Alcohol and other drug (AOD) problems in Uganda are characterised by high per capita alcohol consumption, heavy episodic drinking underage AOD and high rates of both injecting and non-injecting drug use.
These contribute significantly to the burden of disease in Uganda. While the quality and effectiveness of AOD treatment services has routinely been evaluated in high income countries, little is known in this regard in low and middle-income countries like Uganda.
Specifically, a need has been identified for assessing routine outcome measurements in AOD treatment services and patient-reported outcomes and experiences in residential and outpatient treatment modalities.
The research topic is Advancing the Quality of treatment services for Substance Use Disorders in Uganda through the measurement and monitoring of patient-reported outcomes and experiences.
The overall goal of the study is to improve the quality of AOD treatment services in Uganda through the measurement and monitoring of patient-reported outcomes and experiences, involving two public hospitals in Uganda – the Butabika National Referral Mental Health Hospital (BNRMH) in Kampala and the Mental Health Unit (MHU) of the Gulu Regional Referral Hospital (GRRH) in Northern Uganda.
Within BNRMH, the Alcohol and Drug Unit (ADU) functions as Uganda’s only government-run rehabilitation centre for substance-use disorders (SUDs), offering a full continuum of care: medically supervised detoxification; structured inpatient rehabilitation (with a bed capacity of approximately 80 patients delivered on a standard 2–4-week protocol) with step-down planning; and post-discharge outpatient follow-up via scheduled clinics and community linkage.
The service pathway begins with detoxification (medical stabilization of withdrawal symptoms under specialist supervision), followed by a rehabilitation phase involving inpatient care where psychosocial counselling, relapse-prevention planning, group therapy, family involvement and vocational re-integration sessions are provided. Once patients transition from the inpatient phase, the ADU offers outpatient follow-up services, comprising scheduled clinics for monitoring, individual and group counselling, peer-support groups and referral back into community-based care or outreach services.
The ADU also houses Uganda’s first Medically Assisted Therapy (MAT) clinic for opioid use disorder which serves hundreds of clients annually through combined harm-reduction and recovery-oriented care.
The staffing mix at BNRMH combines psychiatrists, psychiatric clinical officers, psychiatric nurses, clinical psychologists, counsellors, social workers and peer-support mentors, together forming a multidisciplinary team responsible for assessment, care-planning, treatment implementation and discharge planning.
The GRRH serves as the primary mental health regional referral centre for districts in the Acholi sub-region (including the districts of Amuru, Gulu, Kitgum, Lamwo and Pader). The GRRH MHU is integrated within the general hospital and provides inpatient (approximately 20 beds) and outpatient psychiatric services, managed by psychiatrists and psychiatric clinical officers with linkages to district and community services.
The research involves evaluating the capability of specific tools and measures to determine the effectiveness of alcohol and drug treatment services in Uganda, referred to as the AQUALEFF study (Advancing Quality and Effectiveness of Treatment of Substance Use Disorders in Uganda). It has a number of specific questions –
1) The feasibility the implementation of the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Addiction tools at Butabika National Referral Hospital, Kampala, Uganda.
2) Identifying the treatment outcomes from a recovery and continuing care perspective for AOD treatment service users at various time points at Butabika National Referral Hospital.
3) Quantifying and understanding the patient-reported experiences and recovery trajectories of service users.
The ICHOM has pioneered the use of patient-reported outcomes (PROMs), which are likely to become the main frame of reference for measuring and advancing health outcome and quality of care, provide standard sets of outcomes for a range of health problems in AOD services globally and provide a global benchmark for assessment.
Adoption of standardized outcome measures opens possibilities to compare performance not only within Uganda and its various regions, but also globally, allowing practitioners to learn from each other and providing policy-makers with tools and evidence to improve the quality and effectiveness of care, to the benefit of AOD treatment services in Uganda.
The findings on treatment outcomes and experiences will develop and support recommendations for improving the accessibility, continuity and overall quality and effectiveness of AOD treatment services globally.