Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare.
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ABSTRACT: Aims
To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by.Methods
Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specific drinking patterns in the Russian Federation.Results and conclusions
The systematic review identified over 60 different Russian-language AUDIT versions without systematic validation studies. The main difficulties encountered with the use of the AUDIT in the Russian Federation were related to the lack of:A revised version of the Russian-language AUDIT was created based on the pilot studies, and was validated in primary healthcare facilities in all regions in 2019/2020.
SUBMITTER: Rehm J
PROVIDER: S-EPMC7576502 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Publications
Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare.
Rehm Jürgen J Neufeld Maria M Yurasova Elena E Bunova Anna A Gil Artyom A Gornyi Boris B Breda João J Bryun Evgeniy E Drapkina Oxana O Fadeeva Eugenia E Kalinina Anna A Khaltourina Daria D Klimenko Tatiana T Kontsevaya Anna A Koshkina Evgenia E Martynova Natalya N Nadezhdin Alexey A Soshkina Kristina K Tetenova Elena E Vujnovic Melita M Vyshinsky Konstantin K Ferreira-Borges Carina C
Alcohol and alcoholism (Oxford, Oxfordshire) 20201001 6
<h4>Aims</h4>To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by.<h4>Methods</h4>Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specifi ...[more]
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Project description:Aims: The Alcohol Use Disorders Identification Test (AUDIT) is one of the most widely used screening instruments worldwide. Although it was translated into many languages, not many country-specific adaptations exist, and a formal validation procedure of the Russian version has been carried out only recently. The present contribution documents the different steps taken to formally translate and adapt a Russian-specific version of the AUDIT (RUS-AUDIT). Methods: The AUDIT was translated into Russian following an established protocol, revised and adapted to the country context using an expert panel, and field-tested in an iterative approach, in line with WHO rules on instrument translation and adaptation A total of three pilot phases were carried out on 134 patients from primary healthcare (PHC) and 33 patients from specialised alcohol treatment facilities (narcology), guided by a specially established advisory board. Changes in each version were informed by the findings of the previous pilot phase and a thorough panel discussion. Results: Based on the findings of three different pilot phases, the RUS-AUDIT was developed as a paper-and-pencil interview for PHC professionals. Since various issues with representation and counting of standard drinks for the second test item arose, a special show card was developed to support the assessment. Preliminary AUDIT-C scores indicated that more than one-third of the screened women (34.2%) and about half of the screened men (50.9%) from PHC facilities have exceeded risk thresholds. Conclusions: The RUS-AUDIT was constructed as a feasible assessment tool for interviewers and patients. The large number of PHC patients who exceed the risk threshold has corroborated the need for formal validation and Russia-specific cut-off scores, considering the specific drinking patterns.
| S-EPMC10634389 | biostudies-literature
Project description:The Alcohol Use Disorders Identification Test (AUDIT) is one of the most frequently used screening instrument for hazardous and harmful use of alcohol and potential alcohol dependence in primary health care (PHC) and other settings worldwide. It has been translated into many languages and adapted and modified for use in some countries, following formal adaptation procedures and validation studies. In the Russian Federation, the AUDIT has been used in different settings and by different health professionals, including addiction specialists (narcologists). In 2017, it was included as a screening instrument in the national guidelines of routine preventive health checks at the population-level (dispanserization). However, various Russian translations of the AUDIT are known to be in use in different settings and, so far, little is known about the empirical basis and validation of the instrument in Russia-a country, which is known for its distinct drinking patterns and their detrimental impact on health. The present contribution is the summary of two systematic reviews that were carried out to inform a planned national validation study of the AUDIT in Russia.Two systematic searches were carried out to 1) identify all validation efforts of the AUDIT in Russia and to document all reported problems encountered, and 2) identify all globally existing Russian translations of the AUDIT and document their differences and any reported issues in their application. The qualitative narrative synthesis of all studies that met the inclusion criteria of the first search highlighted the absence of any large-scale rigorous validation study of the AUDIT in primary health care in Russia, while a document analysis of all of the 122 Russian translations has revealed 61 unique versions, most of which contained inconsistencies and signaled obvious application challenges of the test.The results clearly signal the need for a validation study of the Russian AUDIT.
