ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE)

项目摘要(整体组件) Essence的总体目标(使科学转化为服务以加强抑郁症治疗) 该项目将产生关于扩大循证基础的有效实施方法的知识 印度农村初级保健环境中对抑郁症的干预。实质执行审判 代表了Essence计划两个主要试验中的第二个，并将在以下方面产生有价值的研究结果 支持接受和实施抑郁症的远程策略的有效性和成本 基于世界卫生组织在常规初级保健环境中的mhGAP方案的护理包 印度中央邦的Sehore区。实质执行试验直接建立在成功的基础上 推出并完成了Essence培训试验，证明了杠杆的有效性 通过培训社区卫生工作者提供证据来建设劳动力能力的数字技术- 基于对抑郁症的简短心理治疗。实质执行审判代表着下一步 通过支持初级保健设施，支持实施抑郁症护理的关键步骤 采用和整合抑郁症护理的团队，并建立筛查转诊路径 确定社区中的抑郁症病例，然后确保获得新的 训练有素的社区卫生工作者。Essential实施试验由随机整群组成 对照试验，在Sehore区招募14家初级保健机构，随机分配7家机构接受 强化实施支持战略干预条件，其余7个设施随机 分配到接收例行执行支持控制条件。我们的主要假设是 加强实施支持，包括远程培训和强调质量 改善，在提高门诊率方面将优于常规实施支持 筛查抑郁症(使用PHQ-9，一种常见的抑郁症筛查器)。此外，我们假设 在筛查出抑郁症阳性的门诊患者中，那些在设施中随机接受强化治疗的患者 与实施支持相比，实施支持在3个月的跟踪中将显示症状严重性的更大程度降低 门诊患者在常规实施支持控制条件下。所有14个设施都已在 MhGAP抑郁症护理包，以及实施支持策略已于4、5月份进行了测试， 2022年实施试验的患者招募工作将于2022年6月1日开始正式启动。这 行政副刊将确保实质执行试验的关键活动能够 完成，并且数据分析和对结果的解释可以为抑郁症的扩大提供信息 旨在缩小印度和全球抑郁症护理的治疗差距。

PROJECT ABSTRACT (OVERALL COMPONENT) The overall goal of the ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) project is to generate knowledge on effective implementation approaches for scaling up of evidence based interventions for depression in primary care settings in rural India. The ESSENCE Implementation Trial represents the second of two major trials in the ESSENCE program, and will yield valuable research findings on the effectiveness and costs of remote strategies that can support the uptake and implementation of a depression care package based on the World Health Organization's mhGAP program in routine primary care settings in Sehore district in Madhya Pradesh, India. The ESSENCE Implementation Trial builds directly on the successful roll out and completion of the ESSENCE Training Trial, which demonstrated the effectiveness of leveraging digital technology for building workforce capacity by training community health workers to deliver an evidence- based brief psychological treatment for depression. The ESSENCE Implementation Trial represents the next critical step in supporting the implementation of depression care, by supporting the primary health care facility teams with the adoption and integration of depression care, and establishing the referral pathways for screening and identifying depression cases in the community and then ensuring access to treatment delivered by the newly trained community health workers. The ESSENCE Implementation Trial consists of a cluster-randomized controlled trial, enrolling 14 primary care facilities in Sehore district, with 7 facilities randomly assigned to receive the Enhanced Implementation Support strategy intervention condition, and the remaining 7 facilities randomly assigned to receive the Routine Implementation Support control condition. Our primary hypothesis is that the Enhanced Implementation Support, involving remotely delivered coaching and emphasis on quality improvement, will be superior to Routine Implementation Support in increasing the proportion of outpatients screened for depression (using the PHQ-9, a common screener for depression). Furthermore, we hypothesize that among outpatients screened positive with depression, those in facilities randomized to the Enhanced Implementation Support will show greater reduction in symptom severity at 3-month follow up compared to outpatients in the Routine Implementation Support control condition. All 14 facilities have been trained in the mhGAP depression care package, and the implementation support strategies have been tested in April and May, 2022. The official launch of patient recruitment for the Implementation Trial will begin on June 1st, 2022. This Administrative Supplement will ensure that the key activities for the ESSENCE Implementation Trial can be completed, and that the data analyses and interpretation of the findings can inform the scale up of depression care towards reducing the treatment gap for depression care in India and globally.