STRiDE: Strengthening responses to dementia in developing countries (GCRF)

痴呆症并不是“发达国家”所特有的疾病：与高收入经济体相比，低收入和中等收入国家的痴呆症患者已经更多，但低收入和中等收入国家通常缺乏应对高发病率和不断上升的能力。到2050年，拉美国家将有9000万人患有痴呆症（Prince et al . 2015）。痴呆症患者，特别是处于较严重阶段的痴呆症患者，需要重症监护和支持，这是非常昂贵的。这些费用主要由无薪家庭照顾者（主要是妇女）承担，她们往往不得不离开有薪工作，冒着个人贫困和社会生产力损失的风险。在缺乏发达或资金充足的卫生和保健系统的低收入国家，痴呆症患者人数迅速增加。由于人口、社会和经济的变化，家庭护理的可用性正在减少。我们将利用经济学、流行病学和政策分析建立研究能力，帮助拉美国家以合乎道德和可持续的方式应对日益增多的痴呆症患者的需求。来自英国和南非的共同申请者在高收入国家（HICs）和低收入国家的痴呆症研究以及低收入国家的健康和长期（社会）护理研究方面有着良好的记录。我们将与国际阿尔茨海默病协会（ADI）合作，这是一个由85个国家阿尔茨海默病/痴呆症协会组成的联合会。我们将与巴西、印度、印度尼西亚、肯尼亚、牙买加、墨西哥、南非等7个拉美国家的当地研究人员和非政府组织合作。为了建设能力，我们将提供正式的研究方法培训，应用这些方法来产生新的证据和工具，以及利用证据为政策提供信息的培训和实践。我们将采用最好的方法方法，并在同行评议的期刊上发表我们的研究结果，但更重要的是，我们将确保我们的研究产生实用工具，供利益相关者直接使用，以开发服务和改进实践，或影响政策。我们将使用系统评价和荟萃分析来审查证据，以确定哪些措施在LAMICs中有效，哪些措施可以在特定情况下提供，同时也将这些研究作为证据摘要以通俗易懂（对痴呆症友好）的语言编写，并翻译成相关的当地语言，提供在线和dvd。我们会运用“改变理论”，与本地伙伴（研究人员/非政府机构）和持份者（包括痴呆症患者和照顾者）共同制定项目的研究和培训议程，以确保我们的活动产生最大的影响。ToC还将帮助我们制定评估项目影响的指标。我们的研究计划将包括开发和评估一项干预措施，以提高对痴呆症的认识并减少耻辱感，对不同情况下为痴呆症患者提供家庭护理的成本和其他影响进行定性研究，生成痴呆症对个人和家庭的影响和成本的定量证据，以及收集这些数据的工具。我们将利用所产生的证据，为每个国家制定痴呆症成本和影响的可信估计，并使用模拟模型来预测未来的痴呆症护理需求、满足这些需求所需的卫生和社会服务、其成本，以及实施循证痴呆护理途径和改善覆盖范围的影响。每个国家的模式将很容易更新和适应。我们将评估我们预测的政策含义，考虑当前组织和融资系统以及训练有素的工人的可用性所带来的障碍，并在考虑更广泛的卫生和社会保健系统的情况下，概述改善痴呆症的改革机会。最后，我们将与ADI和其他政策伙伴合作，提出地方建议，以支持国家痴呆症计划的实施。我们将与世卫组织合作，在每个国家组织利益攸关方讲习班，介绍项目成果，并在每个区域组织高级别利益攸关方会议。

Dementia is not a "developed world" condition: there are already more people with dementia in LAMICs than in high-income economies, yet LAMICs are typically less equipped to respond to the high and increasing prevalence. By 2050, there will be 90 million people with dementia in LAMICs (Prince et al 2015). People with dementia, particularly at more severe stages, require intensive care and support, which is very costly. These costs are mostly borne by unpaid family carers, primarily women, who often have to leave paid work, risking personal impoverishment and societal productivity losses. LAMICs face rapid growth in numbers of people with dementia without well-developed or well-funded health and care systems. Family care availability is decreasing as a result of demographic, societal and economic changes. We will build research capability using economics, epidemiology and policy analyses to help LAMICs respond to the needs of the growing numbers of people with dementia in an ethical and sustainable way. The co-applicants, from the UK and South Africa, have strong track-records in dementia research in high-income countries (HICs) and LAMICs, research on health and long-term (social) care in LAMICs. We will partner Alzheimer's Disease International (ADI), a federation of 85 national Alzheimer/dementia associations. We will work with local researchers and NGOs in 7 LAMICs: Brazil, India, Indonesia, Kenya, Jamaica, Mexico, South Africa. To build capability we will offer formal training in research methods, application of those methods to generate new evidence and tools, and training and practice in use of evidence to inform policy. We will apply the best methodological approaches and publish our results in peer-reviewed journals, but more importantly we will ensure that our research generates practical tools for use directly by stakeholders to develop services and improve practice, or to influence policy.We will use systematic reviewing and meta-analysis to review evidence on what works in LAMICs and what can be delivered in particular contexts, but also make that research available online and in DVDs as evidence summaries written in plain (dementia-friendly) language and translated to relevant local languages.We will use Theory of Change (ToC) to co-develop with local partners (researchers/NGOs) and stakeholders (including people with dementia and carers) the research and training agenda for the project to ensure that our activities achieve maximum impact. ToC will also help us develop indicators to evaluate the project's impact. Our research programme will involve development and evaluation of an intervention to increase dementia awareness and reduce stigma, a qualitative study of costs and other impacts of providing family care to people with dementia in different contexts, generation of quantitative evidence on impacts and costs of dementia on individuals and families, and instruments to collect these data.We will use the evidence generated to develop, for each country, credible estimates of the costs and impacts of dementia, and use simulation modelling to project future dementia care needs, the health and social services required to meet those needs, their costs, and the impacts of implementing evidence-informed dementia care pathways and better coverage. Models for each country will be simple to update and adapt. We will assess the policy implications of our projections, consider the barriers presented by current organisation and financing systems and the availability of trained workers, and outline reform opportunities to improve dementia, considering the wider health and social care systems.Finally, we will work with ADI and other policy partners to produce local recommendations to support the implementation of National Dementia Plans. We will organise stakeholder workshops in each country to present project outcomes, and high level stakeholder meetings in each of the regions, in collaboration with WHO.