Integrating evidence-based MDD treatment in primary care: TB in Brazil as a model The WHO and NIMH recognizes the integration of depression treatment into primary as the most viable strategy for increasing access and closing the global mental health (GMH) treatment gap. Several evidence-based treatments for depression have been adapted and demonstrated efficacious in low-resource settings but systematic strategies are needed to bring these practices to scale in low-resource settings where there are few MH specialists. As a leading cause of death in LMIC that is driven, in part, by high comorbidity with depression, tuberculosis (TB) represents a strategic point-of-entry for building capacity for depression treatment in primary care systems in low resource settings. The overall aim of this proposal is to develop a targeted prospective scale-up strategy for integrating evidence-based depression treatment into primary care, using TB services in Brazil as a point-of-entry. My long term career goal is to become an independent GMH researcher specialized in scaling-up evidence-based MH interventions within diverse `real world' systems of care. This K01 award will enable me to build on my strong clinical, theoretical, and methodological foundations in clinical social work, public health, the social sciences, and sustainable development, to develop expertise in a new technical area (social network analysis), and to use research to inform policy around the scale-up of evidence-based interventions in `real world' systems of care. My training goals are to 1) expand my skills and expertise in dissemination and implementation science with a focus on systems-level scale-up of evidence based interventions in GMH; 2) learn and apply the principals of social network analysis to inform system-level scale- up in low resource settings, and 3) to bridge the gap between policy and research in implementation science to maximize public health impact. These goals will be achieved through a combination of direct mentorship, coursework and tutorials, webinars/seminars, directed readings, workshops, conferences and hands-on experience. In my proposed research, I will 1) operationalize the constructs of receptivity (likelihood of adoption) to integrating evidence-based depression treatment and connectivity (likelihood of diffusion) among TB providers to strategically identify and target the two most receptive and well connected pilot clinics from all the clinics in the Itabora public health system in which to implement evidence-based depression treatment, 2) pilot depression/TB treatment integration within these two pilot clinics, and 3) measure diffusion of influence (changes in receptivity) in individuals within the Itabora public health system (connected or not) not part of the two the pilot sites. The overall goal will be to develop an efficient and effective targeted strategy for future scale-up of evidence based interventions that can be applied in diverse settings and other health conditions, in the US and abroad, and gather feasibility data to inform a subsequent R01 proposal.
Several efficacious treatments exist for depression but more knowledge is needed on how these innovations can be brought to scale within `real world' health systems. In this proposal I seek to gain expertise in implementation and dissemination science, social network analysis, and bridging the gap between research and policy, and use these skills to develop a targeted scale-up strategy for integrating evidence-based depression treatment into a system of primary care in Brazil using tuberculosis (TB) as a novel point-of-entry.
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| Sweetland, A C; Kritski, A; Oquendo, M A et al. (2017) Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis 21:852-861 |
| Matsuzaka, Camila T; Wainberg, Milton; Norcini Pala, Andrea et al. (2017) Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care. BMC Psychiatry 17:225 |
| 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 |
| Mason, Paul H; Sweetland, Annika C; Fox, Greg J et al. (2016) Tuberculosis and mental health in the Asia-Pacific. