Preventing Harmful Alcohol Use Among Trauma Patients in Cameroon

June 27, 2026 updated by: Serge Ngekeng, University of Buea

Implementation of a Culturally Adapted Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Program in Cameroon

**Brief Summary**

Alcohol use is a major contributor to injury burden in Cameroon, particularly among trauma patients presenting to emergency departments. Despite the strong association between alcohol use and injury, structured alcohol screening and intervention programs are not routinely integrated into trauma care in Cameroon. This study aims to evaluate a Cameroon-adapted Screening, Brief Intervention, and Referral to Treatment (SBIRT) program for trauma patients at the Limbe Regional Hospital.

The study will be conducted in three phases: (1) training emergency department healthcare providers on a culturally adapted SBIRT program; (2) evaluating the feasibility, acceptability, and fidelity of SBIRT implementation in routine emergency care; and (3) assessing the effectiveness of SBIRT in reducing harmful alcohol use among trauma patients. Healthcare workers will be trained to deliver SBIRT, and eligible trauma patients screening positive for risky alcohol use will be enrolled in a randomized waitlist-controlled trial. Participants will undergo alcohol screening using validated tools and will be followed for six months. Outcomes will include alcohol use measured by the Alcohol Use Disorders Identification Test (AUDIT), phosphatidylethanol (PEth) biomarker levels, referral uptake, implementation outcomes, and patient well-being measures.

The study is expected to generate evidence on the feasibility and effectiveness of integrating alcohol interventions into trauma care in a low-resource setting and inform future scale-up of SBIRT programs in Cameroon and similar settings.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

**Detailed Description**

Alcohol use is a major contributor to the burden of injury in Cameroon and other low- and middle-income countries (LMICs). Studies conducted in Cameroon have demonstrated high levels of alcohol use among road users and trauma patients, with substantial proportions of injured patients reporting recent alcohol consumption or testing positive for alcohol at the time of injury. Harmful alcohol use is associated with increased risk of injury, injury recurrence, disability, and mortality. Despite this burden, systematic alcohol screening and intervention services are not routinely integrated into trauma care in Cameroon.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach designed to identify individuals with risky alcohol use, provide brief counseling to promote behavior change, and facilitate referral to treatment when indicated. SBIRT has been successfully implemented in emergency departments and trauma centers in high-income countries and has demonstrated effectiveness in reducing harmful alcohol use and alcohol-related consequences. However, little is known about the feasibility, acceptability, and effectiveness of SBIRT in resource-constrained emergency care settings in sub-Saharan Africa.

The purpose of this study is to evaluate a Cameroon-adapted SBIRT program implemented within the Emergency Department of the Limbe Regional Hospital. The intervention was developed through a participatory adaptation process involving emergency department clinicians, mental health providers, trauma researchers, implementation scientists, and other stakeholders to ensure cultural appropriateness and operational feasibility within the Cameroonian healthcare context.

The study has three primary objectives: (1) to train emergency department healthcare providers in delivery of a Cameroon-adapted SBIRT program; (2) to evaluate the feasibility, acceptability, adoption, and fidelity of SBIRT implementation in routine emergency care; and (3) to evaluate the effectiveness of SBIRT in reducing harmful alcohol use among trauma patients.

The study will be conducted in phases. During the preparatory phase, stakeholders will be engaged to refine implementation procedures and pretest the training curriculum. Emergency department healthcare workers, including physicians, nurses, and mental health nurses, will then undergo structured training on alcohol screening, motivational interviewing, brief intervention delivery, and referral procedures. Following training, a transition period will be used to integrate SBIRT into routine emergency department operations and optimize implementation workflows before initiation of full study enrollment.

All eligible adult trauma patients presenting to the Emergency Department will be screened for alcohol use using the Single Alcohol Screening Question (SASQ). Patients reporting alcohol use will complete the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Men with AUDIT-C scores of 4 or greater and women with AUDIT-C scores of 3 or greater will be considered positive for risky alcohol use and eligible for study enrollment. Participants will subsequently complete the full Alcohol Use Disorders Identification Test (AUDIT) for characterization of alcohol use severity. Individuals with AUDIT scores of 8 or greater will be referred for additional evaluation and treatment according to the study referral protocol.

Eligible participants will be randomized to either an intervention arm or a waitlist-control arm. Participants assigned to the intervention arm will receive the Cameroon-adapted SBIRT program delivered by trained healthcare workers during their emergency department visit. The intervention consists of alcohol risk screening, personalized feedback regarding alcohol use, a brief motivational interviewing-based counseling session, and referral to treatment when indicated. Participants assigned to the waitlist-control arm will receive usual care during the study period and will be offered the intervention following completion of study follow-up.

Participants will be followed for six months following enrollment. Follow-up assessments will occur at one month, three months, and six months after enrollment. Alcohol use outcomes will be assessed using both self-reported and biological measures. Self-reported alcohol use will be measured using the AUDIT instrument. Biological alcohol use will be assessed using phosphatidylethanol (PEth), a validated biomarker of recent alcohol consumption. Additional outcomes will include referral uptake, treatment engagement, depression symptoms measured using the Patient Health Questionnaire-9 (PHQ-9), and injury-related outcomes.

Implementation outcomes will be evaluated using implementation science frameworks including the Consolidated Framework for Implementation Research (CFIR), Proctor's Implementation Outcomes Framework, and the FRAMES model. Feasibility, acceptability, fidelity, adoption, and implementation determinants will be assessed through implementation monitoring, provider surveys, direct observation of intervention delivery, and qualitative interviews with healthcare workers and patients.

