Strengthening South Africa's health system through integrating treatment for mental illness into chronic disease care (Project MIND)

通过将精神疾病治疗纳入慢性病护理来加强南非的卫生系统（MIND 项目）

• 批准号: MR/M014290/1
• 负责人: Bronwyn Myers
• 金额: $ 114.52万
• 依托单位: South African Medical Research Council
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM014290%2F1
• 关键词: Strengthening; South; Africa; health; system

Integrating mental health care into primary health care services could reduce the impact of both chronic communicable and non-communicable diseases (NCDs). Like many low- and middle-income countries (LMICs), South Africa (SA) faces the challenge of how to reduce the high prevalence and impact of communicable diseases and NCDs, including mental disorders where limited services are available. Mental disorders are important to address among patients with chronic diseases as these problems are associated with poor adherence to treatment, more rapid disease progression and treatment failure. As treatment failure increases the use of health services and health service costs, chronic disease care in LMICs must be expanded to include mental health care. The integrated delivery of mental health services and chronic disease care has been shown to not only improve access to mental health care but also the mental health of patients living with a chronic disease. . Yet, limited knowledge of how mental health care can be integrated into chronic disease services in ways that are acceptable to patients and providers and feasible to implement with few resources has delayed the integration of services in SA. The provision of integrated mental health and chronic disease services has also been delayed by questions about whether services should be vertically or horizontally integrated. Vertically integrated services are delivered at the same location, but mental health and chronic disease services are provided by separate cadres of health workers. Horizontally integrated services are delivered at the same location by the same staff are responsible for mental health and chronic disease care. The goal of this project is to answer these questions by assessing current capacity and barriers to integrating mental health services into chronic disease care and by comparing the effectiveness and cost-effectiveness of a vertically and horizontally integrated model of service integration among patients receiving treatment for HIV or diabetes and who are at risk for treatment failure in Cape Town, SA. Through this project we hope to identify a feasible, acceptable and effective model for integrating mental health services into chronic disease care that is applicable to other LMICs. Findings from this study are likely to be highly relevant for use in other LMICs given similarities between the burden of disease, treatment populations, and treatment systems in SA and other LMICs.The study will comprise two phases. In the first phase, we will conduct in-depth interviews with a range of healthcare providers in HIV and diabetes services to assess barriers to integration and the feasibility and acceptability of our proposed models of service integration (Aim 1). Findings from this phase will be used to adapt our evidence-based mental health service package for optimal integration into chronic disease services. In phase two, a clustered randomised controlled trial will be conducted. We will select 24 HIV and 24 diabetes clinics to randomise to a vertically integrated arm, horizontally integrated arm, or treatment as usual (no integration). We will recruit 25 patients at risk for treatment failure from each of these clinics (total 1200 patients). After study enrollment, a baseline assessment will be completed by a fieldworker. Participants recruited from clinics randomised to either the vertically integrated or horizontally integrated arm will then receive their intervention sessions. All participants, irrespective of their intervention arm, will be tracked for 6- and 12-month follow-up interviews. At these interviews, fieldworkers blinded to their intervention arm will re-administer the baseline assessment and biological specimens will be collected to assess for chronic disease outcomes. Findings from this phase will be used to evaluate the relative effectiveness and cost-effectiveness of our proposed models of service integration (Aims 2-3).