| S-EPMC8495672 | biostudies-literature
Project description:In Rwanda, alcohol use disorder (AUD) is estimated to affect 7% of the population. The Alcohol Use Disorder Identification Test (AUDIT) is an excellent screening instrument for AUD, but a Rwanda-focused version previously was unavailable. Our objective was to develop a Rwanda- focused AUDIT and evaluate its psychometric properties. The English AUDIT was adapted to the Rwandan language through translation and back- translation by a panel of native English and Kinyarwanda speakers. Random sampling was used to recruit participants from the emergency department, outpatient clinics, and inpatient wards at a tertiary care center in Rwanda, excluding those < 18 years old, declining to participate, unable to provide consent, or when participation would interfere with care. Participants completed the Rwanda-focused AUDIT using an audio computer-assisted self-interviewing format. Internal structure was assessed using one-, two- and three-dimensional models of fit and confirmatory factor analysis (CFA), assessed by Chi-square (χ2), Root Mean Square Error of Approximation (RMSEA), Tucker-Lewis index (TLI) and comparative fit index (CFI). Of 775 patients assessed for enrollment, 7% were unable to provide consent, 12% declined to participate, 2% could not participate because it would disrupt their medical care, and 1.3% dropped out, leaving 614 included for analysis. Of the 614, the majority were male (61%), married (53%) and had only primary education (65%). Their ages were: 33% 18-30, 43% 31-50, and 25% > 50 years-old. Factor loading for the AUDIT CFA model was between 0.62 and 0.96 for all items. Model fit indices included χ2 of < 0.001, RMSA of 0.061 (0.049 - 0.073), TLI of 0.994, and CFI of 0.995. Reliability statistics included Cronbach's alpha at 0.91 (0.90 - 0.92), Omega 6 at 0.948 and composite reliability at 0.977. The Rwanda-focused AUDIT showed excellent performance for measures of internal structure with high factor loading on CFA and model fit indices meeting traditional parameters of RMSEA < 0.08, TLI > 0.90, and CFI > 0.95. In this context, χ2 should ideally be > 0.05, however a relatively large sample, such as ours, tends to depress the number. All reliability statistics were above 0.90, indicating strong internal consistency. These findings support the reliability of this screening instrument. Further research should focus on the development of brief interventions for those who screen positive.
| S-EPMC11856578 | biostudies-literature
Project description:Russian Federation's (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.
| S-EPMC4752500 | biostudies-literature
Project description:BackgroundAlcohol use disorder is a major cause of morbidity and mortality in low- and middle-income countries. Alcohol screening using a validated tool is a useful way to capture high-risk patients and engage them in early harm reduction interventions. Our objectives were to 1) evaluate the psychometric evidence the Alcohol Use Disorders Identification Test (AUDIT) and its subscales in the general population of Moshi, Tanzania, and 2) evaluate the usefulness of the tool at predicting alcohol-related harms.MethodsTwo hundred and fifty-nine adults living in Moshi, Tanzania were included in the study. We used the AUDIT and its subscales to determine the classification of harmful and hazardous drinking. To analyze the internal structure of AUDIT and the model adequacy we used Confirmatory Factor Analysis (CFA). The reliability of AUDIT was analyzed for Cronbach's alpha, Omega 6 and Composite Reliability. The optimal cut off point for the AUDIT was determined by the receiver operating characteristic (ROC) curve, using the Youden approach to maximize sensitivity and specificity.ResultsThe median score of the AUDIT was 1 (inter-quartile range: 0-7). The internal structure of the AUDIT showed factor loadings ranging from 0.420 to 0.873. Cronbach's alpha, Omega and Composite Reliability produced values above 0.70. The Average Variance Extracted was 0.530. For the AUDIT, a score of 8 was identified as the ideal cut-off value in our population.ConclusionsThis study validates AUDIT in the general population of Moshi and is one of the only studies in Africa to include measures of the internal structure of the AUDIT and its subscales.
| S-EPMC10631671 | biostudies-literature
Project description:BackgroundDespite a considerable reduction in alcohol consumption, Russia has one of the highest levels of alcohol-attributable burden of disease worldwide due to heavy episodic drinking patterns. Further improvement of alcohol control measures, including early provision of screening and brief interventions (SBI), is needed. The legislative framework for delivering SBI in Russia was introduced in 2013. As part of the creation and validation of a Russian version of the Alcohol Use Disorders Identification Test (AUDIT), the present contribution explored challenges in using the AUDIT in Russia to inform a subsequent validation study of the tool.MethodsQualitative in-depth expert interviews with patients and healthcare professionals from four primary healthcare and narcology facilities in Moscow. A total of 25 patients were interviewed, 9 from a preventive medicine hospital, 8 from a polyclinic, and 9 from narcology clinics. Also, 12 healthcare professionals were interviewed, 5 of whom were primary healthcare doctors and 7 were narcologists.ResultsPatients and healthcare professionals expressed difficulties in dealing with the concept of a "standard drink" in the AUDIT, which is not used in Russia. Various patients struggled with understanding the meaning of "one drinking occasion" on the test, mainly because Russian drinking patterns center around festivities and special occasions with prolonged alcohol intake. Narcology patients had specific difficulties because many of them experienced zapoi-a dynamic drinking pattern with heavy use and a withdrawal from social life, followed by prolonged periods of abstinence. Surrogate alcohol use was described as a common marker of alcohol dependence in Russia, not accounted for in the AUDIT.ConclusionsThe provided analyses on the perception of the Russian AUDIT in different patient and professional groups suggest that a series of amendments in the test should be considered to capture the specific drinking pattern and its potential harms.
