Strengthening the Integration of Mental Health and HIV Services in South Africa: Implementation Science in Support of Scale-Up, Adaptation, and Dissemination

摘要 南非艾滋病毒和精神疾病并存的负担令人震惊：19%的南非人 艾滋病毒携带者，14%-30%的艾滋病毒携带者患有常见的精神障碍。只有25%的人收到 任何类型的心理健康治疗。与艾滋病毒共病的常见精神障碍威胁到疗效 这是艾滋病毒治疗的一大障碍，并带有破坏性的污名。将精神疾病护理纳入艾滋病毒相关服务 消除这些耻辱、缩小治疗差距和改善治疗结果的潜力。集成 南非的服务正在显示出有效性，但成功的障碍和促进者 实现方式仍未定义。这个多学科的项目受益于及时的协作，丰富的 在精神健康和艾滋病毒/艾滋病的交叉点上结合了多年的经验，并应用 实施科学方法，以加强综合心理健康和艾滋病毒的实施-- 在南非的相关服务。本研究应用综合框架进行实施研究 确定并解释与以下方面相关的干预和服务提供者级别的障碍和促进者 年，作为综合艾滋病毒和精神卫生服务的一部分，护士成功地筛查和转介了病人 南非。通过结合问卷调查，全面了解整合所面临的挑战 以及从护士那里收集的访谈数据，以及从常规项目监测中获得的二次数据。这 研究是在三个正在进行的项目的成果和资源的基础上进行的。英国国际发展部资助的 改善精神卫生保健(PRIME)项目和NIH资助的务实集群随机对照 共病情感障碍、艾滋病/艾滋病毒和长期健康(钴)试验正在研究治疗 以及在北部两个区的部分保健设施中提供综合精神卫生和艾滋病毒服务的影响 南非西部省。与此同时，华盛顿大学疾控中心资助的一项合作- 南非理工学院和夸祖鲁-纳塔尔大学正在加强这些努力，并扩大到两个新的 地区。通过利用这些项目，并三角测量可靠的定量和定性数据，这项研究将 解决与心理健康成功融合相关的因素知识方面的主要差距 和艾滋病毒服务。这将是第一次应用严格的实施科学框架的研究。 研究，包括对成功实施的预测因素的有效衡量，以调查 在低资源环境下整合心理健康和艾滋病毒服务的过程。此外，对 这些障碍和促进者将直接导致改进在南非扩大规模的方法， 改善扩大规模和随后的患者结局。

Abstract The burden of co-morbid HIV and mental illness in South Africa is staggering: 19% percent of South Africans live with HIV, and 14-30% of people living with HIV suffer from common mental disorders. Only 25% receive mental health treatment of any kind. Common mental disorders co-morbid with HIV threaten the effectiveness of HIV treatment and carry damaging stigmas. Integrating care for mental illness into HIV-related services has the potential to address these stigmas, reduce treatment gaps, and improve treatment outcomes. Integrated services are demonstrating effectiveness in South Africa, yet the barriers to and facilitators of successful implementation remain undefined. This multi-disciplinary project benefits from a timely collaboration, rich with many combined years of experience at the intersection of mental health and HIV/AIDS, and applies the methods of implementation science to strengthen the implementation of integrated mental health and HIV- related services in South Africa. This study applies the Consolidated Framework for Implementation Research to identify and explain the intervention- and provider-level barriers and facilitators that are associated with the successful screening and referral of patients by nurses as part of integrated HIV and mental health services in South Africa. It will gain a holistic understanding of the challenges of integration by combining questionnaire and interview data collected from nurses with available secondary data from routine program monitoring. This study builds on the results and resources of three ongoing projects. The DFID-funded Programme for Improving Mental Health Care (PRIME) project and NIH-funded pragmatic cluster randomized controlled Comorbid Affective Disorders, AIDS/HIV, and Long Term Health (COBALT) trial are examining the methods for and impact of integrated mental health and HIV services in a subset of health facilities in two districts in North West Province, South Africa. Simultaneously, a CDC-funded collaboration of the University of Washington, I- TECH South Africa, and the University of KwaZulu-Natal is strengthening these efforts and scaling to two new districts. By leveraging these projects, and triangulating robust quantitative and qualitative data, this study will address key gaps in knowledge about the factors associated with the successful integration of mental health and HIV services. This will be the first study to apply a rigorous framework for implementation science research, including validated measures of predictors of successful implementation, to the investigation of the process of integrating mental health and HIV services in a low-resource setting. Moreover, assessment of these barriers and facilitators will lead directly to refinement of approaches to scale-up in South Africa, improving scale-up and subsequent patient outcomes.