Over the last few months, we have been deeply affected and concerned by the war in Ukraine. We have seen that the mental health and psychosocial support (MHPSS) needs amongst affected populations have increased hugely due to exposure to the conflict, threat of violence, and forced displacement. The war has meant that we have had to make important decisions for the CHANGE project, adjusting our initial programme of work to ensure the safety and wellbeing of our partners in Ukraine. We are instead in the process of conducting a qualitative study that seeks to investigate MHPSS needs and resilience of conflict-affected civilians in Ukraine. This qualitative study will inform MHPSS programming and will provide a contextual update for CHANGE and other MHPSS projects that are being implemented in Ukraine.

Simultaneously, we are progressing well with CHANGE in Uganda. Over the last couple of months, we have recruited new team members in Arua, including PM+A supervisors, PM+ facilitators and research assistants. We have successfully finalised training of the intervention master trainers, and facilitators who have completed their first practice cases. We are now actively recruiting participants for a treatment cohort.

Please stay tuned for more progress updates.

We were busy driving forward the development of our intervention in the past few months, and conducted a series of research activities to inform content of the intervention:

1. Meta-review of common elements of treatments for alcohol use disorders (AUD): We conducted an umbrella review of all meta-analyses of psychological therapies for AUD to identify what common elements characterize psychological therapies for AUD. We identified 30 different common elements of AUD treatments which included psychoeducation, change & action planning, cognitive restructuring, and motivational interviewing.
2. Community qualitative interviews: We collected N=126 in-depth interviews in both sites (N=57 in Uganda and N=69 in Ukraine) on the perceived need, explanatory models and current treatment options for AUD. Data was collected from men with alcohol misuse problems, family members of men, community & religious leaders, and MHPSS providers.
3. Delphi study: A 2-round Delphi survey was conducted with international experts to gauge relevance of different active ingredients/intervention components for AUD that were identified in the systematic review. We had 25 experts from all over the world completing the first round of the Delphi survey and 23 experts completing the second round to reach consensus.
4. Treatment development workshop: We conducted three treatment development workshops with 25 international experts to build the intervention architecture (two treatment development workshops conducted in English, and one treatment development workshop conducted in Ukrainian).
5. Theory of change (ToC) workshops: ToC workshops were held in both Uganda and Ukraine to develop a causal map outlying how the intervention may influence the desired outcome in the contexts where the intervention will be implemented. Three ToC workshops took place in Uganda (one in the Rhino refugee camp, one in Arua, and one in Kampala) and two ToC workshops took place online in Ukraine.

We have also published two open access papers:

• A commentary published in the Intervention Journal of Mental Health and Psychosocial Support in Conflict Affected Areas introducing the CHANGE project
• A protocol paper detailing all the qualitative components that will be included in the CHANGE project published in the International Journal of Qualitative Methods

We look forward to getting started with our next steps: a treatment cohort of the CHANGE intervention to refine it and a pilot randomized controlled trial.

Stay tuned for more updates on our progress!

Our project has been featured on the London School of Hygiene and Tropical Medicine's newsfeed. The text from the article can be found below, read the original post.

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Every two seconds someone in the world is forcibly displaced as a result of conflict, violence or persecution. These populations affected by conflict are particularly vulnerable to psychosocial distress and much higher levels of mental disorders, including alcohol misuse, than populations who don’t experience conflict. In these settings, alcohol may be used as a coping strategy for adversities that refugees and internally displaced persons may face.

The CHANGE study is a five-year project, led by Dr Daniela Fuhr and Professor Bayard Roberts, titled ‘Alcohol use in Humanitarian settings: a programme of work to address alcohol and associated adversities among conflict-affected populations in Uganda and Ukraine’. Launched in July 2020, project partners include LSHTM, HealthRight International Uganda, the National University of Kyiv-Mohyla, WordsHelp Ukraine, and the University of Copenhagen.

CHANGE seeks to develop the first evidence-based psychological intervention with a component addressing alcohol misuse. Specifically, they seek to further develop Problem Management Plus (PM+), an intervention developed by the World Health Organization (WHO) designed for people with psychological distress who are exposed to adversity by identifying and integrating strategies and techniques from alcohol use therapies.

An expanded version of this intervention, Project Management Plus Alcohol (PM+A), can then be adapted to local circumstances, and its feasibility, acceptability, cost-effectiveness and scalability can be assessed through two randomised control trials in Uganda and Ukraine. In-depth qualitative research will be conducted throughout the project to better understand the implementation of the intervention, and how local contextual mechanisms influence outcomes.

The United Nations Higher Commission for Refugees (UNHCR) have highlighted alcohol misuse as a neglected problem among forcibly displaced populations, and that psychological interventions addressing mental health co-morbidities including alcohol misuse are lacking.

PM+A will be implemented among South Sudanese refugees living in the Rhino refugee settlement in Uganda and internally displaced persons in the Dnipro region of Ukraine. These regions have been found to have high levels of alcohol misuse, mental disorders, gender-based violence and a high mental health treatment gap.

These country settings represent varied different socio-economic, cultural and humanitarian characteristics and populations, which supports understanding of the contextual influences on adapting and implementing PM+A in differing circumstances.

Dr Fuhr, Assistant Professor in Mental Health Systems at LSHTM and project lead, said: “We are very pleased to have received this funding for the CHANGE project. Conflict-affected areas create environments where people are much more vulnerable, so psychosocial distress, mental disorders and alcohol misuse are more common in these populations.  

“By introducing a component addressing alcohol misuse to the PM+ mental health intervention, we hope to address this neglected problem and associated adversities in these populations. We are keen to develop an intervention which can be integrated into existing mental health and psychosocial support programmes.

“Our partners bring in-depth expertise about the local population, and it is very exciting for us to be able to compare outcomes and processes between our two study sites which are so very different to each other. This will inform the future development, application and scalability of PM+A with other conflict-affected populations.”

We are currently in the process of recruiting research staff for our sites in Uganda and Ukraine. Watch out for updates on our team page!

We are delighted to announce that the CHANGE project has been awarded funding by the NIHR–Wellcome Partnership for Global Health Research.