The burden of substance use disorders (SUDs) is heavy and growing, with alcohol being the fourth-highest cause of years lost-to-disability in low- and middle-income countries (LMICs). This burden could be substantially lightened by delivering high-quality, accessible, integrated SUD services at the primary care level. In Kenya and many other LMICs, there is little attention paid to SUDs during training or for continuing education due to challenges such as limited human and financial resources. This creates a primary care workforce ill-prepared to identify and treat those with SUDs. Our goal is to massively increase the accessibility of high-quality SUD training, and to evaluate the impact of this educational intervention. This is a first step in building capacity to address other mental health conditions all over the world, for any trainee with a computer and a willing mentor. This project tests NextGenU.org’s model of free, high-quality, computer-based learning with online and in-person mentored and peer activities to train Kenyan primary care workers about SUD.

To train large numbers of primary health care workers to successfully identify and treat substance use disorders in their practices through high-quality, globally-available, free-to-use, and low-cost to assemble, computer-, peer-, and mentor-supported learning.

1. Train professional and lay health workers on alcohol, tobacco, and other substance use disorders to increase access to SUD services in primary care in several districts in Kenya
2. Train clinical leaders in quality improvement and practice change to support the institutionalization of the interventions in practice in one district in Kenya
3. Provide the trainings worldwide for free
4. In public and private educational institutions and healthcare settings, evaluate the feasibility and impact of the SUD training (with and without the practice support training) on health care worker stigma, the availability and sustainability of the intervention, and patient outcomes

This is a developmental evaluation, with a pilot study and a randomized control trial (RCT) using qualitative methods (focus group discussions, key informant discussions, direct observation, and trainee journaling) and quantitative methods (comparison of trainees’ pre- and post-training levels of stigma, self-efficacy, knowledge, attitude, and practices); post-training online and in-person competency assessment. We also compared controls vs. brief intervention subjects for alcohol and other substance use, to assess impact of the intervention on consumption level, quality of life, and health services utilization.

Like all NextGenU courses, these courses are competency-based, with competencies adapted from the WHO Mental Health Gap Action Programme (mhGAP) and the WHO ASSIST manuals. Course resources come from world-class academic and governmental organizations such as the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA), National Institute on Drug Abuse, World Health Organization, and the World Medical Association. The aim of the courses are to enable health workers to:
1. Identify those with substance use disorders;
2. Provide care to those with substance use disorders with appropriate and ethical care and non-judgmental attitude and communication;
3. Use clinical brief intervention techniques;
4. Assist in identifying and managing co-morbidities;
5. Provide basic psychological and pharmaceutical treatment;
6. Assist patients and families with self-help strategies;
7. Determine the need for, and feasibility of referral and follow-up; and
8. Support primary care sites to implement those interventions in practice in a sustainable and scalable manner. This course is cosponsored by the Africa Mental Health Foundation, the Annenberg Physician Training Program in Addiction Medicine, and the University of Florida.
End date: September 2015