With 29 million people and only 18 psychiatrists (trained abroad) and 125 clinical psychologists, none of whom had a PhD prior to this D43, Mozambique faces enormous mental health (MH) care challenges. To address the country?s large MH treatment and research gaps, through a North- South-South collaboration between the US, Brazil and Mozambique, our PALOPmhIS-1 (Pases Africanos de Lngua Oficial Portuguesa ?Portuguese-speaking African countries? MH implementation science; 2014-2019) D43 program has provided individually mentored hands-on research and didactic training to four senior mentors from other medical fields and 11 trainees, the majority of whom are women. We have had an enviable ?return-on-investment? in only five years surpassing our targets: a) Research capacity building: nine fellows and two others are in the final stages of obtaining their PhDs and Masters in Brazil, respectively (15 publications in international journals); b) Research funding: fellows have become valuable investigators, and as a team, we have garnered over $8.5 million in NIH-funded research; c) Implementation science (IS): in a multiplier effect, fellows oversaw the training of 25 trainers, who in turn are training 300 primary care providers and 900 community health workers in evidence-based practices (EBPs) targeting common mental disorders (Interpersonal Counseling), substance use disorders (Motivational Interviewing), severe disorders (Psychiatric Medications), and suicidal risk (Safety Planning), as part of two NIH-funded studies scaling-up comprehensive MH (NIMH) and substance use (NIAAA) care integrated into primary care using mobile health technology; and, d) Policy impact: our team, which includes Ministry of Health personnel, is leading the integration of electronic medical records for clinical and research purposes, previously functioning as separate disease-silos. We also initiated training activities for other PALOP countries. In response to evolving needs and opportunities, PALOPmhIS-2 will (Objective 1) recruit and support long- term (4 years) doctoral training of eight Fellows integrating a novel concentration in MH IS within a Public Health PhD program in Mozambique; (Objective 2) offer past PALOPmhIS D43 graduates (N=11) and other Mozambican Mid-Level Faculty (N=50) medium-term training on new scientific content: MH IS sustainability (Fogarty International Center Strategic Plan Goal 3), e- Health (Goal 2), health informatics, EMR, large datasets, multimorbidities; and (Objective 3) train five graduates in research leadership towards independence and local program sustainability. We will extend training to other local and regional partners (Goal 1); pursue further research funding opportunities, and continue to train the local workforce while scaling up the use of e-Health EBIs.

Public Health Relevance

A Mental Health Implementation Research Training Program will continue to prepare scientists to develop effective and feasible mental health interventions that are adapted to a specific culture and context, making more efficient use of less specialized human resources available in various low-resource systems of care that can help increase access to effective treatments and reduce the mental health treatment gap. In Mozambique, an expanding mental health service infrastructure will require implementation science research guiding the implementation and scale up of evidence-based interventions capable of reaching those often excluded from care. As a clear leader in the Portuguese speaking African countries (PALOP ? Pases Africanos de Lngua Oficial Portuguesa), Mozambique can be a model to other PALOP and sub-Saharan African countries as well as other to low-resource settings, including the US, and thus help decrease the global mental health research and treatment gap.

National Institute of Health (NIH)
Fogarty International Center (FIC)
International Research Training Grants (D43)
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Special Emphasis Panel (ZRG1)
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Michels, Kathleen M
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New York State Psychiatric Institute
New York
United States
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Matsuzaka, Camila T; Wainberg, Milton L; Norcini Pala, Andrea et al. (2018) Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting. Braz J Psychiatr 40:56-62
Audet, Carolyn M; Wainberg, Milton L; Oquendo, Maria A et al. (2018) Depression among female heads-of-household in rural Mozambique: A cross-sectional population-based survey. J Affect Disord 227:48-55
Wainberg, Milton; Oquendo, Maria A; Peratikos, Meridith Blevins et al. (2018) Hazardous alcohol use among female heads-of-household in rural Mozambique. Alcohol 73:37-44
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Dos Santos, Palmira Fortunato; Wainberg, Milton L; Caldas-de-Almeida, José Miguel et al. (2016) Overview of the mental health system in Mozambique: addressing the treatment gap with a task-shifting strategy in primary care. Int J Ment Health Syst 10:1
Sweetland, Annika C; Oquendo, Maria A; Carlson, Catherine et al. (2016) Mental Health Research in the Global Era: Training the Next Generation. Acad Psychiatry 40:715-20