We propose to conduct two complementary randomized controlled trials (RCTs) of task shifting to primary health care (PHC), one in Ethiopia on the care of severe mental disorders (SMDs) (n=690), and one in South Africa (SA) on the care of maternal depression (n=380). In two complementary sets of disorders (SMD and maternal depression) and two country contexts (Ethiopia and South Africa) our specific alms are: 1. To determine the effectiveness and cost-effectiveness of task shifting care to PHC, compared to specialist mental health care in Ethiopia and enhanced usual care in SA, on both primary outcome measures(of effectiveness and cost-effectiveness) and on a series of secondary outcome measures. 2. To examine factors influencing the implementation of the task shifting intervention and future scale up, by assessing feasibility, sustainability, quality, and safety, and by qualitative exploration of the experience of task shifting from the perspectives of both PHC workers and patients. 3. To evaluate locally relevant but generalizable measures, including both symptom severity measures and functioning/quality of life measures, for evaluating the effectiveness and cost-effectiveness of task shifting care to PHC In Ethiopia, the intervention will be task shifting of care of stabilised persons with SMD to PHC, through 2 weeks of training and ongoing supervision by a psychiatric nurse, and refresher training. In South Africa, PHC staff will be trained (1 week of training with ongoing weekly supervision from the mental health specialist and emergency consultation) to routinely screen women attending antenatal clinics for maternal depression using the Edinburgh Postnatal Depression Scale. Community health workers (CHWs) servicing the area will also be trained to deliver the adapted IPT intervention under the supervision of the mental health specialist. Primary outcome measures will be symptom severity, measured on the Brief Psychiatric Rating Scale in Ethiopia at 12 months, and the Hamilton Depression Scale in SA at 6 months postnatal. Both of the trials will also calculate cost per Disability Adjusted Life, and include a qualitative component.
Centralized services and critical shortages of specialist mental health workers are the main causes of the large treatment gap for mental disorders In sub-Saharan Africa. The proposed trials will be the first RCTs evaluating task-shifting models of delivering care for persons with SMD and maternal depression in sub-Saharan Africa. Evidence from these trials will have major implications for other LMICs in sub-Saharan Africa which face similar challenges of limited specialist mental health workers and rapidly urbanizing populations.
|Nyatsanza, Memory; Schneider, Marguerite; Davies, Thandi et al. (2016) Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa. BMC Psychiatry 16:164|
|Mayston, Rosie; Alem, Atalay; Habtamu, Alehegn et al. (2016) Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia. Health Policy Plan 31:367-76|
|Hanlon, Charlotte; Alem, Atalay; Medhin, Girmay et al. (2016) Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial. Trials 17:76|
|Habtamu, Kassahun; Alem, Atalay; Medhin, Girmay et al. (2016) Development and validation of a contextual measure of functioning for people living with severe mental disorders in rural Africa. BMC Psychiatry 16:311|
|Lund, C; Alem, A; Schneider, M et al. (2015) Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM. Epidemiol Psychiatr Sci 24:233-40|
|Habtamu, Kassahun; Alem, Atalay; Hanlon, Charlotte (2015) Conceptualizing and contextualizing functioning in people with severe mental disorders in rural Ethiopia: a qualitative study. BMC Psychiatry 15:34|
|Schneider, Marguerite; Baron, Emily; Davies, Thandi et al. (2015) Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town. Soc Psychiatry Psychiatr Epidemiol 50:797-806|
|Lund, Crick; Schneider, Marguerite; Davies, Thandi et al. (2014) Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: study protocol for a randomized controlled trial. Trials 15:457|
|Udedi, Michael; Swartz, Leslie; Stewart, Robert C et al. (2014) Health service utilization by patients with common mental disorder identified by the Self-Reporting Questionnaire in a primary care setting in Zomba, Malawi: a descriptive study. Int J Soc Psychiatry 60:454-61|
|De Silva, Mary J; Breuer, Erica; Lee, Lucy et al. (2014) Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions. Trials 15:267|
Showing the most recent 10 out of 11 publications