Implementing screening and brief intervention for substance use in primary care in rural Georgia

Project title: Implementing screening and brief intervention for substance use in primary care in rural Georgia PROJECT SUMMARY/ABSTRACT Background: Substance use disorders (SUD) pose a global public health challenge, yet evidence-based interventions like Screening and Brief Intervention (SBI) remain underutilized in primary care, particularly in low- and – middle-income countries, such as Georgia. Despite strong evidence supporting SBI’s effectiveness, major implementation gaps persist. These challenges hinder SBI delivery and leave vulnerable populations underserved, as is the case in the context of rural Georgian communities. This K43 Emerging Global Leader application seeks to address these barriers and bridge the SBI implementation gap through innovative, scalable interventions. Candidate: Dr. Ilia Nadareishvili is a junior faculty member at David Tvildiani Medical University in Tbilisi, Georgia, with expertise in addiction medicine, health policy, and capacity building. This project supports his long-term goal of becoming an independent global health scientist and educator focused on addressing health systems’ addiction and mental health needs in Georgia and other low-resource settings. Through training in implementation science, survey design, biostatistics, and study design, this K43 project will build on Dr. Nadareishvili’s extensive experience in medical education and health systems research. Research: The proposed study aims to identify individual, environmental, and systemic barriers to SBI implementation in rural Georgian primary care and address these barriers through a tailored educational intervention. Using frameworks such as the Implementation Outcomes Framework, the SBIRT Program Matrix, and the Consolidated Framework for Implementation Research, the project will (1) assess contextual barriers and facilitators to SBI implementation in rural primary care (Aim 1), (2) develop a culturally tailored online educational intervention promoting SBI using virtual patient scenarios and problem-based learning cases (Aim 2), and (3) pilot test the intervention to assess its feasibility and inform a future community-level implementation randomized controlled trial (RCT). Innovation: This study leverages a combination of multiple implementation science frameworks to provide a comprehensive and systematic approach to identifying and addressing SBI implementation gaps. Its unique focus is to address SBI implementation in rural settings through a culturally adapted online continuing medical education (e-CME) program. The intervention will provide an innovative model for improving SBI adoption in resource-limited contexts, contributing to the global evidence base on scalable solutions for SUDs. Future directions: Supported by a multidisciplinary team of expert mentors, Dr. Nadareishvili will gain the skills and collect the preliminary data to design and submit a competitive R01 proposal for a full-scale implementation RCT. This research will lead to accredited e-CME resources, policy recommendations, and improved SBI practices in rural Georgia and similar global contexts.