1 Jané-Llopis E, et al. BMJ Open 2020;10:e038226. doi:10.1136/bmjopen-2020-038226 Open access Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: fnal protocol for a quasiexperimental study (SCALA study) Eva Jané-Llopis , 1,2,3 Peter Anderson , 2,4 Marina Piazza, 5 Amy O'Donnell , 4 Antoni Gual, 6,7,8 Bernd Schulte, 9 Augusto Pérez Gómez, 10 Hein de Vries, 2 Guillermina Natera Rey, 11 Daša Kokole, 2 Ines V Bustamante, 5 Fleur Braddick, 6 Juliana Mejía Trujillo, 10 Adriana Solovei, 2 Alexandra Pérez De León, 11 Eileen FS Kaner, 4 Silvia Matrai, 6 Jakob Manthey , 12 Liesbeth Mercken, 2 Hugo López-Pelayo, 6,7,8 Gillian Rowlands, 4 Christiane Schmidt, 9 Jürgen Rehm 3,12,13,14,15 To cite: Jané-Llopis E, Anderson P, Piazza M, et al. Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: fnal protocol for a quasiexperimental study (SCALA study). BMJ Open 2020;10:e038226. doi:10.1136/ bmjopen-2020-038226 ► Prepublication history and additional material for this paper are available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2020- 038226). Received 03 March 2020 Revised 06 May 2020 Accepted 14 May 2020 For numbered affliations see end of article. Correspondence to Eva Jané-Llopis; eva.jane@esade.edu Protocol © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. INTRODUCTION This paper outlines the protocol for a quasi- experimental study 1 to test the implemen- tation of primary healthcare (PHC)-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American coun- tries, Colombia, Mexico and Peru (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America (SCALA) study). Heavy drinking is a cause of considerable disability, morbidity and mortality. 2 Heavy drinking is a causal factor for some communi- cable diseases (including TB and HIV/AIDS), for many non-communicable diseases (NCDs, including cancers, cardiovascular diseases and gastrointestinal diseases) and for many mental and behavioural disorders, including depression, dementias and suicide. 3 4 In PHC settings, two-fifths of people with heavy drinking have depression, with risks of incident depression higher for heavier as opposed to lighter drinkers. 5 In addition to its role in the aetiology of depression, heavy drinking is associated with worsening the depression course, including suicide risk, impaired social functioning and impaired healthcare utilisation. 6 Heavy drinking is also a major contributor to global health inequalities, with alcohol-related harm aggravated by lower socioeconomic status 7 and extending beyond the individual Strengths and limitations of study ► Uses a theory-based approach to tailor clinical ma- terials and training programmes, creating city-based Community Advisory Boards, and user-based user panels to ensure that tailoring matches user needs, municipal services and coproduction of health. ► Tests the added value of embedding and implement- ing primary healthcare activity within municipal- based adoption mechanisms and support systems, and community-based communication campaigns. ► Has a longer time frame (18 months) than is tradi- tionally used in implementation studies, to assess longer term impacts. ► Gives considerable emphasis to process evaluation, developing logic models to document the fdelity of all implementation strategies, and to identify, the drivers and barriers and facilitators to successful implementation and scale-up. ► Due to municipal-based political and technical considerations, we are unable to randomise the involved municipal areas. We adopt a quasiexperi- mental design, optimising comparator municipal ar- eas for confounding, and by using propensity score matching. on July 29, 2020 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2020-038226 on 28 July 2020. Downloaded from