Set-up phase
The first 18 months of the project was the set-up phase, with the following undertaken: (i) full adaptation, tailoring and preparation of all clinical and training materials available in English and Spanish languages with variants for Colombia, Mexico and Peru; (ii) recruitment of 58 primary health care centres; (iii) appointments of stakeholder members and meetings of Community Advisory Boards; (iv) full identification and preparation of municipal support mechanisms and community-based communication campaigns; and, (v) finalization and testing of all instruments required for evaluation.
First implementation phase and adaptation due to COVID
The second 18 months of the project was the implementation phase, with the following undertaken: (i) completed the one-month baseline measurement period; (ii) delivered pre-implementation training to providers in Arms 2, 3 and 4; (iii) completed at least five months of full 18-month implementation period in all countries before impact of COVID-19 mitigation measures; (iv) maintained partial implementation during the months of March to November 2020, providing primary health care centres with mental well-being support and resilience training; (vi) tailored and adapted all clinical interventions and protocols, community support mechanisms, communication campaigns and measurement instruments in face of COVID-19 mitigation measures; (vii) developed and delivered online training programme for primary health care providers; and, (viii) developed tele-medicine approaches for measurement and advice giving to continue programme in Peru.
Extended implementation phase and completion of project
The last 12 months of the project was the completion and exploitation phase, with the following main results:
(i) completion and availability on project website of all materials required for implementation and scale-up;
(ii) demonstration that training increases the proportion or patients whose alcohol consumption is measured 13-fold, and the proportion of heavy drinking patients assessed for depression three-fold.
(iii) demonstration that community support increases the proportion or patients whose alcohol consumption is measured by a further 28% over and above training, with no further increase in the proportion of heavy drinking patients assessed for depression.
(iv) estimated the cost to implement the programme at int$3 per person whose alcohol consumption was measured, with a return on investment in saved hospital admission of 1.8.
(v) identified the main facilitators of success as strong leadership at the centre level, a high level of motivation of providers at the outset, strong views of self-efficacy at the outset, simple and easy-to-use clinical packages, and a supportive organisational or broader policy environment.
(vi) presented the SCALA Framework for asking and advising about alcohol in primary health care at municipal level.
(vii) actioned sustainability plans in each country with local and national health authorities, and, more broadly, with the Pan-American Health Organization.
