Implementation of a culturally adapted alcohol screening, brief intervention and referral to treatment (SBIRT) program in Cameroon.

About This Grant

Alcohol use is a major contributor to injury burden worldwide and remains an important public health challenge in the United States (US), particularly in underserved regions with limited access to trauma and behavioral health services. Cameroon, like other Sub-Saharan African countries, is disproportionately affected by alcohol- related injuries (ARIs), with higher injury burden and alcohol consumption than neighboring countries. Similar barriers to integrating alcohol use disorder (AUD) interventions into trauma care also persist in low-resource trauma settings in the US, where workforce shortages and constrained trauma systems limit delivery of evidence-based AUD care. As involvement in an ARI significantly increases the risk of subsequent ARIs, failure to address AUD in injured patients currently represents a missed opportunity for both AUD treatment and injury prevention. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) model is an evidence-based intervention used in emergency departments (EDs) in high-income countries, including the US, to identify and address AUD. However, implementation of SBIRT remains inconsistent in US resource- limited trauma settings due to staffing, workflow, and infrastructure barriers. Cameroon provides a unique opportunity to evaluate scalable SBIRT implementation strategies in a severely resource-constrained trauma system where AUD services are limited but where strong trauma research infrastructure and pilot data already exist. The long-term goal of this project is to reduce the burden of ARIs by leveraging research infrastructure in Cameroon to develop scalable evidence-based models for integrating AUD interventions into trauma systems. The overall objective is to evaluate the feasibility and effectiveness of a Cameroon-adapted SBIRT intervention in the ED setting. We hypothesize that the adapted SBIRT intervention will significantly reduce hazardous alcohol use among trauma patients. To achieve this objective, the study will pursue three aims: 1) train ED healthcare providers on a Cameroon-adapted SBIRT program; 2) evaluate feasibility, acceptability, and fidelity of SBIRT implementation in the Cameroonian ED context; and 3) evaluate effectiveness of SBIRT implementation in reducing hazardous drinking behaviors and PEth biomarker levels. This study will leverage implementation science methods to evaluate real-world implementation and scalability of SBIRT in a resource- constrained trauma system. Findings from this work may inform scalable implementation approaches for underserved trauma settings in the US, including rural hospitals and trauma deserts with limited access to integrated AUD care, while also supporting broader implementation across low-resource settings globally.