Research Component

项目总结(见说明)： 我们建议进行两个互补性随机对照试验(RCT)，将任务转移到初级卫生保健(PHC)，一个在埃塞俄比亚关于严重精神障碍(SMDS)的护理(n=690)，另一个在南非(SA)关于产妇抑郁的护理(n=380)。在两组相辅相成的疾病(SMD和产妇抑郁)和两个国家的情况(埃塞俄比亚和南非)中，我们的具体施舍是： 1.确定将任务转移到初级保健中心的效果和成本效益，将其与埃塞俄比亚的专科精神保健和南非的强化常规护理进行比较，包括主要结果衡量标准(有效性和成本效益)和一系列次要结果衡量标准。 2.通过评估可行性、可持续性、质量和安全性，以及从PHC工作者和患者的角度对任务转移的经验进行定性的探索，考察影响任务转移干预实施和未来推广的因素。 3.评估与当地相关但具有普遍性的措施，包括症状严重程度措施和功能/生活质量措施，以评估将任务转移到PHC护理的有效性和成本效益 在埃塞俄比亚，干预措施将是通过两周的培训和一名精神科护士的持续监督，将病情稳定的SMD患者的护理转移到PHC，以及进修培训。在南非，初级保健中心的工作人员将接受培训(为期一周的培训，由精神健康专家持续每周监督和紧急咨询)，以便对到产前诊所就诊的妇女进行常规筛查。 使用爱丁堡产后抑郁量表进行抑郁测试。服务该地区的社区卫生工作者(CHW)也将接受培训，以便在精神卫生专家的监督下提供适当的IPT干预。主要的结果测量将是症状严重程度，在埃塞俄比亚在12个月时用简明精神病评定量表测量，在出生后6个月在南非用汉密尔顿抑郁量表测量。这两项试验还将计算每残疾调整后生命的成本，并包括定性部分。

PROJECT SUMMARY (See instructions): We propose to conduct two complementary randomized controlled trials (RCTs) of task shifting to primary health care (PHC), one in Ethiopia on the care of severe mental disorders (SMDs) (n=690), and one in South Africa (SA) on the care of maternal depression (n=380). In two complementary sets of disorders (SMD and maternal depression) and two country contexts (Ethiopia and South Africa) our specific alms are: 1. To determine the effectiveness and cost-effectiveness of task shifting care to PHC, compared to specialist mental health care in Ethiopia and enhanced usual care in SA, on both primary outcome measures(of effectiveness and cost-effectiveness) and on a series of secondary outcome measures. 2. To examine factors influencing the implementation of the task shifting intervention and future scale up, by assessing feasibility, sustainability, quality, and safety, and by qualitative exploration of the experience of task shifting from the perspectives of both PHC workers and patients. 3. To evaluate locally relevant but generalizable measures, including both symptom severity measures and functioning/quality of life measures, for evaluating the effectiveness and cost-effectiveness of task shifting care to PHC In Ethiopia, the intervention will be task shifting of care of stabilised persons with SMD to PHC, through 2 weeks of training and ongoing supervision by a psychiatric nurse, and refresher training. In South Africa, PHC staff will be trained (1 week of training with ongoing weekly supervision from the mental health specialist and emergency consultation) to routinely screen women attending antenatal clinics for maternal depression using the Edinburgh Postnatal Depression Scale. Community health workers (CHWs) servicing the area will also be trained to deliver the adapted IPT intervention under the supervision of the mental health specialist. Primary outcome measures will be symptom severity, measured on the Brief Psychiatric Rating Scale in Ethiopia at 12 months, and the Hamilton Depression Scale in SA at 6 months postnatal. Both of the trials will also calculate cost per Disability Adjusted Life, and include a qualitative component.