Evaluation of an ongoing scale-up of a task shared, evidence-based package for integrating care for common mental disorders into primary health care in two under-resourced provinces in South Africa.

许多南部非洲国家面临着必须调整其 卫生系统应对不断变化的疾病概况，其特点是 慢性合并症。艾滋病毒，现在被认为是一种慢性疾病， 与此同时，非传染性疾病的负担日益加重。 包括在这种混合是常见的精神障碍（CMD），这干扰了坚持 和自我保健，损害全球对疫苗，药物和其他 治疗。拟议的扩大规模研究响应了迫切需要， 了解如何最好地将CMD的综合循证实践扩展到真实的- 世界初级卫生保健（PHC）平台，为多种慢性病提供资源- 约束设置。我们提出的研究将分层到正在进行的规模扩大我们的 任务共享，以证据为基础的包，将CMD护理整合到这个综合 目标1：利用可再生能源， 目的框架，以审查范围，有效性，采用，实施和 在两个不同的实际地区背景下维持扩大规模。目标1.1：追踪可再生能源- 目标1.2：参与持续质量改进 在设施和地区层面。我们将检查精神健康筛查、转诊、 治疗接受率、依从性、护理质量;卫生保健工作者培训、知识， 态度和满意度;患者结果和满意度;成本影响;以及组织 一体化目标2：利用实施研究综合框架 审查和适应影响《公约》执行工作的多层面因素的框架 两个不同的真实区域环境。目标2.1：确定和评估多层次因素 目标2.2：让卫生系统管理人员和规划人员参与 在地区、省和国家一级，在参与性进程中， 继续高效实施。我们会在高-， 中等和低绩效诊所，以确定多层次的因素，并使利益相关者参与 一个参与的过程。

Many Southern African countries are confronted with the challenge of having to adapt their health systems to respond to a changing disease profile characterized by a rise in multiple chronic comorbidities. HIV, which is now considered a chronic condition, and tuberculosis are increasingly co-occurring with a rising burden of non-communicable diseases (NCDs). Included in this mix are Common Mental Disorders (CMDs), which interfere with adherence and self-care, compromising global investments in vaccines, medications and other treatments. The proposed scale-up study responds to the urgent need to generate knowledge of how best to scale up integrated evidence-based practices for CMDs into real- world primary health care (PHC) platforms for multiple chronic diseases in resource- constrained settings. Our proposed study will be layered onto the ongoing scale-up of our task-shared, evidence-based package for integrating care for CMDs into this integrated chronic care system in PHC facilities with the following specific aims: Aim 1: Utilize the RE- AIM framework to examine the reach, effectiveness, adoption, implementation and maintenance of scale-up in the two different real-world district contexts. Aim 1.1: Track RE- AIM outcomes in implementing facilities; Aim 1.2: Engage in continuous quality improvement at facility and district levels. We will examine indicators of mental health screening, referral, treatment uptake, adherence, quality of care; health care worker training, knowledge, attitudes and satisfaction; patient outcomes and satisfaction; cost impact; and organizational integration. Aim 2: Utilize the Consolidated Framework for Implementation Research (CFIR) framework to examine and adapt to multi-level factors that influence implementation in the two different real-world district contexts. Aim 2.1: Identify and assess multi-level factors affecting package implementation; Aim 2.2: Engage health system managers and planners at district, provincial and national levels in a participatory process to propose adaptations for continued efficient implementation. We will conduct key informant interviews in high-, medium- and low-performing clinics to identify multi-level factors and engage stakeholders in a participatory process.