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

规模扩大研究-摘要 抑郁症在低收入和中等收入国家造成了沉重的死亡和残疾负担， 导致高的社会、经济和生活质量成本。抑郁症往往与慢性病并发。 在LMIC中患病率急剧增加的疾病，如高血压和糖尿病， 与这些合并症的临床结局更差相关。这一融合导致人们呼吁 将精神卫生治疗与扩大中低收入国家慢性病护理系统相结合。 由于严重缺乏熟练的心理医生， 中小微国家的卫生专业人员。因此，全球精神卫生界的许多注意力都集中在 关于任务分担的方法，让非专家，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 作为高度优先事项。抑郁症的循证护理（ABCD）是一项资源有效、以证据为基础的任务， 在非精神病临床环境中提供抗抑郁药的共享方法，包括系统性措施 以及为非专家设计的算法指导的抗抑郁治疗决策。提供和 低成本抗抑郁药在许多低资源环境中的疗效使得ABCD这样的方法成为一种高度有效的方法。 将抑郁症治疗有效整合到现有临床护理系统中的有前途的策略。 在资源匮乏的环境中，阻碍ABCD推广的一个关键知识差距是资源水平。 在现实世界的诊所中实现可接受的保真度和有效性所需的投资。执行 开展科学研究以确定最佳执行战略，对于推动扩大努力至关重要。的 扩大研究核心的总体目标是确定最有效的设计， 将ABCD纳入马拉维和类似环境中现有的慢性病护理。规模扩大研究 中心将进行一项临床随机试验，以比较实施，有效性和成本- 促进扩大ABCD规模的两项执行战略的有效性成果。扩大研究将 此外，我们亦会提供资料，说明具备某些特徴的诊所是否需要额外资源， 为了达到足够的ABCD保真度。与能力建设核心项目协调， 将提供宝贵的“在职”培训机会，选择夏普受训人员作出贡献的设计 并开展一项与心理健康有关的实施科学研究。最后，研究结果 将指导起草一份详细的修订国家精神卫生行动计划，与 卫生部和其他SHARP伙伴。总体而言，扩大研究核心的活动将提供 关键信息，以指导马拉维卫生部进一步扩大其意图循证， 在现有的慢性病护理环境中进行资源有效的抑郁症治疗。

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.