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.

行政补充申请仅限于对南部非洲的扩大研究。 心理健康整合（SMhINT）研究联盟，并寻求补充资金， 完成从2020年3月推迟到2021年11月的研究活动，原因是 2019冠状病毒病。使用学习健康系统方法，SMhINT规模扩大研究使用现场， 迭代观察实施科学设计，以完善循证心理健康 整合（MhINT）任务共享协作护理模式，用于整合抑郁症患者的护理，南非真实的世界初级卫生保健环境中的慢性病患者-以便 促进在南非夸祖鲁-纳塔尔省以及可能在 南非如下图所示，第一阶段包括评估原始 MhINT模型在现实世界条件下在夸祖鲁-纳塔尔的一个城市分区，以 为完善和加强该模式及相关实施战略提供信息， 实施和扩大真实的世界初级保健服务。第二阶段 包括在城市、城郊和农村地区评估强化模式。在 在这两个阶段中，使用RE-AIM（到达-有效性-采用）评估人口水平效应执行-维持）评价框架，有各种数据来源， 二次数据收集和患者队列研究。综合框架 实施研究（CFIR）用于了解实施的背景决定因素 成功涉及定量和定性访谈。更多信息请参见已发表的研究方案 详细说明1. 而原有的评估“设置”模式已经完成， 根据第一阶段的调查结果，大大加强了一揽子措施， 在第二阶段评价中，加强的一揽子计划的成果和效力 由于COVID-19大流行的影响，包括全国封锁，以及IRB， 2020年3月至2021年12月在南非进行面对面实地考察的限制。这 申请行政补助金以寻求补充资金来完成研究 因新型冠状病毒而由二零二零年三月延迟至二零二一年十一月的第二阶段活动19波和相关的封锁。虽然我们能够开发和实施完善的， 鉴于我们的工作支持卫生系统， 然而，为了科普COVID-19对心理健康的影响，我们无法进行 设计第二阶段的实地考察活动，特别是要求 考虑到基线和 后续评估。因此，我们只能从队列数据收集开始 第二阶段研究将于2022年1月进行。来自地区卫生信息的二级数据（也是必需的 用于填充RE-AIM框架的服务级别结果）还可以 只有从2022年初开始，考虑到医疗服务的中断， 疫情期间，这一数据不能真实反映日常服务。鉴于 理解实施成功的背景决定因素，包括CFIR定量和 定性数据收集取决于RE-AIM服务水平结果， 虽然这些数据的收集工作已分阶段进行，但也被推迟。 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， 作为队列研究的一部分，已完成771名参与者的招募和基线评估。 然而，三个月的随访和扫荡期预计将使我们到年底。 2022年9月。因此，我们预计队列研究的数据收集时间会延长。 2022年6月30日（项目正式结束日期）后三个月。此外，我们还没有开始 收集数据以了解RE-AIM服务水平结果，其中涉及横截面 对提供者的调查以及对提供者、管理者和患者的定性访谈 （N=282）。预计这将发生在队列研究的扫荡期（2010年8月至2011年8月）。 二零二二年九月）。最后，进一步完善的包是依赖于两个RE-AIM 服务水平成果和CFIR决定因素，预计将于10月至 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.