Integrating a Stepped Care Model of Screening and Treatment for Depression into Malawi's National HIV Care Delivery Platform
将抑郁症筛查和治疗的阶梯式护理模式纳入马拉维国家艾滋病毒护理服务平台
基本信息
- 批准号:10426113
- 负责人:
- 金额:$ 59.56万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-07-01 至 2025-06-30
- 项目状态:未结题
- 来源:
- 关键词:AccountingAddressAdherenceAdultAffectAfrica South of the SaharaAftercareAntidepressive AgentsBlood PressureCaringChronic CareClinicCluster randomized trialCollaborationsCost Effectiveness AnalysisCountryDiabetes MellitusEffectivenessEmotionalEnrollmentEpidemicEvaluationFinancial SupportFundingGoldHIVHealthHealth care facilityHouseholdHuman ResourcesHypertensionIncidenceIndividualInfrastructureInstitutesInstitutionInternationalInterventionInterviewInvestmentsLeadMajor Depressive DisorderMalariaMalawiMapsMeasuresMental DepressionMental HealthMental disordersMentorshipMethodsModelingOutcomeOutputParticipantPatient CarePatientsPerceptionPhasePrevalenceProtocols documentationProviderRandomizedResearchScreening procedureServicesTimeTrainingUgandaUniversitiesViralViral Load resultWorkWorld Health Organization Disability Assessment Schedulebaseburden of illnesscare burdencare deliverycare systemscomorbiditycostcost effectivecost effectivenesscost estimatedepression modeldepressive symptomsdesigndiagnostic tooldisabilityeconomic impacteffectiveness evaluationeffectiveness measureevidence baseexperiencefeasibility researchfollow-upfunctional disabilityhuman capitalimprovedinfectious disease treatmentinformantlow and middle-income countriesmemberphysical conditioningpost interventionprimary outcomeproblem solving therapyprogramsresponsescale upscreeningsecondary outcomeservice deliverysuccesssymposiumsystolic hypertensiontooltreatment effect
项目摘要
PROJECT SUMMARY
This proposal brings together leading experts on mental health and HIV service delivery from top US and
Malawian institutions, including the Malawian Ministry of Health (MOH), to evaluate the effectiveness and
cost-effectiveness of an evidence-based stepped model of depression care integrated into Malawi's
national HIV platform. Malawi has the 9th highest HIV prevalence in the world, and the 2nd lowest GDP per
capita. Additionally, depression is a leading cause of disability but remains untreated in over 90% of cases.
Lack of cost-effective, scalable solutions is a fundamental barrier. Against this backdrop, one major success
has been the scale-up of a network of 709 HIV clinics, with over half a million patients enrolled in ART. As a
chronic care system with dedicated human resources and infrastructure, this presents a strategic platform for
integrating depression care, and responds to a robust evidence base outlining the bi-directionality of
depression and HIV outcomes. Members of the research team have already successfully piloted this model in
a neighboring district, demonstrating feasibility, acceptability and preliminary efficacy. Moreover, the team has
already integrated treatment for other non-communicable diseases such as hypertension and diabetes into the
HIV care system of Neno District, Malawi. Additionally, team members have successfully integrated depression
care into HIV services in similar settings (Uganda) and instituted depression care models such as Problem
Solving Therapy (PST) in settings throughout sub-Saharan Africa, in addition to conducting formative work on
depression prevalence, screening and diagnostic tools in Malawi. Building from this, we will evaluate a gold
standard stepped model of depression care that combines group-based PST with antidepressant therapy
(ADT) in n=420 patients with moderate/severe depression (PHQ-9>10), following a stepped wedge cluster
randomized design in which 14 facilities are randomized to implement the model in five steps over a 15-month
period. Primary outcomes (depression symptoms, functional impairment, and overall health) and secondary
outcomes (e.g. HIV: viral load, ART adherence; diabetes: A1C levels; hypertension: systolic blood pressure)
will be measured every three months, inclusive of baseline, pre-treatment, post-treatment (3 months), 6- and
12 months follow-up. We will also evaluate the model's suitability for national scale-up from three perspectives:
cost-effectiveness, feasibility and research capacity. Cost-effectiveness will examine direct treatment effects on
depressive symptoms, as well as indirect benefits on (a) comorbid conditions, and (b) burden of care among
household members of participants. Feasibility will be assessed through key informant interviews with n=20
study participants and n=10 providers. Research capacity will be supported through (i) a university course and
field placement instituted in Years 3-5, (ii) a local research mentorship program, and (iii) a training protocol on
the depression care package, inclusive of evaluation tools, for national dissemination launched in Year 5.