| S-EPMC9648709 | biostudies-literature
Project description:BackgroundNo validated tools exist to screen for substance use or dependence in Mozambique. The aim of this study was to validate the Alcohol Use Disorder Identification Test (AUDIT) for use in primary care settings in Mozambique.MethodsThe study administered a final adapted Mozambican 10-item AUDIT (AUDIT-10-MZ) to 502 individuals from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary health care clinics in Sofala Province, Mozambique. The study evaluated the AUDIT-10-MZ against the MINI 5.0-MZ as a gold standard diagnostic tool.ResultsUsing the MINI 5.0-MZ, 16 (3.2%) of the sample tested positive for alcohol dependence and 3 (0.6%) tested positive for harmful alcohol use. The full AUDIT-10-MZ had acceptable internal consistency (α = 0.74); however, the shorter AUDIT-C-MZ had a higher alpha value than the full AUDIT screener (α = 0.79). The AUDIT-10-MZ performed well for screening in primary care, achieving areas under the receiver operating characteristic curves (AUROCs) of 0.94 (95% CI: 0.91, 0.96) for alcohol dependence. The AUDIT-C-MZ also performed well with an AUROC of 0.88 (95% CI: 0.80, 0.96) for alcohol dependence. Using a cut-off of ≥6, the AUDIT-10-MZ achieved a sensitivity of 68.8% and specificity of 92.0% for screening for alcohol dependence; a cut-off of ≥3 for the AUDIT-C-MZ achieved a sensitivity of 56.3% and specificity of 90.7%.ConclusionsBoth the AUDIT-10-MZ and AUDIT-C-MZ are valid instruments for screening for alcohol dependence in Mozambique. The AUDIT-C-MZ performed particularly well and providers could use it as a brief screener in primary care settings. Optimal cut-points will depend on weighing false positives and false negatives but could be employed at ≥ 6 or ≥ 7 for the AUDIT-10-MZ and at ≥ 2 or ≥ 3 for the AUDIT-C-MZ. Future implementation research is needed to examine how best to integrate screening for substance use or dependence in primary care settings in Mozambique and other similar LMICs.
| S-EPMC8217722 | biostudies-literature
Project description:BackgroundEarly identification of potential alcohol-problems is central for timely intervention and treatment referral. The Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) serve as globally recognized and validated screening tools for this purpose. We aimed to evaluate the diagnostic validity of internationally recommended AUDIT cut-off scores ≥ 8, ≥16, ≥ 20, and AUDIT-C cut-off scores ≥ 4, ≥5 using the Danish language versions of questionnaires in a hospital setting.MethodsQuestionnaire data were collected from 2/15/2023, to 4/27/2023 at the Department of Gastroenterology and Hepatology, Odense University Hospital, Denmark. We tested the World Health Organization's recommended AUDIT cut-offs: ≥8 for hazardous use, ≥ 16 suggestive of dependence, ≥ 20 high likelihood of dependence, along with AUDIT-C ≥ 4 and ≥ 5 using the following reference standard: Danish low-risk drinking guidelines (≤ 10 standard drinks/week) for hazardous use and self-reported ICD-10 alcohol dependence criteria for alcohol dependence. Analyses included ROC curves, AUC, sensitivity, specificity, predictive values, and agreement.ResultsThree hundred patients participated, mean age 52 years (SD 17.4, median 54) and 51.3% males. Mean AUDIT score was 4.5 (SD 5.8, median 3) with fourteen (4.7%) meeting at least three self-reported ICD-10 criteria for alcohol dependence. The prevalence of hazardous use was 10.7%. AUDIT ≥ 8 exhibited a sensitivity of 56% (95% CI 40.6-73.6) and specificity 91% (95% CI 87.8-94.5) for detecting hazardous use. Against at least three self-reported ICD-10 criteria for alcohol dependence, AUDIT cut-off ≥ 16 showed a sensitivity of 85% (95% CI 66.1-98.2) with 97% specificity (95% CI 96.0-99.2), while cut-off ≥ 20 had a sensitivity of 71% (95% CI 49.2-91.6) with 99% specificity (95% CI 98.1-99.9). The AUDIT-C cut-offs ≥ 4 and ≥ 5 exhibited low positive predictive values in detecting hazardous use (30.8% for ≥ 4 and 36.8% for ≥ 5) and dependence (13.5% for ≥ 4 and 18.4% for ≥ 5) and demonstrated a specificity ranging from 68.5 to 82.1% with negative predictive values from 98.2 to 100%.ConclusionIn Danish gastroenterology and hepatology departments, the AUDIT and AUDIT-C may be used to identify patients who are unlikely to have an alcohol problem, while positive screen results should be carefully considered and followed by more exhaustive assessment.
