Southern African Research Consortium for Mental health INTegration (S-MhINT)-Research and capacity building consortium to strengthen mental health integration in South Africa, Mozambique and Tanzania.

行政补充请求仅限于对南部非洲的扩大研究。 精神健康整合(SMhINT)研究联盟，并寻求补充资金以 完成因下列原因从2020年3月推迟至2021年11月的研究活动 新冠肺炎。使用学习卫生系统的方法，SMhINT扩大研究使用了现场， 迭代观察性实施科学设计以完善循证心理健康 整合(MhINT)任务分担协作护理模式，用于整合南非现实世界初级保健环境中与慢性病并存的抑郁症护理--以便 促进在南非夸祖鲁-纳塔尔省以及可能在全国范围内广泛扩大 南非。如下图所示，第一阶段包括对原始版本的评估 夸祖鲁-纳塔尔城市街道真实条件下的MhINT模型 通报改进和加强模式和相关执行战略的情况 现实世界初级卫生保健服务的实施和扩大。第二阶段 包括评估在城市、城市周边和农村范围内加强的模式。在……里面 在这两个阶段，使用RE-AIM(Reach-Effectiveness-AdoptionImplementation-Maintenance)评估框架评估人口水平的影响，数据来源包括 二次数据收集和患者队列研究。综合框架，用于 实施研究(CFIR)用于了解实施的上下文决定因素 成功包括定量和定性的访谈。有关更多信息，请参阅已发表的研究方案 详细信息1。 而对最初的“建立”模式的评估已经完成，并进行了干预 根据第一阶段的调查结果大大加强了一揽子计划，即实地评估服务 强化一揽子计划在第二阶段评价中的水平、结果和效果 由于新冠肺炎大流行的影响而延迟，包括全国范围的封锁和IRB 南非在2020年3月至2021年12月期间限制面对面的实地考察。这 申请行政补助寻求补充资金以完成研究 由于COVID19波和相关的封锁，第二阶段的活动从2020年3月推迟到2021年11月。虽然我们能够开发和实施改进的和 考虑到我们的工作支持卫生系统，在这一封锁期间加强了一揽子计划 然而，为了应对新冠肺炎对心理健康的影响，我们无法进行 设计第二阶段的实地调查活动，特别是需要 现场工作人员应长期呆在设施中，以满足基线和 后续评估。因此，我们只能开始收集队列的数据 2022年1月对第二阶段的研究。来自地区健康信息的次要数据(还需要 用于填充RE-AIM框架的服务级别结果)第二阶段还可以 只有在医疗保健服务中断的情况下，才能从2022年初真正可靠地使用 在大流行期间，这一数据不能真实反映常规服务。考虑到 了解实施成功的上下文决定因素，包括CFIR量化和 定性数据收集取决于RE-AIM服务级别结果 阶段队列和二次数据收集，这些数据收集也被推迟了。 然而，我们已经能够在2022年1月开始第二阶段评估的实地工作，以及 作为队列研究的一部分，已经完成了对771名参与者的登记和基线评估。 然而，预计为期三个月的后续行动和扫荡期间将把我们带到 2022年9月。因此，我们预计在队列研究中将有较长的数据收集时间。 2022年6月30日(项目正式结束日期)之后三个月。此外，我们还没有开始 收集数据以了解RE-AIM服务级别结果，这涉及横截面 对提供者的调查以及对提供者、管理人员和患者的定性访谈 282例。预计这将发生在队列研究的扫荡期间(8月-10月)。 2022年9月)。最后，包的进一步细化取决于RE-AIM 服务级别结果和CFIR决定因素，预计从10月到 2022年12月。

The administrative supplement request is restricted to the scale-up study of the Southern African Mental Health Integration (SMhINT) research consortium, and seeks supplementary funds to complete the research activities that were delayed from March 2020 to November 2021 due to COVID-19. Using a learning health system approach, the SMhINT scale-up study uses an in-site, iterative observational implementation science design to refine the evidence-based Mental Health Integration (MhINT) task-sharing collaborative care model for integration of care for depression comorbid with chronic disease in real world primary health care settings in South Africa – so as to promote widespread scale-up in the province of KwaZulu-Natal, South Africa and potentially across South Africa. As depicted in the Figure below, the first stage comprises assessment of the original MhINT model under real-world conditions in an urban sub-district in KwaZulu-Natal in order to inform refinement and strengthening of the model and associated implementation strategies for real world primary health care service delivery implementation and scale-up. The second stage comprises assessment of the strengthened model across urban, peri-urban and rural contexts. In both stages, population-level effects are assessed using the RE-AIM (Reach-Effectiveness-AdoptionImplementation-Maintenance) evaluation framework, with various sources of data including secondary data collection and a patient cohort study. The Consolidated Framework for Implementation Research (CFIR) is used to understand contextual determinants of implementation success involving quantitative and qualitative interviews. See published research protocol for more detail 1. While the evaluation of the original “set up” model has been completed and the intervention package substantially strengthened based on findings of this first stage, fieldwork to evaluate service level outcomes and effectiveness of the strengthened package in the second stage evaluation has been delayed due to the impacts of COVID-19 pandemic including countrywide lockdowns, and IRB restrictions on face-to-face fieldwork from March 2020 to December 2021 in South Africa. This application for an administrative supplement seeks supplementary funds to complete the research activities of the second stage that were delayed from March 2020 to November 2021 due to COVID19 waves and associated lock-downs. While we were able to develop and implement the refined and strengthened package during this lockdown period given that our work supported the health system to cope with the mental health impacts of COVID-19, we were, however, unable to conduct fieldwork activities for the second stage of the design, specifically for the cohort study that required fieldworkers to be in facilities for long periods of time given the requirement for both a baseline and follow-up assessment. We were thus only able to commence with data collection for the cohort study of Stage 2 in January 2022. Secondary data from the district health information (also required for populating the service level outcomes of the RE-AIM framework) for the second stage can also only really be reliably used from the beginning of 2022 given disruptions to the health care services during the pandemic, making this data not a true reflection of routine services. Given that understanding contextual determinants of implementation success involving CFIR quantitative and qualitative data collection is contingent on the RE-AIM service level outcomes requiring the second stage cohort and secondary data collection, these data collection has also been delayed. We have, however, been able to start fieldwork for the second stage evaluation in January 2022, and have completed enrolment and baseline assessment of 771 participants as part of the cohort study. Three-month follow-up and a mop-up period is, however, anticipated to take us to the end of September 2022. We thus anticipate an extended period of data collection for the cohort study of three months beyond 30 June 2022 (the official end date of the project). Further, we have not begun collecting data to understand the RE-AIM service level outcomes, which involves a cross sectional survey of providers as well as qualitative interviews with both providers, managers and patients (N=282). It is anticipated that this will occur during the mop-up period of the cohort study (August - September 2022). Finally, further refinement of the package is dependent on both the RE-AIM service level outcomes and CFIR determinants and is anticipated to follow from October to December 2022.