The SCALA study will test the hypothesis that the scale-up of implementing a tailored intervention package embedded in a wider strategy of community and municipal support in Latin American cities, will increase screening and advice rates more than the usual practice, carried out by health care providers alone.

SCALA will use a quasi-experimental study to compare PHC-based prevention and management of heavy drinking and co-morbid depression in three intervention districts (municipal areas) within three Latin American cities, with service as usual or training unsupported by community or municipal action in three comparator districts in the same cities.

The SCALA study is making several changes to continue and advance during the COVID-19 pandemic: Country partners in Latin America are keeping log diaries to document the changes and challenges in their countries due to the virus The researchers are in contact with providers to explore ways to support mental health and well-being (of professionals and the general population) The ‘tally sheets’ to input and record data have been developed as an online version to avoid transmission through physical paper copies Another arm to the study – representing a telemedicine SBIRT implementation – is underway A second implementation phase (phase 2) of 6 months is being undertaken from December 2020 to May 2021, to recuperate data lost through disruption due to COVID Given the unusual mental strain that the pandemic places on populations, several of the clinical tools and materials have been adjusted for this phase 2 to place greater emphasis on detecting and treating depression in the intervention package. This involves screening for depression in all primary health patients (as opposed to screening for depression only in patients identified as risk drinkers), and required changes in clinical materials and data collection instruments.

The cities taking part in the trial are Bogota (Colombia), Mexico City (Mexico) and Lima (Peru), where matched districts (locally governed municipal areas) will be identified and assigned to either “scale-up” implementation or control conditions. In the implementation districts, primary health care units (PHCUs) will receive training embedded within on-going supportive action at the municipal level (A municipal Action Plan or MAP involving the local government, workforce and infrastructure), over an 18-month implementation period. In order to distinguish and examine the separate impacts of the MAP and training, in half the units of the comparator districts, practice as usual will continue at both municipal and PHCU levels, while the other half will receive unit-level training, but without municipal support.

In addition, to give further insight into the requirements of effective screening programmes in terms of resources and duration, a short and long form of the SCALA programme have been designed. In the "scale-up" districts, half of the units will receive training in the long form of the SCALA intervention programme, while the other half will receive training in the short form of the programme.

• Read about the overall study objectives in the original SCALA Study publication
• Read about the revised 4-arm study design in the SCALA Protocol report (D3.1 - revised study design)

Two changes have been made to the SCALA study and program since the beginning of the project:

• As hypothesized, the initial phase of the study provided evidence that the longer intervention (tested in arm 4) did not perform better than the shorter one (arm 3); and, in line with this finding, arms 3 and 4 of the study were merged in November 2020, with both continuing with the shorter programme.
• A second 6-month deployment phase (phase 2) began in December 2020 through to May 2021 to recover data lost from the COVID pandemic disruption.

Study summary diagram