Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review

Abstract

The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.

Digital psychiatry in low-and-middle-income countries: New developments and the way forward

“…Studies from Africa and the Middle East are relatively scarce. China, Brazil, and India are the countries with the highest number of studies[ 37 , 44 , 46 - 48 ]. Although videoconferencing-based telepsychiatry, telephone, and computer-delivered treatments are still used[ 38 , 44 , 45 , 47 , 48 ], there has been a clear shift to mobile and internet-delivered digital interventions[ 37 , 40 , 43 , 44 , 46 ].…”

“…China, Brazil, and India are the countries with the highest number of studies[ 37 , 44 , 46 - 48 ]. Although videoconferencing-based telepsychiatry, telephone, and computer-delivered treatments are still used[ 38 , 44 , 45 , 47 , 48 ], there has been a clear shift to mobile and internet-delivered digital interventions[ 37 , 40 , 43 , 44 , 46 ]. Common mental disorders such as depression and anxiety are the most frequently studied conditions[ 37 , 38 , 40 , 43 , 46 ].…”

“…Other conditions examined include substance use disorders[ 37 , 40 , 43 , 47 , 48 ]. A recent systematic review[ 44 ] that focused exclusively on digital interventions in substance use disorders, identified 39 studies most of which were randomized-controlled trials (RCTs). Fewer studies have focused on psychotic disorders.…”

“…Expectedly, the most common outcome examined was the feasibility and acceptability of delivering digital interventions, which was satisfactory in almost all the studies[ 37 , 38 , 40 , 48 , 49 ]. These studies included patients with depression[ 37 , 38 , 40 , 48 , 49 ], anxiety[ 45 , 47 , 48 ], substance use[ 37 , 40 , 44 , 47 , 48 ], psychosis[ 37 , 40 , 45 , 50 ], and other disorders. The feasibility and acceptability of digital interventions were found in studies from South American countries[ 47 , 51 ], China[ 45 ], and India[ 52 ].…”

“…Many studies reported high levels of patient and clinician satisfaction[ 38 , 40 , 51 , 52 ]. Treatment efficacy was the other commonly studied outcome, and the majority of studies reported that digital interventions were efficacious in reducing symptoms of all psychiatric disorders[ 37 , 38 , 40 , 44 , 48 ]. Two meta-analyses reported effect sizes of 0.60 for all disorders, 0.61 for depressive, and 0.73 for anxiety symptoms for digital interventions compared to waiting list controls, usual treatment, or other active treatments[ 43 , 46 ].…”