PRIDE SSA - Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence Based Practices in sub-Saharan Africa

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Global mental health (MH) treatment and research gaps require that efficacious treatments be scaled-up, leveraging existing platforms. In tandem, policies must sustain them over time. PRIDE SSA may generate templates for other LMICs by conducting a state of the art scale up study in Mozambique and by establishing a collaborative research network of nascent research “Seed Teams.” Such “Seed Teams,” trained by the capacity building component, may work across the region to build capacity and conduct implementation research to sustainably scale-up MH services. Scale Up Research (Mozambique) in MH and substance use disorders will evaluate strategies and costs of scaling up an innovative, integrated, sustainable, stepped-care community approach. We will leverage: (1) Mozambique's task-shifting strategy of training psychiatric technicians (PsyTs) to provide MH care, (2) the WHO-funded epilepsy community care program successfully implemented in 5 Provinces, now primed for scale-up by the Health Ministry. Our cost-effective approach redefines work roles without requiring new human resources. Importantly, it comports with the Health Ministry's plan to implement prevention and treatment for all MH conditions, rather than single disorders. The model employs EBPs (e.g. Psychopharmacology; Interpersonal Therapy), already in use by PsyTs to: a) establish a sustainable program delivered and supervised by non-MH professionals, overseen by MH specialists; b) provide community screening, care and/or referrals for all MH disorders; and c) use implementation tools to monitor sustainability. This collaborative network will scale-up a cost-effective, sustainable program and inform policy. Capacity Building Regional Partnerships will leverage well-established capacity building institutions (Foundation for Professional Development; U of Cambridge; U of Pretoria; Mozambique's Institute of Health Education and Research) and our Mozambique Fogarty/NIMH MH Implementation Program (partnership: Mozambique [Ministry of Health; U Eduardo Mondlane]; US [Columbia; U of Pennsylvania]; and Brazil [U Federal do São Paulo]) to train service providers, investigators and policy-makers from Botswana, Malawi, Mozambique, South Africa, Zambia. Each country will contribute `seed teams' committed to working together, that include all actors needed to develop, test, implement and sustain community based MH services using EBPs: 1) new researchers to conduct MH implementation and dissemination research; 2) policy makers to leverage evidence generated by local research to improve and test MH policies and programs; 3) trainer-of- trainers to prepare staff to deliver adapted EBPs that preserve fidelity; and 4) senior-level faculty to develop university programs to prepare the next generation of investigators. Training comprises synergistic didactics, hands-on research experience designed in partnership local stakeholders, and mentorship from local or US senior investigators. Lessons learned in the scale up research will be adapted for research in partner countries and other LMICs.