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.

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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.