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Abstract
The alcohol use disorders identification test (AUDIT), a screening instrument to identify individuals at risk of alcohol use-related problems, has not been validated in a Russian primary care population. We assessed the reliability, factor structure, sensitivity, and specificity of AUDIT scores among 254 subjects initiating tuberculosis treatment from 2005 to 2007 in Tomsk City. Our findings support the use of the AUDIT as a screening instrument among Russian individuals seeking primary care. We discuss implications, limitations, and future research.
RÉSUMÉ
Alcohol Use Disorders Identification Test (AUDIT) est un test de dépendance à l’alcool qui n’a pas été validé dans le contexte des services de soins en santé primaire en Russie. Nous avons évalué la fiabilité, la structure des facteurs, la sensibilité et la spécificité des résultats de AUDIT avec 254 sujets qui ont commencé le traitement de tuberculose entre 2005 et 2007 à la Ville de Tomsk, Russie. Nos résultats confiment l’eficacité de AUDIT pour les individus qui cherchent les services de santé primaire en Russie. Nous discutons des implications, des limitations et des recherches à venir. Les sources des fonds étaient: Eli Lilly Foundation, International Resources & Exchanges Board Foundation, Whitman Fellowship et National Institute on Drug Abuse.
RESUMEN
El “Alcohol Use Disorders Identification Test” (AUDIT), un instrumento de despistaje para identificar individuos con riesgo de problemas con el uso de alcohol, no se ha validado en una población de atención primaria Rusa. Evaluamos la confiabilidad, estructura de factor, sensibilidad y especificidad de los puntajes de AUDIT en 254 sujetos iniciando tuberculosis entre 2005–2007 en la Tomsk Ciudad. Nuestros resultados suportan el uso de AUDIT como instrumento de despistaje en individuos Rusos buscando atención primaria. Discutimos las implicaciones, limitaciones e investigaciones del futuro. Fuentes de fondos eran Eli Lilly Foundation, International Resources & Exchanges Board Foundation, Whitman Fellowship y el National Institute on Drug Abuse.
THE AUTHORS
Trini A. Mathew, MD, MPH completed her medical school from Tver State Medical Academy, Tver, Russia, and her residency in Internal Medicine from Jacobi Medical Center, Bronx, NY, during which she participated in Physicians in Residence training at Hazelden, New York, NY. She completed her fellowship in Infectious Diseases from Beth Israel Deaconess Medical Center, Boston, MA. She worked with Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston and Partners In Health, Tomsk, Russia, to integrate care and management of TB and alcohol use disorders (AUDs) in Tomsk. As an Assistant Professor in Medicine, Division of Infectious Diseases at University of Mississippi Medical Center, Jackson, MS, she worked with HIV patients and also served as ID consultant to State Tuberculosis program, MS Dept. of Health. Her current clinical and research interests include integrating TB and HIV care, as well as addressing AUDs in TB/HIV patients.
Alan L. Shields, Ph.D., is a full time scientist with PRO Consulting® and invivodata.com® and provides self-report measurement strategy services within the pharmaceutical industry. He was recently an Assistant Professor of Psychology at East Tennessee State University and currently maintains a clinical affiliation with that institution. Dr. Shields has special interest in testing, measurement, and psychometrics. Dr. Shields’ research efforts have focused on alcohol use in the context of co-occurring illness, yet he has provided measurement consultation and assessment training on projects across a spectrum of pathology including HIV/AIDS, skin cancer, respiratory and cardiac disorders, diabetes, and a variety of central nervous system and psychological disorders. Dr. Shields received his Ph.D. in Clinical Psychology from the University of Montana, and later served jointly as an Instructor of Psychology in the Harvard Medical School and Research Psychologist at McLean Hospital.
Hilary Smith Connery, M.D., Ph.D., is Medical Director in the McLean Hospital Alcohol and Drug Abuse Treatment Program and Instructor in Psychiatry at Harvard Medical School. She specializes in the treatment of patients with co-occurring psychiatric disorders and substance use disorders.
Sonya Shin, MD, MPH is an Assistant Professor of Medicine at Harvard Medical School and an Associate Physician in the Division of Infectious Diseases and the Division for Global Health Equity at Brigham and Women's Hospital. Her research interests are predicated on her dedication to serving the needs of HIV and TB patients in Boston, Peru, and Russia through the non-profit Partners In Health. Her current projects include a randomized trial to treat alcohol disorders among Russian TB patients and a controlled study to provide community-based accompaniment with directly observed antiretroviral therapy to impoverished TB-HIV patients in Peru, among others.
Garrett M. Fitzmaurice, Sc.D., is Director of the Laboratory for Psychiatric Biostatistics at McLean Hospital in Belmont, MA. He is Professor of Psychiatry (Biostatistics) at Harvard Medical School and Professor in the Department of Biostatistics at the Harvard School of Public Health. He is Adjunct Professor of Biostatistics at the Karolinska Institute, Stockholm, Sweden. Fitzmaurice has research interests in statistical methodology for longitudinal analysis, missing data, and psychiatric epidemiology.
