Advancing Research to Reduce Alcohol Related Harms -Lessons for Policy, Practice and Sustainable Development in India

Background Hazardous/harmful drinking are major contributors to morbidity, mortality and disability across the world. India, and other low- and middle-income countries (LMICs), are experiencing a steady increase in alcohol consumption and hazardous/harmful drinking. 86% of such individuals in India do not have access to any kind of care for their drinking problems, the highest treatment gap amongst all mental and substance use disorders. There is robust evidence of the effectiveness of psychosocial treatments for drinking problems, there remains a gap in the understanding of (a) integrated interventions that can be used to respond to the whole spectrum of drinking problems, (b) providing care for difficult to engage hazardous/harmful drinking individuals, and (c) effective implementation models to scale up such treatments. Hence, we have been unable to translate to implementation at scale, most commonly due to the lack of contextually relevant interventions and capacity of the health systems to integrate the evidence-based interventions. Aims The overarching goal of my programme is to guide the translation of research evidence in LMICs informed by evidence generated through a series of studies aimed at (a) developing, and implementing a contextually relevant, scalable and integrated intervention for hazardous and harmful drinking, and (b) identifying and disseminating contextually-relevant health systems strengthening processes to aid implementation in low resource settings. I will leverage the studies described below as exemplars to develop a research translation guidance document suitable for use in low resource settings. Methods Study 1 (Development of Alcohol Problems Treatment Plus (APT+)): Using systematic and evidence-based intervention development processes I will integrate interventions developed in the study setting into a single integrated intervention (APT+). The process will include consultations with various stakeholders such as expert clinicians, individuals with drinking problems, and family members; followed by evaluation of acceptability and feasibility through treatment cohorts using process evaluation and in-depth interviews with the various stakeholders. Study 2 (Integrated Care for Alcohol Problems): hybrid effectiveness-implementation RCT with two arms comparing treatment as usual (TAU) with APT+. Study 3 (IMPRESS): hybrid implementation cluster RCT which will compare two task-sharing models for delivering a psychological intervention by non-specialist health workers, i.e. as a stand-alone intervention in public-sector primary care clinics versus being integrated with an evidence-based community intervention delivered by community based agents aimed at increasing demand for care and improving treatment adherence and effectiveness. Study 4 (Bench to Bedside-B2B): I will systematically review lessons learnt from ICAP and IMPRESS and consolidate them into strategies using a systematic process which includes triangulation of data from nested qualitative studies and process data from the two studies, Delphi process with implementation science experts, and semi-structured interviews with key stakeholders, including policymakers. Community engagement/Dissemination A range of community stakeholders will actively contribute to the intervention development and/or implementation and testing as equal partners. Through rapid feedback loops integrated into the study design; and involving participatory research and dissemination through various channels, we will ensure that the study outputs are responsive to inputs and felt needs of the communities in which they will be implemented.