Research Component

项目总结（见说明）： 我们建议进行两项补充随机对照试验（RCT）的任务转移到初级卫生保健（PHC），一个在埃塞俄比亚的严重精神障碍（SMD）的护理（n=690），和一个在南非（SA）的孕产妇抑郁症（n=380）的护理。在两组互补的疾病（SMD和孕产妇抑郁症）和两个国家（埃塞俄比亚和南非），我们的具体施舍是： 1.确定任务转移护理到PHC的有效性和成本效益，与埃塞俄比亚的专科精神卫生保健和SA的增强常规护理相比，主要结局指标（有效性和成本效益）和一系列次要结局指标。 2.通过评估可行性、可持续性、质量和安全性，以及从PHC工作者和患者的角度对任务转移的经验进行定性探索，研究影响任务转移干预实施和未来扩大规模的因素。 3.评价当地相关但可推广的指标，包括症状严重程度指标和功能/生活质量指标，以评价任务转移护理对PHC的有效性和成本效益 在埃塞俄比亚，干预措施将是通过为期2周的培训和精神科护士的持续监督以及进修培训，将对稳定的SMD患者的护理任务转移到PHC。在南非，初级保健工作人员将接受培训（为期一周的培训，由心理健康专家每周进行监督，并提供紧急咨询），对到产前诊所就诊的妇女进行常规筛查，以检查是否有孕产妇死亡。 爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale）为该地区服务的社区卫生工作者也将接受培训，以便在精神卫生专家的监督下提供适应性IPT干预。主要结局指标为症状严重程度，在埃塞俄比亚采用简明精神病评定量表，在南非采用汉密尔顿抑郁量表，在出生后6个月进行测量。这两项试验还将计算每个残疾调整寿命的成本，并包括定性部分。

PROJECT SUMMARY (See instructions): We propose to conduct two complementary randomized controlled trials (RCTs) of task shifting to primary health care (PHC), one in Ethiopia on the care of severe mental disorders (SMDs) (n=690), and one in South Africa (SA) on the care of maternal depression (n=380). In two complementary sets of disorders (SMD and maternal depression) and two country contexts (Ethiopia and South Africa) our specific alms are: 1. To determine the effectiveness and cost-effectiveness of task shifting care to PHC, compared to specialist mental health care in Ethiopia and enhanced usual care in SA, on both primary outcome measures(of effectiveness and cost-effectiveness) and on a series of secondary outcome measures. 2. To examine factors influencing the implementation of the task shifting intervention and future scale up, by assessing feasibility, sustainability, quality, and safety, and by qualitative exploration of the experience of task shifting from the perspectives of both PHC workers and patients. 3. To evaluate locally relevant but generalizable measures, including both symptom severity measures and functioning/quality of life measures, for evaluating the effectiveness and cost-effectiveness of task shifting care to PHC In Ethiopia, the intervention will be task shifting of care of stabilised persons with SMD to PHC, through 2 weeks of training and ongoing supervision by a psychiatric nurse, and refresher training. In South Africa, PHC staff will be trained (1 week of training with ongoing weekly supervision from the mental health specialist and emergency consultation) to routinely screen women attending antenatal clinics for maternal depression using the Edinburgh Postnatal Depression Scale. Community health workers (CHWs) servicing the area will also be trained to deliver the adapted IPT intervention under the supervision of the mental health specialist. Primary outcome measures will be symptom severity, measured on the Brief Psychiatric Rating Scale in Ethiopia at 12 months, and the Hamilton Depression Scale in SA at 6 months postnatal. Both of the trials will also calculate cost per Disability Adjusted Life, and include a qualitative component.