TY - JOUR
T1 - Adaptation of a model for integration of interventions for alcohol use disorders in primary health care in Tanzania
AU - Mushi, Dorothy
AU - Hanlon, Charlotte
AU - Francis, Joel M
AU - Candida, Moshiro
AU - Demissie, Mekdes
AU - Teferra, Solomon
N1 - Funding Information: DM acknowledges support from the Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), a World Bank Africa Centre of excellence at Addis Ababa University, as part of her training fellowship. The opinions in this paper are those of the authors and do not reflect the views of CDT-Africa. CH receives support from the National Institute of Health Research through the NIHR Global Health Research Group on Homelessness and Mental Health in Africa (NIHR134325) and the SPARK project (NIHR200842) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CH receives support from the Wellcome Trust through grants 222154/Z20/Z and 223615/Z/21/Z. Funding Information: We gratefully acknowledge the support from the administrative offices in the Kilimanjaro Region and the Moshi district council. Our appreciation should also go to the Ministry of Health, Kilimanjaro region, and Moshi district council representatives. Moreover, to the religious and community leaders, representatives, primary health care in-charges, and staff in the Moshi district council. Muhimbili University of Health and Allied Sciences and the Muhimbili National Hospital mental health specialists. Funding Information: We gratefully acknowledge the support from the administrative offices in the Kilimanjaro Region and the Moshi district council. Our appreciation should also go to the Ministry of Health, Kilimanjaro region, and Moshi district council representatives. Moreover, to the religious and community leaders, representatives, primary health care in-charges, and staff in the Moshi district council. Muhimbili University of Health and Allied Sciences and the Muhimbili National Hospital mental health specialists. Publisher Copyright: © 2023, The Author(s).
M1 - 106
PY - 2023/4/21
Y1 - 2023/4/21
N2 - BACKGROUND: Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels.METHODS: A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC.RESULTS: A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored.CONCLUSIONS: The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
AB - BACKGROUND: Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels.METHODS: A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC.RESULTS: A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored.CONCLUSIONS: The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
KW - Humans
KW - Alcoholism/epidemiology
KW - Tanzania/epidemiology
KW - Primary Health Care/methods
KW - Delivery of Health Care
KW - Mental Health
U2 - 10.1186/s12875-023-02061-1
DO - 10.1186/s12875-023-02061-1
M3 - Article
SN - 2731-4553
VL - 24
JO - BMC Primary Care
JF - BMC Primary Care
IS - 1
M1 - 106
ER -