STRiDE: Strengthening responses to dementia in developing countries (GCRF)

痴呆症并不是一种“发达国家”的情况：拉美和加勒比地区的痴呆症患者已经比高收入经济体中的人数更多，但这些地区的痴呆症患者通常缺乏应对高发病率和不断增加的发病率的能力。到2050年，LAMICs中将有9000万人患有痴呆症(Prince等人，2015年)。痴呆症患者，特别是处于更严重阶段的患者，需要重症监护和支持，这是非常昂贵的。这些费用主要由无薪家庭照料者承担，主要是妇女，她们经常不得不离开带薪工作，冒着个人贫困和社会生产力损失的风险。LAMIC面临着没有发达或资金充足的卫生和护理系统的痴呆症患者数量的快速增长。由于人口、社会和经济的变化，家庭护理的可获得性正在减少。我们将利用经济学、流行病学和政策分析来建设研究能力，以帮助LAMIC以道德和可持续的方式应对日益增长的痴呆症患者的需求。共同申请者来自英国和南非，在高收入国家(HICs)和LAMICs的痴呆症研究、LAMICs的健康和长期(社会)护理研究方面有着良好的记录。我们将与阿尔茨海默病国际(ADI)合作，这是一个由85个国家阿尔茨海默病/痴呆症协会组成的联合会。我们将与7个LAMIC的当地研究人员和非政府组织合作：巴西、印度、印度尼西亚、肯尼亚、牙买加、墨西哥、南非。为了建设能力，我们将提供研究方法的正式培训，应用这些方法生成新的证据和工具，以及培训和实践使用证据为政策提供信息。我们将应用最好的方法方法并在同行评审的期刊上发表我们的结果，但更重要的是，我们将确保我们的研究产生实用工具，供利益相关者直接用于开发服务和改进实践，或影响政策。我们将使用系统审查和荟萃分析来审查关于LAMIC中哪些有效以及哪些可在特定背景下交付的证据，我们将使用变化理论(TOC)与当地合作伙伴(研究人员/非政府组织)和利益相关者(包括痴呆症患者和照顾者)共同制定项目的研究和培训议程，以确保我们的活动达到最大影响。TOC还将帮助我们制定评估项目影响的指标。我们的研究计划将包括制定和评估提高痴呆症意识和减少耻辱的干预措施，对在不同情况下向痴呆症患者提供家庭护理的成本和其他影响进行定性研究，生成关于痴呆症对个人和家庭的影响和成本的量化证据，以及收集这些数据的工具。我们将使用生成的证据为每个国家制定可信的痴呆症成本和影响估计，并使用模拟模型预测未来的痴呆症护理需求、满足这些需求所需的卫生和社会服务、成本，以及实施循证痴呆症护理路径和更好的覆盖范围的影响。每个国家的模式都将易于更新和调整。我们将评估我们预测的政策影响，考虑当前组织和融资系统带来的障碍以及训练有素的工人的可用性，并概述改善痴呆症的改革机会，考虑到更广泛的医疗和社会保健系统。最后，我们将与ADI和其他政策合作伙伴合作，提出地方建议，以支持国家痴呆症计划的实施。我们将与世卫组织合作，在每个国家组织利益攸关方讲习班，介绍项目成果，并在每个区域召开高级别利益攸关方会议。

Dementia is not a "developed world" condition: there are already more people with dementia in LAMICs than in high-income economies, yet LAMICs are typically less equipped to respond to the high and increasing prevalence. By 2050, there will be 90 million people with dementia in LAMICs (Prince et al 2015). People with dementia, particularly at more severe stages, require intensive care and support, which is very costly. These costs are mostly borne by unpaid family carers, primarily women, who often have to leave paid work, risking personal impoverishment and societal productivity losses. LAMICs face rapid growth in numbers of people with dementia without well-developed or well-funded health and care systems. Family care availability is decreasing as a result of demographic, societal and economic changes. We will build research capability using economics, epidemiology and policy analyses to help LAMICs respond to the needs of the growing numbers of people with dementia in an ethical and sustainable way. The co-applicants, from the UK and South Africa, have strong track-records in dementia research in high-income countries (HICs) and LAMICs, research on health and long-term (social) care in LAMICs. We will partner Alzheimer's Disease International (ADI), a federation of 85 national Alzheimer/dementia associations. We will work with local researchers and NGOs in 7 LAMICs: Brazil, India, Indonesia, Kenya, Jamaica, Mexico, South Africa. To build capability we will offer formal training in research methods, application of those methods to generate new evidence and tools, and training and practice in use of evidence to inform policy. We will apply the best methodological approaches and publish our results in peer-reviewed journals, but more importantly we will ensure that our research generates practical tools for use directly by stakeholders to develop services and improve practice, or to influence policy.We will use systematic reviewing and meta-analysis to review evidence on what works in LAMICs and what can be delivered in particular contexts, but also make that research available online and in DVDs as evidence summaries written in plain (dementia-friendly) language and translated to relevant local languages.We will use Theory of Change (ToC) to co-develop with local partners (researchers/NGOs) and stakeholders (including people with dementia and carers) the research and training agenda for the project to ensure that our activities achieve maximum impact. ToC will also help us develop indicators to evaluate the project's impact. Our research programme will involve development and evaluation of an intervention to increase dementia awareness and reduce stigma, a qualitative study of costs and other impacts of providing family care to people with dementia in different contexts, generation of quantitative evidence on impacts and costs of dementia on individuals and families, and instruments to collect these data.We will use the evidence generated to develop, for each country, credible estimates of the costs and impacts of dementia, and use simulation modelling to project future dementia care needs, the health and social services required to meet those needs, their costs, and the impacts of implementing evidence-informed dementia care pathways and better coverage. Models for each country will be simple to update and adapt. We will assess the policy implications of our projections, consider the barriers presented by current organisation and financing systems and the availability of trained workers, and outline reform opportunities to improve dementia, considering the wider health and social care systems.Finally, we will work with ADI and other policy partners to produce local recommendations to support the implementation of National Dementia Plans. We will organise stakeholder workshops in each country to present project outcomes, and high level stakeholder meetings in each of the regions, in collaboration with WHO.