducted to map literature on BIs in Africa. Both studies found that most of the research had been conducted in Southern and Eastern Africa [119,120].”

    From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [120]

    The Results section reports that most included studies were conducted in Southern (n = 12) and Eastern Africa (n = 10). However, the Methods describe a review of alcohol use disorder interventions integrated into general health care, not a review limited to brief interventions (BIs); the geographic finding therefore applies to a broader set of studies than the claim suggests. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Petersen publication year differs from the cited reference

    Minor

    Table 2 lists Petersen et al. as published in 2018, whereas reference 38 gives 2016.

  • Harder publication year differs from the cited reference

    Minor

    Table 1 lists Harder et al. as published in 2019, whereas reference 55 gives 2020.

  • Wandera publication year differs from the cited reference

    Minor

    Table 1 lists the Wandera article as published in 2017, but reference 21 gives its publication year as 2015.

  • Fekadu publication year differs from the cited reference

    Minor

    Table 2 lists Fekadu et al. as published in 2018, whereas reference 37 gives 2016.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. 2018, Global Status Report on Alcohol and Health
  2. Rotheram-Borus, 2015, Alcohol use, partner violence, and depression: a cluster randomized controlled trial among urban South African mothers over 3 Years, Am J Prev Med, 49, 715, 10.1016/j.amepre.2015.05.004 · DOI · Paper page
  3. Integrated Health Services What and Why

Cited by

Sorted by citations

Authors
Mushi, D., Francis, J. M., Moshiro, C., Hanlon, C., & Teferra, S.
Affiliations
  • Muhimbili University of Health and Allied Sciences (TZ)
  • King's College London (GB)
  • Addis Ababa University (ET)
Corresponding author
Mushi, Dorothy
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2022-03-15
Volume
13
Pages
822791-822791
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2022.822791
PMC
PMC8964495
OpenAlex
W4220807189
Semantic Scholar
64150d49671ed91d4fc98e0c82c5dbd31095c4b1
Cited by
21
References
60
Citations by year
2026: 1 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 1
FWCI
0.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Addis Ababa University
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
alcoholism, integrated care, treatment gap, mental health integration, sub-Saharan Africa

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