Shelly F. Greenfield, MD, MPH Dr Greenfield is Associate Professor of Psychiatry at Harvard Medical School, Chief Academic Officer of McLean Hospital, and Director, Clinical and Health Services Research and Education, Division of Alcohol and Drug Abuse, McLean Hospital in Belmont, Massachusetts. Dr. Greenfield serves as Principal Investigator and Co-Investigator on federally funded research focusing on treatment for substance use disorders, gender differences in substance disorders, and health services for substance disorders. She is a current recipient of a career award in patient oriented research from NIDA and a past recipient of a National Institute on Drug Abuse (NIDA)-funded career award. She is the Principal Investigator of a NIDA-funded Stage II trial of a new manual-based group therapy for women with substance use disorders. She serves as the co-Principal Investigator of the Northern New England node of the NIDA Clinical Trials Network and is the chair of the NIDA Clinical Trial Network's Gender Special Interest Group. Dr. Greenfield is the Director of the Harvard Medical School/Partners Addiction Psychiatry Fellowship and directs addiction psychiatry education in the Adult Psychiatry Residency of the Massachusetts General and McLean Hospitals. She served as the Founding Scientific Director of National Alcohol Screening Day, is past Chair of the American Psychiatric Association's Council on Addiction Psychiatry, and is a member of the Board of Directors of the American Academy of Addiction Psychiatry. She is the Editor-in-Chief of the Harvard Review of Psychiatry. Dr. Greenfield serves on the Addiction Psychiatry Committee of the American Board of Psychiatry and Neurology. She has been elected to the American College of Psychiatrists and is a Distinguished Fellow of the American Psychiatric Association.
Dr. Sergey P. Mishustin, is the Chief TB doctor of Tomsk and Tomsk oblast. He has graduated from the Tomsk Medical School in 1980 specializing in Internal Medicine. His scientific and clinical interests include improving treatment adherence among TB patients, early TB detection in general medical services, enhancement of treatment management for MDR and XDR-TB, implementation of methods of molecular epidemiology in Tomsk oblast TB services, and ventilation-perfusion pulmonoscintigraphy in diagnosis of pulmonary tuberculosis. He is an author and co-author of more than 70 different publications, including conferences, abstracts and presentations.
Dr. Vera T. Golubchikova, is the Medical Superintendent of the ambulatory TB services in Tomsk, Russia since 1989. She graduated from the Tomsk Medical School in 1974. She worked as TB doctor for 8 years, then 4 years as a deputy chief of clinical program in TB services, and 3 years as a deputy chief of the educational program in TB services. Dr. Golubchikova has been the primary site coordinator for the implementation of the DOTS program in Tomsk since 1995 through 2000. She is an independent WHO expert in anti-tuberculosis interventions in Russia. Dr. Golubchikova has been presented with the Order of Merit for Country in 2003. She is the author and co-author more than 40 publications in Russian and foreign scientific journals.
Dr. Galina V. Yanova is the head physician of the Tomsk Oblast Tuberculosis Hospital since 1994, the doctor of the supreme category. She has graduated from the Tomsk Medical School in 1976 specializing in Internal Medicine. Since 1987, she has been a member of the faculty at the Department of Tuberculosis and Lung Diseases, Siberian State Medical University in Tomsk, Russia. She is winner of a competition in fields of a science and education of Tomsk Oblast. In 1994, she defended her PhD dissertation on: “Alcoholism among patients with lung tuberculosis in Western Siberia and an approach for a management of their medical rehabilitation”. She also has completed a training course in the National Tuberculosis Centre in the Newark, New Jersey. She is author and co-author of more than 100 publications.
Professor Aivar – Janis K. Strelis is head of the faculty for the Department of Tuberculosis and Lung Diseases, Siberian State Medical University in Tomsk, Russia. He is a professor and academician member of the Russian Academy of Medical Science and the Latvian Academy of Sciences, and completed his PhD in medical sciences. He graduated from the Tomsk Medical School in 1966 specializing in Internal Medicine. Professor Strelis is the author and co-author of 700 publications, including 20 manuscripts, a practical manual for doctors, a lecture module on treatment of tuberculosis and lung diseases, and 3 practical manuals for students. His articles are published in 45 different scientific journals. Dr. Strelis, is a leading expert in the field of tuberculosis management, bronchology, lung diseases, and lung surgeries, and has 22 exclusive rights (copyrights) for different inventions. He has prepared 10 doctor dissertations and 30 master's thesis in medical sciences. Prof. Strelis passed away in spring 2009
Dr. Sergey A. Yanov, is a narcologist (addiction specialist) and psychiatrist at the Tomsk Oblast Tuberculosis Hospital. He graduated from the Tomsk Medical School in 2001 specializing in Internal Medicine. During 2001–2002, he trained as a clinical intern in psychiatry and narcology. Now, Dr. Yanov is a PhD Candidate at the department of narcology and psychiatry of the Tomsk Research Institute of Mental Health, Centre of Science, Russian Academy of Medical Science. Currently, he is working on a dissertation “Concomitant conditions, clinical dynamics and prevention of Alcohol Use Disorders in patients with tuberculosis who is taking treatment under the programs DOTS and DOTS-Plus”. He is the author and co-author on more than 10 publications.