| S-EPMC11829362 | biostudies-literature
Project description:ObjectiveAlcohol use disorders are common conditions that have enormous social and economic consequences. Genome-wide association analyses were performed to identify genetic variants associated with a proxy measure of alcohol consumption and alcohol misuse and to explore the shared genetic basis between these measures and other substance use, psychiatric, and behavioral traits.MethodThis study used quantitative measures from the Alcohol Use Disorders Identification Test (AUDIT) from two population-based cohorts of European ancestry (UK Biobank [N=121,604] and 23andMe [N=20,328]) and performed a genome-wide association study (GWAS) meta-analysis. Two additional GWAS analyses were performed, a GWAS for AUDIT scores on items 1-3, which focus on consumption (AUDIT-C), and for scores on items 4-10, which focus on the problematic consequences of drinking (AUDIT-P).ResultsThe GWAS meta-analysis of AUDIT total score identified 10 associated risk loci. Novel associations localized to genes including JCAD and SLC39A13; this study also replicated previously identified signals in the genes ADH1B, ADH1C, KLB, and GCKR. The dimensions of AUDIT showed positive genetic correlations with alcohol consumption (rg=0.76-0.92) and DSM-IV alcohol dependence (rg=0.33-0.63). AUDIT-P and AUDIT-C scores showed significantly different patterns of association across a number of traits, including psychiatric disorders. AUDIT-P score was significantly positively genetically correlated with schizophrenia (rg=0.22), major depressive disorder (rg=0.26), and attention deficit hyperactivity disorder (rg=0.23), whereas AUDIT-C score was significantly negatively genetically correlated with major depressive disorder (rg=-0.24) and ADHD (rg=-0.10). This study also used the AUDIT data in the UK Biobank to identify thresholds for dichotomizing AUDIT total score that optimize genetic correlations with DSM-IV alcohol dependence. Coding individuals with AUDIT total scores ≤4 as control subjects and those with scores ≥12 as case subjects produced a significant high genetic correlation with DSM-IV alcohol dependence (rg=0.82) while retaining most subjects.ConclusionsAUDIT scores ascertained in population-based cohorts can be used to explore the genetic basis of both alcohol consumption and alcohol use disorders.
| S-EPMC6365681 | biostudies-literature
Project description:BackgroundThe Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a three-item screening measure of unhealthy alcohol use that is widely used in healthcare settings. Evidence shows high test-retest reliability of the AUDIT-C in research samples, but most studies had limited external validity and used small samples that could not be used to evaluate reliability across demographic subgroups and/or screening modalities. This study evaluates the test-retest reliability of the AUDIT-C completed in routine care in a large primary care sample, including across demographic subgroups defined by age, sex, race, ethnicity, and screening modality (i.e., completed in-clinic or online).MethodsWe used electronic health record (EHR) data from Kaiser Permanente Washington. The sample included 18,491 adult primary care patients who completed two AUDIT-C screens 1-21 days apart as part of routine care in 2021. Test-retest reliability was evaluated for AUDIT-C total scores (0-12) and for a binary measure indicating unhealthy alcohol use (scores ≥3 women, ≥4 men). Using previously established cutoffs, we interpreted reliability coefficients >0.75 as indicating "excellent" reliability.ResultsAUDIT-C screens completed in routine care and documented in EHRs had excellent test-retest reliability for total scores (ICC = 0.87, 95% CI: 0.87-0.87) and the binary indicator of unhealthy alcohol use (κ = 0.79, 95% CI: 0.78-0.80). Reliability coefficients were good to excellent across all demographic groups and for in-clinic and online modalities. Higher reliability was seen when both screens were completed through online patient portals (ICC = 0.93, 95% CI: 0.93-0.93) versus in-clinic (ICC = 0.81, 95% CI: 0.79-0.82) or when one screen was completed using each modality (ICC = 0.83, 95% CI: 0.82-0.83). Lower reliability was seen in American Indian/Alaska Native (ICC = 0.82, 95% CI: 0.75-0.87) and multiracial individuals (ICC = 0.82, 95% 0.80-0.84).ConclusionsIn real-world routine care conditions, AUDIT-C screens have excellent test-retest reliability across demographic subgroups and modalities (online and in-clinic). Future research should examine why reliability varies slightly across modalities and demographic subgroups.
| S-EPMC10922542 | biostudies-literature