项目摘要
该提案汇集了从我们顶级和
马拉维机构,包括马拉维卫生部(MOH),以评估有效性和
纳入马拉维的证动抑郁症护理模型的成本效益
国家艾滋病毒平台。马拉维在世界上最高的艾滋病毒患病率是第9大,第2次最低GDP
国会大厦。此外,抑郁症是残疾的主要原因,但在90%以上的病例中仍未治疗。
缺乏具有成本效益的可扩展解决方案是一个基本障碍。在这个背景下,一个主要的成功
一直是709个HIV诊所网络的扩大规模,其中有超过50万名患者参加了ART。作为
慢性护理系统具有专门的人力资源和基础设施,这是一个战略平台
整合抑郁症护理,并回应有力的证据基础,概述了双向
抑郁症和艾滋病毒结局。研究小组的成员已经成功地试用了该模型
一个邻近地区,表现出可行性,可接受性和初步疗效。而且,团队有
已经对其他非传染性疾病(例如高血压和糖尿病)进行了整合的治疗
马拉维Neno区的HIV护理系统。此外,团队成员已经成功整合了抑郁症
在类似环境(乌干达)和建立诸如问题之类的抑郁症护理模型中为艾滋病毒服务的护理
在整个撒哈拉以南非洲地区的环境中解决疗法(PST),除了对
马拉维的抑郁症患病率,筛查和诊断工具。从此构建,我们将评估黄金
标准的抑郁症护理模型,将基于组的PST与抗抑郁治疗相结合
(ADT)n = 420例中度/重度抑郁症患者(PHQ-9> 10),阶梯楔形簇之后
随机设计,其中14个设施被随机分配以在15个月的时间内以五个步骤实施该模型
时期。主要结果(抑郁症状,功能障碍和整体健康)和次要
结果(例如HIV:病毒载荷,艺术依从性;糖尿病:A1C水平;高血压:收缩压)
将每三个月测量一次,包括基线,治疗,治疗后(3个月),6-和6和
随访12个月。我们还将从三个角度评估该模型对国家规模扩大的适用性:
成本效益,可行性和研究能力。成本效益将检查直接治疗对
抑郁症状以及(a)合并症的间接益处,以及(b)护理负担
参与者的家庭成员。可行性将通过n = 20的主要线人访谈评估
研究参与者和n = 10个提供者。研究能力将通过(i)大学课程和
(ii)本地研究指导计划和(iii)关于3 - 5年的现场安置
抑郁症护理包(包括评估工具)在第5年推出了全国传播工具。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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- DOI:
- 发表时间:
2023 - 期刊:
- 影响因子:0
- 作者:
S. Hunter;Adam Scherling;M. Cefalu;Ryan K McBain - 通讯作者:
Ryan K McBain
Ryan K McBain的其他文献
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{{ truncateString('Ryan K McBain', 18)}}的其他基金
Integrating a Stepped Care Model of Screening and Treatment for Depression into Malawi's National HIV Care Delivery Platform
将抑郁症筛查和治疗的阶梯式护理模式纳入马拉维国家艾滋病毒护理服务平台
- 批准号:
10650882 - 财政年份:2020
- 资助金额:
$ 59.56万 - 项目类别:
Integrating a Stepped Care Model of Screening and Treatment for Depression into Malawi's National HIV Care Delivery Platform
将抑郁症筛查和治疗的阶梯式护理模式纳入马拉维国家艾滋病毒护理服务平台
- 批准号:
10197032 - 财政年份:2020
- 资助金额:
$ 59.56万 - 项目类别:
Integrating a Stepped Care Model of Screening and Treatment for Depression into Malawi's National HIV Care Delivery Platform
将抑郁症筛查和治疗的阶梯式护理模式纳入马拉维国家艾滋病毒护理服务平台
- 批准号:
10053551 - 财政年份:2020
- 资助金额:
$ 59.56万 - 项目类别:
Evaluation of a Community-Based Psychosocial Intervention for War-Affected Youth
对受战争影响的青少年进行基于社区的社会心理干预的评估
- 批准号:
8396963 - 财政年份:2012
- 资助金额:
$ 59.56万 - 项目类别:
Evaluation of a Community-Based Psychosocial Intervention for War-Affected Youth
对受战争影响的青少年进行基于社区的社会心理干预的评估
- 批准号:
8535024 - 财政年份:2012
- 资助金额:
$ 59.56万 - 项目类别:
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