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不得不调整他们的 卫生系统应对以多发性疾病上升为特征的不断变化的疾病概况 慢性合并症。艾滋病毒，现在被认为是一种慢性病，以及结核病 与不断增加的非传染性疾病(NCD)负担日益并存。 这种混合包括常见的精神疾病(CMD)，它们会干扰坚持 和自我护理，损害了全球在疫苗、药物和其他方面的投资 治疗。拟议的扩大研究回应了产生 了解如何最好地将CMD的综合循证实践扩展为真正的 针对多种慢性病的世界初级卫生保健(PHC)平台 受约束的设置。我们建议的研究将基于我们正在进行的 任务共享、基于证据的包，用于将对CMD的护理整合到 PHC设施中的慢性护理系统，具体目标如下：目标1：利用可再生能源-- 目标框架，以检查覆盖范围、有效性、采用、实施和 在两个不同的真实地区背景下保持扩大规模。目标1.1：跟踪RE- 目标1.2：致力于持续的质量改进 在设施和地区层面。我们将审查心理健康筛查、转诊、 治疗吸收、依从性、护理质量；医护人员培训、知识、 态度和满意度；患者结果和满意度；成本影响；以及组织 整合。目标2：利用执行研究综合框架(CFIR) 审查和适应影响执行工作的多层次因素的框架 两个不同的真实地区背景。目标2.1：确定和评估多层次因素 影响一揽子计划的实施；目标2.2：让保健系统管理人员和规划人员参与 在区、省和国家各级开展参与性进程，为 持续高效实施。我们将在高层进行关键线人采访， 中低绩效诊所，以识别多层次因素并吸引利益相关者参与 一个参与性的过程。

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.