Adaptation of a model for integration of interventions for alcohol use disorder in primary health care in Tanzania

Abstract 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 The consensus long-term outcome of the Theory of Change map is to improve the physical, mental health, and social well-being of people treated for AUD to increase productivity in the community. Necessaryinterventions for the community were identified as awareness-raising, improving access to care, community engagement, and resource mobilization. Facility interventions included capacity building to strengthen staff competencies and supportive supervision. Organizational level interventions included strengthening infrastructure for the mental health service delivery system and financing. Identified facilitators for implementing the intervention packages were leveraging existing health system resources and recognizing that mental health was part of PHC. Potential barriers included an under-resourced health system, reflected in an inadequate number of HCPs in the community and facility and inadequate prioritization of mental health care. Conclusions The intervention packages for an adapted model for integrating AUD interventions in PHC in Tanzania have been identified, as well as their potential barriers and facilitators to the feasibility of implementation. There is a need to pilot the adapted model to inform plans for wider implementation or scaling up.