The primary hypothesis is that the Cameroon-adapted SBIRT program can be feasibly integrated into routine emergency department care and that participants receiving the intervention will demonstrate greater reductions in harmful alcohol use over six months compared with participants receiving usual care. The study will generate evidence regarding implementation strategies, intervention effectiveness, and scalability of alcohol interventions in trauma care settings within LMICs.

Results from this study are expected to inform future implementation and scale-up of SBIRT programs in Cameroon and other resource-limited settings. The findings may also provide implementation insights relevant to underserved trauma systems and emergency care settings globally where access to behavioral health and substance use services remains limited.

Study Type

Interventional

Enrollment (Estimated)

690

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Cameroon
    • South-West Region
      • Limbe, South-West Region, Cameroon, 00237
        • Limbe Regional Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult trauma patients aged 18 years and older presenting to the Emergency Department of Limbe Regional Hospital.
  • Positive alcohol screening based on the Single Alcohol Screening Question (SASQ).
  • AUDIT-C score ≥4 for men or ≥3 for women.
  • Able to provide informed consent.
  • Resident within the study catchment area and available for follow-up.
  • Access to a telephone or another reliable means of contact for follow-up assessments.

Exclusion Criteria:

  • Severe cognitive impairment preventing participation in study procedures or - provision of informed consent.
  • Severe traumatic brain injury or other medical condition requiring immediate life-saving intervention that precludes participation.
  • Current psychosis or severe psychiatric illness preventing meaningful participation in the intervention.
  • In police custody or other circumstances limiting ability to participate in follow-up.
  • Planned relocation outside the study catchment area during the study follow-up period.
  • Previously enrolled in the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Immediate SBIRT
Participants receive the Cameroon-adapted Screening, Brief Intervention, and Referral to Treatment (SBIRT) program during their emergency department visit. The intervention includes alcohol screening, personalized feedback, a brief motivational interviewing-based counseling session, and referral to treatment when indicated.
Behavioral: Cameroon-Adapted SBIRT
A culturally adapted Screening, Brief Intervention, and Referral to Treatment (SBIRT) program delivered by trained emergency department healthcare workers. The intervention includes alcohol risk screening, brief motivational interviewing-based counseling, and referral to treatment when appropriate.
Active Comparator: Waitlist Control
Participants receive usual care during the follow-up period and are offered the SBIRT intervention after completion of the six-month follow-up assessment.
Other: Usual Care
Standard emergency department care without structured SBIRT delivery during the study follow-up period. Participants are offered SBIRT after completing six months of follow-up.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Alcohol Use at 6 Months
Time Frame: Baseline and 6 months
Change in harmful alcohol use from baseline to 6 months following enrollment, measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C).
Baseline and 6 months
Change in Phosphatidylethanol (PEth) Levels
Time Frame: Baseline and 6 months
Change in alcohol consumption measured using phosphatidylethanol (PEth), a biomarker of recent alcohol use, from baseline to 6 months.
Baseline and 6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Alcohol Use at 1 Month
Time Frame: 1 month
Change in Alcohol Use Measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score at 1 month following enrollment. The total score ranges from 0 to 12, with higher scores indicating greater alcohol consumption and increased risk of hazardous or harmful drinking.
1 month
Alcohol Use at 3 Months
Time Frame: 3 Months
Change in Alcohol Use Measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score at 3 month following enrollment. The total score ranges from 0 to 12, with higher scores indicating greater alcohol consumption and increased risk of hazardous or harmful drinking.
3 Months
PEth Levels at 1 Month
Time Frame: 1 Month
PEth concentration at 1 month following enrollment.
1 Month
PEth Levels at 3 months
Time Frame: 3 month
PEth concentration at 3 month following enrollment.
3 month
Referral Uptake
Time Frame: Within 6 months
Proportion of participants referred for additional alcohol treatment services who attend at least one referral appointment.
Within 6 months
Depressive Symptoms
Time Frame: Baseline, 1 month, 3 months, and 6 months
Depressive symptoms will be assessed using the Patient Health Questionnaire-9 (PHQ-9), a validated nine-item self-report questionnaire that measures the severity of depressive symptoms over the preceding two weeks. The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms
Baseline, 1 month, 3 months, and 6 months
SBIRT Delivery Rate
Time Frame: Through study completion, an average of 36 months.
Proportion of eligible participants who receive all components of the SBIRT intervention.
Through study completion, an average of 36 months.
Intervention Fidelity
Time Frame: Through study completion, an average of 36 months.
Adherence of healthcare workers to SBIRT delivery protocols assessed using structured fidelity checklists.
Through study completion, an average of 36 months.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Buea

Investigators

  • Principal Investigator: Serge Ngekeng, PhD in Public Health, University of Buea

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

March 1, 2027

Primary Completion (Estimated)

August 1, 2030

Study Completion (Estimated)

August 1, 2030

Study Registration Dates

First Submitted

June 19, 2026

First Submitted That Met QC Criteria

June 27, 2026

First Posted (Actual)

June 30, 2026

Study Record Updates

Last Update Posted (Actual)

June 30, 2026

Last Update Submitted That Met QC Criteria

June 27, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SBIRT_UB

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data (IPD) will not be made publicly available at this time. The study collects sensitive clinical, behavioral, and biomarker data, and participant confidentiality must be protected. Future sharing of de-identified data may be considered upon reasonable request and subject to applicable ethical, institutional, and regulatory approvals.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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