Integrating evidence-based MDD treatment in primary care: TB in Brazil as a model

 描述(由申请人提供)：将循证MDD治疗纳入初级保健：巴西的结核病作为模式世卫组织和NIMH承认将抑郁症治疗纳入初级保健是增加获得机会和缩小全球精神卫生(GMH)治疗差距的最可行的战略。几种基于证据的抑郁症治疗方法已经被采用，并被证明在低资源环境下有效，但需要系统的战略来使这些做法在低资源环境下规模化，因为那里的MH专家很少。结核病是LMIC的主要死亡原因，部分是由抑郁症的高发病率驱动的，它是在资源匮乏的初级保健系统中建设抑郁症治疗能力的战略切入点。这项提案的总体目标是制定一项有针对性的前瞻性扩大战略，将循证抑郁症治疗纳入初级保健，以巴西的结核病服务为切入点。我的长期职业目标是成为一名独立的GMH研究员，专门在不同的“现实世界”护理系统中扩大基于证据的MH干预。这一K01奖项将使我能够在我在临床社会工作、公共卫生、社会科学和可持续发展方面的坚实的临床、理论和方法论基础上建立基础，在一个新的技术领域(社会网络分析)发展专业知识，并利用研究为政策提供信息，以扩大“现实世界”护理系统中基于证据的干预措施的规模。我的培训目标是1)扩展我在传播和实施科学方面的技能和专业知识，重点是在GMH中扩大基于证据的干预措施的系统层面；2)学习和应用社会网络分析的原理，以在资源不足的情况下为系统层面的扩大提供信息；以及3)弥合实施科学方面的政策和研究之间的差距，以最大限度地提高公共卫生影响。将通过直接指导、课程和教程、网络研讨会/研讨会、定向阅读、讲习班、会议和实践经验相结合的方式实现这些目标。在我提议的研究中，我将1)将“接受性”(采用的可能性)的概念应用到整合基于证据的抑郁症治疗和结核病提供者之间的“连接性”(扩散的可能性)，以战略性地确定 并以伊塔博拉伊公共卫生系统所有诊所中接受程度最高和联系最好的两个试点诊所为目标，在这两个试点诊所内开展循证抑郁症治疗试点，2)在这两个试点诊所内进行抑郁症/结核病综合治疗试点，3)衡量不属于两个试点地点的伊塔博拉伊公共卫生系统(连接与否)内个人的影响力扩散(接受度变化)。总体目标将是为未来扩大循证干预措施制定有效和有效的有针对性的战略，这些干预措施可以应用于美国和国外的不同环境和其他健康状况，并收集可行性数据，为后续的R01提案提供参考。

 DESCRIPTION (provided by applicant): Integrating evidence-based MDD treatment in primary care: TB in Brazil as a model The WHO and NIMH recognizes the integration of depression treatment into primary as the most viable strategy for increasing access and closing the global mental health (GMH) treatment gap. Several evidence-based treatments for depression have been adapted and demonstrated efficacious in low-resource settings but systematic strategies are needed to bring these practices to scale in low-resource settings where there are few MH specialists. As a leading cause of death in LMIC that is driven, in part, by high comorbidity with depression, tuberculosis (TB) represents a strategic point-of-entry for building capacity for depression treatment in primary care systems in low resource settings. The overall aim of this proposal is to develop a targeted prospective scale-up strategy for integrating evidence-based depression treatment into primary care, using TB services in Brazil as a point-of-entry. My long term career goal is to become an independent GMH researcher specialized in scaling-up evidence-based MH interventions within diverse `real world' systems of care. This K01 award will enable me to build on my strong clinical, theoretical, and methodological foundations in clinical social work, public health, the social sciences, and sustainable development, to develop expertise in a new technical area (social network analysis), and to use research to inform policy around the scale-up of evidence-based interventions in `real world' systems of care. My training goals are to 1) expand my skills and expertise in dissemination and implementation science with a focus on systems-level scale-up of evidence based interventions in GMH; 2) learn and apply the principals of social network analysis to inform system-level scale- up in low resource settings, and 3) to bridge the gap between policy and research in implementation science to maximize public health impact. These goals will be achieved through a combination of direct mentorship, coursework and tutorials, webinars/seminars, directed readings, workshops, conferences and hands-on experience. In my proposed research, I will 1) operationalize the constructs of "receptivity" (likelihood of adoption) to integrating evidence-based depression treatment and "connectivity" (likelihood of diffusion) among TB providers to strategically identify and target the two most receptive and well connected pilot clinics from all the clinics in the Itaboraí public health system in which to implement evidence-based depression treatment, 2) pilot depression/TB treatment integration within these two pilot clinics, and 3) measure diffusion of influence (changes in receptivity) in individuals within the Itaboraí public health system (connected or not) not part of the two the pilot sites. The overall goal will be to develop an efficient and effective targeted strategy for future scale-up of evidence based interventions that can be applied in diverse settings and other health conditions, in the US and abroad, and gather feasibility data to inform a subsequent R01 proposal.