Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review

The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.Author summary: Substance use disorders (SUDs) are an increasing public health problem which affects both children and adults across the world. Increasing numbers of individuals who live in low- and middle-income countries (LMICs) are affected by the worsening problems of SUDs compared to other regions. The wide treatment gap between people who suffer from the consequences of SUDs compared to those who have access to appropriate treatment ensures that out of reach populations and people in rural areas lack adequate healthcare for SUDs. Repeatedly, studies show that SUDs are chronic and recurring in nature. Therefore, affordable treatment innovations which integrate holistic strategies, promote self-monitoring and management approaches, that can be accessed by out of reach populations should be embraced. Although this may appear unrealistic and implausible in LMICs, telehealth intervention which is the use of communication technologies (text messages, phone calls, mobile applications, virtual reality to mention a few) to deliver healthcare across a distance has the potential to reduce this treatment gap. Our scoping review summarizes published studies which assessed the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs and highlights the gaps and directions for future research.