将精神卫生保健纳入初级卫生保健服务可以减少慢性传染性和非传染性疾病的影响。与许多低收入和中等收入国家一样，南非（SA）面临着如何降低传染病和非传染性疾病（包括服务有限的精神障碍）的高流行率和影响的挑战。精神障碍在慢性病患者中很重要，因为这些问题与治疗依从性差、疾病进展更快和治疗失败有关。由于治疗失败增加了卫生服务的使用和卫生服务成本，必须扩大中低收入国家的慢性病护理，将精神卫生保健包括在内。事实证明，综合提供精神卫生服务和慢性病护理不仅可以改善获得精神卫生保健的机会，还可以改善慢性病患者的精神健康。.然而，有限的知识，如何精神卫生保健可以整合到慢性病服务的方式，可以接受的患者和供应商和可行的实施资源很少，推迟了SA的服务整合。提供综合精神健康和慢性病服务也因服务应纵向还是横向综合的问题而被推迟。纵向一体化服务在同一地点提供，但精神健康和慢性病服务由不同的保健工作人员骨干提供。由负责精神卫生和慢性病护理的同一批工作人员在同一地点提供横向综合服务。该项目的目标是通过评估目前的能力和障碍，将精神卫生服务纳入慢性病护理，并通过比较的有效性和成本效益的纵向和横向一体化模式的服务整合患者之间接受治疗的艾滋病毒或糖尿病，谁是在南非开普敦治疗失败的风险来回答这些问题。通过这个项目，我们希望确定一个可行的，可接受的和有效的模式，将精神卫生服务纳入慢性病护理，适用于其他低收入国家。鉴于南非和其他中低收入国家的疾病负担、治疗人群和治疗系统之间的相似性，本研究的结果可能与其他中低收入国家的使用高度相关。在第一阶段，我们将与艾滋病毒和糖尿病服务的一系列医疗保健提供者进行深入访谈，以评估整合的障碍以及我们提出的服务整合模式的可行性和可接受性（目标1）。这一阶段的研究结果将用于调整我们的循证心理健康服务包，以最佳方式融入慢性病服务。在第二阶段，将进行一项随机分组对照试验。我们将选择24家HIV和24家糖尿病诊所，随机分配至垂直整合组、水平整合组或常规治疗组（无整合）。我们将从每个诊所招募25名有治疗失败风险的患者（共1200名患者）。研究入组后，将由现场工作人员完成基线评估。然后，从随机分配到垂直整合或水平整合组的诊所招募的参与者将接受干预治疗。所有参与者，无论其干预组如何，都将接受6个月和12个月的随访访谈。在这些访谈中，对干预组设盲的现场工作人员将重新进行基线评估，并收集生物标本以评估慢性疾病结局。这一阶段的研究结果将用于评估我们建议的服务整合模式（目标2-3）的相对有效性和成本效益。

项目成果

Strategies for supporting the implementation of a task-shared psychological intervention in South Africa's chronic disease services: qualitative insights from health managers' experiences of project MIND.

• DOI: 10.1080/16549716.2022.2123005
• 发表时间: 2022-12-31
• 期刊: GLOBAL HEALTH ACTION
• 影响因子: 2.6
• 作者: Brooke-Sumner, Carrie;Petersen-Williams, Petal;Sorsdahl, Katherine;Kruger, James;Mahomed, Hassan;Myers, Bronwyn
• 通讯作者: Myers, Bronwyn

Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa.

• DOI: 10.1007/s10597-020-00734-0
• 发表时间: 2021-08
• 期刊: Community mental health journal
• 影响因子: 2.7
• 作者: Jacobs Y;Myers B;van der Westhuizen C;Brooke-Sumner C;Sorsdahl K
• 通讯作者: Sorsdahl K

Protocol for development and validation of a context-appropriate tool for assessing organisational readiness for change in primary health clinics in South Africa.

• DOI: 10.1136/bmjopen-2017-020539
• 发表时间: 2018-04-09
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Brooke-Sumner C;Sorsdahl K;Lombard C;Petersen-Williams P;Myers B
• 通讯作者: Myers B

Closing The Treatment Gap: Insights Into Implementation Strategies for Task-Shared Counselling for Depression and Unhealthy Alcohol use In South Africa

缩小治疗差距：深入了解南非抑郁症和不健康饮酒的任务共享咨询实施策略

• DOI: 10.21203/rs.3.rs-703529/v1
• 发表时间: 2021
• 作者: Brooke-Sumner C

Brief problem-solving therapy for antenatal depressive symptoms in primary care in rural Ethiopia: protocol for a randomised, controlled feasibility trial.

• DOI: 10.1186/s40814-021-00773-8
• 发表时间: 2021-01-30
• 期刊: Pilot and feasibility studies
• 影响因子: 1.7
• 作者: Bitew T;Keynejad R;Myers B;Honikman S;Medhin G;Girma F;Howard L;Sorsdahl K;Hanlon C
• 通讯作者: Hanlon C