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：
10053551
负责人：
Ryan K McBain
金额：
$ 69.99万
依托单位：
RAND CORPORATION
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：
https://reporter.nih.gov/project-details/10053551
关键词：
Accounting Address Adherence Adult Affect Africa South of the Sahara Aftercare Antidepressive Agents Blood Pressure Caring Chronic Care Clinic Cluster randomized trial Collaborations Cost Effectiveness Analysis Country Diabetes Mellitus Diagnostic Effectiveness Emotional Enrollment Epidemic Evaluation Financial Support Funding Gold HIV Health Health care facility Household Human Resources Hypertension Incidence Individual Infrastructure Institutes Institution International Intervention Interview Investments Lead Major Depressive Disorder Malaria Malawi Maps Measures Mental Depression Mental Health Mental disorders Mentorship Methods Modeling Outcome Output Participant Patient Care Patients Perception Phase Prevalence Protocols documentation Provider Randomized Research Services Time Training Uganda Universities Viral Viral Load result Work World Health Organization Disability Assessment Schedule base burden of illness care burden care delivery care systems comorbidity cost cost effective cost effectiveness cost estimate depression model depressive symptoms design disability economic impact effectiveness evaluation effectiveness measure evidence base experience follow-up functional disability human capital improved infectious disease treatment informant low and middle-income countries member physical conditioning post intervention primary outcome problem solving therapy programs response scale up screening secondary outcome service delivery success symposium systolic hypertension tool treatment 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.