LAUSR

BACKGROUND AND AIMS Low and middle-income countries (LMIC) have a disproportionately higher alcohol-attributable disease burden, in conjunction with a minimal focus on primary prevention. Screening and brief interventions can be a promising approach to address this problem. This systematic review aimed to perform a qualitative and quantitative synthesis of studies of brief interventions for harmful and hazardous alcohol use in LMIC. METHODS Systematic review of randomized controlled trials of brief interventions for harmful and hazardous alcohol identified from four electronic databases, conducted in any country identified as LMIC as per the World Bank. We measured differences in intervention and control groups on risk-scores using standard screening instruments, the frequency of heavy drinking, the drinking risk-level, or quality of life and other mental health-related outcomes. RESULTS A total of 14 studies were included, seven of them from South Africa. On standardized screening instruments, the brief intervention (BI) group had significantly lower scores than controls at 3 months (Hedges' g= - 0.34, P =0.04), but the effects did not persist at 6- and 12-month follow-up (g= - 0.06, P =0.68 and g= 0.15, P =0.41, respectively). There was little evidence to suggest that brief interventions led to changes in the frequency of heavy drinking or change in the risk level of alcohol use. Surprisingly, a single session (g= -0.55, P <0.001) fared better than multiple sessions (g= -0.03, P=0.85). A nurse delivered brief intervention (g= -0.44, P=0.02) showed better results than brief interventions delivered by others (g=-0.14, P=0.66), while the outcomes were similar for young adults and middle-aged people. CONCLUSION Brief interventions for alcohol use show some promise in low- and middle-income (LAMI) countries. Specifically, a single session, nurse-delivered brief intervention for harmful and hazardous alcohol use appears to show a small but significant positive effect in LAMI countries.