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.

南部非洲心理健康一体化研究联盟 (S-MhINT) - 研究和能力建设联盟，旨在加强南非、莫桑比克和坦桑尼亚的心理健康一体化。

• 批准号: 10613603
• 负责人: Arvin Bhana
• 金额: $ 7.94万
• 依托单位: UNIVERSITY OF KWAZULU-NATAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-26 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10613603
• 关键词: Administrative Supplement; African; COVID-19; COVID-19 impact; COVID-19 pandemic effects; Caring; Chronic Disease; Cohort Studies; Consolidated Framework for Implementation Research; Cross-Sectional Studies; Data; Data Collection; Drops; Effectiveness; Evaluation; Field Workers; Funding; Health; Health system; Institutional Review Boards; Intervention; Interview; Learning; Mental Depression; Mental Health; Methods; Modeling; Mozambique; Outcome; Participant; Patients; Population; Primary Health Care; Protocols documentation; Provider; Province; Publishing; Reach Effectiveness Adoption Implementation and Maintenance; Research; Research Activity; Rural; Services; Site; Source; South Africa; Tanzania; Time; Work; base; cohort; collaborative care; comorbid depression; design; dissemination research; evidence base; follow up assessment; follow-up; health care service; health care settings; implementation determinants; implementation science; implementation strategy; pandemic disease; peri-urban; scale up; service delivery; success; voltage

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.

行政补充请求仅限于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 完成因以下原因而从 2020 年 3 月推迟至 2021 年 11 月的研究活动 SMHINT 扩大研究采用学习健康系统方法，采用现场、 迭代观察科学实施设计，以完善循证心理健康 集成（MhINT）任务共享协作护理模型，用于在南非现实世界初级卫生保健机构中整合与慢性病共存的护理抑郁症 - 以便 促进在南非夸祖鲁-纳塔尔省以及可能在全国范围内的广泛推广 南非：如下图所示，第一阶段包括对原始文件的评估。 夸祖鲁-纳塔尔省一个城市分区现实条件下的 MhINT 模型 为模型及相关实施策略的完善和加强提供信息 现实世界初级卫生保健服务的实施和扩大 第二阶段。 包括对城市、城郊和农村环境下强化模型的评估。 在这两个阶段，人口层面的影响均使用 RE-AIM（覆盖范围-有效性-采用实施-维护）评估框架进行评估，数据来源包括 二次数据收集和患者队列研究的综合框架。 实施研究 (CFIR) 用于了解实施的背景决定因素 涉及定量和定性访谈的成功，请参阅已发表的研究方案以了解更多信息。 细节1. 而对原有“建立”模型的评估和干预已经完成 根据第一阶段实地工作评估服务的结果，大大加强了一揽子计划 第二阶段评估中强化一揽子计划的成果和有效性 由于 COVID-19 大流行的影响（包括全国范围内的封锁）和 IRB 的影响而被推迟 2020 年 3 月至 2021 年 12 月南非对面对面实地考察的限制。 申请行政补助寻求补充资金以完成研究 由于 COVID 19 浪潮和相关的封锁，第二阶段的活动从 2020 年 3 月推迟到 2021 年 11 月，尽管我们能够制定和实施细化和实施的活动。 鉴于我们的工作支持了卫生系统，因此在封锁期间加强了一揽子计划 然而，为了应对 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，特别是需要进行的队列研究 考虑到基线和 因此，我们只能开始收集该队列的数据。 2022 年 1 月进行第二阶段研究。来自地区健康信息的辅助数据（也需要 用于填充 RE-AIM 框架的服务水平结果）第二阶段也可以 鉴于医疗保健服务中断，只有从 2022 年初才能真正可靠地使用 鉴于在大流行期间，该数据不能真实反映日常服务。 了解成功实施的背景决定因素，涉及 CFIR 定量和 定性数据收集取决于 RE-AIM 服务水平结果，需要第二个 阶段队列和二次数据收集，这些数据收集也被推迟。 不过，我们已于 2022 年 1 月开始第二阶段评估的实地工作，并且 作为队列研究的一部分，已完成 771 名参与者的入组和基线评估。 然而，三个月的后续行动和清理期预计将带我们结束 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（该项目的正式结束日期）后三个月内，我们尚未开始。 收集数据以了解 RE-AIM 服务水平结果，其中涉及横截面 对提供者进行调查以及对提供者、管理人员和患者进行定性访谈 (N=282) 预计这将发生在队列研究的清理期间（8 月 - 12 月）。 最后，该计划的进一步完善取决于 RE-AIM。 服务水平结果和 CFIR 决定因素，预计将于 10 月至 2022 年 12 月。

项目成果

Intersectoral and multisectoral approaches to enable recovery for people with severe mental illness in low- and middle-income countries: A scoping review.

使低收入和中等收入国家患有严重精神疾病的人能够康复的跨部门和多部门方法：范围界定审查。

• 发表时间: 2023
• 作者: J van Rensburg, André;Brooke
• 通讯作者: Brooke

Validation of a brief mental health screening tool for common mental disorders in primary healthcare.

验证初级保健中常见精神障碍的简短心理健康筛查工具。

• 发表时间: 2019-03-29
• 作者: Bhana, A;Mntambo, N;Gigaba, S G;Luvuno, Z P B;Grant, M;Ackerman, D;Ntswe, E;Nomathemba, M;Petersen, I
• 通讯作者: Petersen, I

Accuracy of a community mental health education and detection (CMED) tool for common mental disorders in KwaZulu-Natal, South Africa.

南非夸祖鲁-纳塔尔省社区心理健康教育和检测 (CMED) 工具针对常见精神障碍的准确性。

• 发表时间: 2022-08-23
• 作者: Grant, Merridy;Petersen, Inge;Mthethwa, Londiwe;Luvuno, Zamasomi;Bhana, Arvin
• 通讯作者: Bhana, Arvin

Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19.

应用学习卫生系统思维在 COVID-19 背景下共同制定综合结核病干预措施。

• 发表时间: 2022-10
• 影响因子: 8.1
• 作者: van Rensburg, André Janse;Petersen, Inge;Awotiwon, Ajibola;Bachmann, Max Oscar;Curran, Robyn;Murdoch, Jamie;Ras, Christy Joy;Fairall, Lara
• 通讯作者: Fairall, Lara

Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa.

对南非一项综合心理保健试验的实施结果进行模糊定性比较分析。

• 发表时间: 2021
• 影响因子: 2.6
• 作者: Janse van Rensburg, André;Kathree, Tasneem;Breuer, Erica;Selohilwe, One;Mntambo, Ntokozo;Petrus, Ruwayda;Bhana, Arvin;Lund, Crick;Fairall, Lara;Petersen, Inge
• 通讯作者: Petersen, Inge