Two-Year Outcomes of a Brief Intervention to Reduce Harmful Alcohol Use for Emergency Department Injury Patients

In a pragmatic trial, a culturally adapted brief negotiational interview (BNI), "Punguza Pombe Kwa Afya Yako" (PPKAY) and text-based boosters promoting alcohol reduction significantly reduced binge-drinking among injury patients who presented at the emergency department (ED) with alcohol use disorder (AUD) at 3 months post-discharge. This finding is encouraging for health facilities in sub-Saharan settings where AUD is one of the leading causes of ED visits, and treatment options are limited. Using data from additional follow-up assessments, this study aims to examine the long-term sustainability of the intervention's effectiveness for over two years post-discharge.

This was a randomized controlled trial conducted at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Adult injury patients with prior alcohol use or AUD were enrolled at the ED. They were randomly assigned to one of three arms: standard treatment, PPKAY with standard texts, or PPKAY with personalized texts. The intervention's impact was evaluated using mixed effects, zero-inflated negative binomial models, with effects presented as predicted means. The primary outcome measure was the self-reported number of binge-drinking days in the last 28 days assessed at baseline, 3-, 6-, 9-, 12-, and 24-months post-discharge.

A total of 513 patients were enrolled and randomized: 171 to standard care, 168 to PPKAY with standard texts, and 174 to PPKAY with personalized texts. Throughout the follow-up period, patients in the intervention arms reported lower binge-drinking compared to the standard care arm, but these differences were not statistically significant except for the last timepoint. At 24 months, we observed a significant reduction in binge-drinking in both intervention arms compared to control, PPKAY with standard texts: (predicted mean difference: 0.5 days [95% CI: -1.1, -0.02], p=0.043), and PPKAY with personalized texts (0.7 days [95% CI: -1.2, -0.1], p=0.012).

This exploratory analysis showed that PPKAY, a brief ED based intervention, has potential for long-term benefit of reducing binge-drinking events among injury AUD presenting at ED. Future studies with adequate power to assess long-term effects are necessary to provide definitive evidence and to explore the implementation of the intervention in other populations.