JMIR Publications

ABSTRACT

Background:

Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMIC), the World Health Organization has launched an e-health portal that includes the Web-based self-help program “Alcohol e-Health”.

Objective:

To test the effectiveness of this program in a randomized controlled trial.

Methods:

Ours was a two-arm individually-randomized and controlled trial, across four LMIC, that compared this self-help program and a psycho-education and Internet-access-as-usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with time frame of six months between baseline and 6-month follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week, and cessation of harmful or hazardous drinking (AUDIT < 8).

Results:

For this study, we recruited 1’400 predominantly male (70.1%) at least harmful or hazardous alcohol drinkers, mean age 37.6 years (SD=10.5), from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall complete case analysis identified higher AUDIT changes in the intervention group (SD=7.1; B=-4.18, 95% CI: -5.42 to -2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=-9.34, 95% CI: -15.90 to -2.77, P<.005, d=0.28) and cessation rates for harmful or hazardous drinking (Χ2(1, N=561)=14.56, P<.001). The supplementary ITT analyses largely confirmed these initial results.

Conclusions:

The expansion of the Alcohol e-Health program to other LMIC countries with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results. Clinical Trial: This study is registered at ISRCTN (trial number ISRCTN14037475).