Digital interventions for alcohol use and alcohol use disorders in low- and-middle-income countries: a systematic review.

Background: Despite the high burden of alcohol use and alcohol use disorders (AUDs) in low-and-middle-income countries (LMICs), access to health care is poor. Digital interventions (DIs) have recently emerged as promising avenues for addressing substance use. Such interventions could potentially address barriers to help-seeking in LMICs, such as travel costs, shortage of professionals, stigma, etc. Aim: To synthesize evidence on the effectiveness and implementation of DIs for AUDs in LMICs. Methods: The systematic review had a comprehensive search strategy that combined search terms for DIs (e.g. SMS, eHealth), alcohol use (e.g. hazardous drinking) and LMICs (e.g. India). Studies presenting primary data that reported effectiveness (e.g. relapse) and/or implementation or intervention-related outcomes (e.g. feasibility) of DIs for AUDs in LMICs were eligible. Three databases (EMBASE, MEDLINE and PsycINFO) were searched from their inception till June 2023. Data was extracted in relevant categories and analysed. Results: Twenty-one reports from 19 studies were included. Types of DIs ranged from standalone mobile applications and web portals to human-delivered interventions via digital platforms. 12 studies reported positive or partially positive alcohol use outcomes (e.g. number of drinking days, abstinence). DIs with human involvement were found to be more effective than standalone DIs. Additionally, high levels of acceptability, feasibility and satisfaction were reported across interventions. Conclusion: DIs are acceptable and feasible in LMICs and broadly effective in improving alcohol use outcomes. Firm conclusions could not be drawn because of methodological issues such as small sample sizes, short follow-up periods and limited generalisability. Adequate investment, improved research methodology and increased focus on implementation outcomes are required for determining the role that DIs can play in addressing AUDs in LMICs.