Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients
Sexually Transmitted Infections
Objectives: Brief intervention for excessive alcohol consumption is effective yet not implemented widely. Alcohol misuse is implicated in unsafe sex and sexually transmitted infections and is common in clients of sexual health services. Our aims were to assess feasibility, acceptability and effectiveness of screening and brief intervention for risky alcohol consumption by a nurse in a sexual health clinic. Methods: Patients completed the AUDIT questionnaire on handheld computers. Those scoring
... 8 on AUDIT were asked to participate in the study and the 3 months' follow-up and were randomised to intervention or control groups. The Drink-less package (based on WHO validated methods) was used to implement the brief intervention by a trained registered nurse. Results: Of 519 (87%) who completed screening, 204 (39%) scored >8 on AUDIT (eligible), 184 agreed to follow-up and 133 completed it. At follow-up, both groups showed significant reductions in AUDIT scores. Mean scores decreased from 13.7 to 11.5 (control group) and 14.0 to 10.7 (intervention group); most (94%) recalled the intervention and 62% reported reducing drinking compared with 47% of controls (p,0.001). The nurse screening and intervention process was reported acceptable by 74% of patients at follow-up and a majority (71%) of staff. Conclusions: Screening and brief intervention in a sexual health clinic for risky alcohol consumption is feasible, acceptable and effective in producing significant reductions in drinking as measured by AUDIT. Both intervention and control groups decreased consumption, suggesting that screening alone is sufficient to influence behaviour. Further study of brief intervention in this setting is appropriate. Excessive consumption of alcohol is associated with a range of behavioural and health problems. In particular, alcohol is an important risk factor for unsafe sexual practices and is implicated in the spread of sexually transmitted infections (STIs). 1 2 Several studies have been published about alcohol screening in sexual health clinics. The tools most often used are questionnaires-for example, AUDIT, 1 3 CAGE and its variants, 1 4 5 CRAFFT 1 and FAST 6 -while others have used frequency and quantity questions, 7 laboratory tests 8 and blood alcohol reading. 9 Brief advice has been shown to be effective in a variety of settings. 10 Two studies reported attempts to give advice in a sexual health service. In one, 90% of the participants were willing to accept written material; however, less than a third agreed to accept an appointment with an alcohol health worker and only one person attended the appointment, leading to a disappointing result. 11 This experience suggests that timely on-the-spot intervention is more likely to be deliverable. A pilot study reported a trial of the feasibility of screening and brief intervention for substance abuse in one clinic; however, the effect of the intervention was not measured and it was not the focus of the study. 5 Our project tested the feasibility, acceptability and effectiveness of screening and brief intervention for risky alcohol consumption by sexual health clinic patients using a trained registered nurse. Effectiveness of the intervention was assessed by measuring recall of the intervention and any reported changes in drinking behaviour or reduction in levels of drinking by patients at 3 months after the index visit. Other aims were to assess the acceptability and efficiency of the screening and intervention process to practice staff.