Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building - Scale-Up Component

放大研究-摘要 抑郁症在低收入和中等收入国家造成沉重的死亡和残疾负担， 导致高昂的社会、经济和生活质量成本。抑郁症常与慢性内科疾病并存 在LMIC中患病率急剧上升的情况，如高血压和糖尿病，并且 与这些并存情况下较差的临床结果相关。这种融合导致了要求 将心理健康治疗与扩大LMIC慢性病护理系统相结合。 对精神卫生保健的迫切需求的反应因严重缺乏熟练的精神卫生而受阻 LMIC中的卫生专业人员。因此，全球心理卫生界的许多关注都集中在 关于让非专科医生，如初级保健提供者或社区工作者， 解决常见心理健康问题的技能和结构。 马拉维卫生部已确定在慢性病诊所扩大抗抑郁治疗。 作为最高优先事项。基于算法的抑郁症护理(ABCD)是一项资源高效、基于证据的任务- 分享在非精神科临床环境中提供抗抑郁药物的方法，涉及系统措施 以及为非专科医生设计的算法指导的抗抑郁药物治疗决策。可获得性和 低成本抗抑郁药在许多低资源环境中的有效性使像ABCD这样的方法具有高度的 有效地将抑郁症治疗与现有的临床护理系统相结合的战略前景看好。 阻碍ABCD在低资源环境下扩大规模的一个关键知识差距是资源水平 在现实世界的诊所中达到可接受的保真度和有效性所需的投资。实施 开展科学研究以确定最佳实施战略，将是推进扩大工作的关键。这个 扩大研究核心的整体目标是找出最具效率和效益的设计 将ABCD纳入马拉维和类似环境中现有的慢性病护理。扩大规模的研究 CORE将进行临床随机试验，以比较实施情况、效果和成本- 促进ABCD扩大的两个实施战略的成效结果。扩大规模的研究将 还生成关于具有某些特征的诊所是否需要额外资源的信息 为了达到足够的保真度。与能力建设核心相协调，扩大研究 将为精挑细选的学员提供宝贵的在职培训机会，为设计做出贡献 并开展与心理健康相关的实施科学研究。最后，本研究的结果 将指导起草国家精神卫生行动计划的详细修订，与 卫生部和其他尖锐的合作伙伴。总体而言，扩大研究核心的活动将提供 指导马拉维卫生部进一步扩大以证据为基础的意图的关键信息， 在现有的慢性病护理环境中进行资源节约型抑郁症治疗。

SCALE-UP STUDY – ABSTRACT Depression causes a heavy burden of death and disability in low- and middle-income countries (LMICs), resulting in high societal, economic, and quality-of-life costs. Depression often co-occurs with chronic medical conditions whose prevalence is dramatically increasing in LMIC, such as hypertension and diabetes, and is associated with worse clinical outcomes for those comorbid conditions. This confluence has led to calls for integration of mental health treatment with expanding chronic disease care systems in LMICs. Response to the urgent need for mental health care is hampered by the severe shortage of skilled mental health professionals in LMICs. As a result, much attention in the global mental health community has focused on task-sharing approaches that give non-specialists, such as primary care providers or community workers, the skills and structure to address common mental health problems. The Malawi Ministry of Health has identified antidepressant treatment expansion in chronic diseases clinics as a high priority. Algorithm-based care for depression (ABCD) is a resource-efficient, evidence-based, task- sharing approach to antidepressant provision in non-psychiatric clinical settings involving systematic measures and algorithm-guided antidepressant treatment decisions designed for non-specialists. The availability and efficacy of low-cost antidepressants in many low-resource settings makes an approach like ABCD a highly promising strategy for efficient integration of depression treatment into existing clinical care systems. A key knowledge gap impeding the scale-up of ABCD in low-resource settings is the level of resource investment required to achieve acceptable fidelity and effectiveness in real-world clinics. Implementation science research to identify optimal implementation strategies will be critical to advance scale-up efforts. The overall objective of the Scale-Up Study Core is to identify the most efficient and effective design for the integration of ABCD into existing chronic disease care in Malawi and similar settings. The Scale-Up Study Core will conduct a clinic-randomized trial to compare the implementation, effectiveness, and cost- effectiveness outcomes of two implementation strategies to facilitate ABCD scale-up. The scale-up study will also generate information on whether clinics with certain characteristics will require additional resources in order to achieve sufficient ABCD fidelity. In coordination with the Capacity-Building Core, the scale-up study will provide invaluable “on the job” training opportunities for select SHARP trainees to contribute to the design and conduct of a mental health-related implementation science research study. Finally, the results of the study will guide the drafting of a detailed revision to the national Mental Health Action Plan, in collaboration with the Ministry of Health and other SHARP partners. Overall, the activities of the Scale-Up Study Core will provide key information to guide the Malawi Ministry of Health in furthering its intention of scaling up evidence-based, resource-efficient depression treatment in existing chronic disease care settings.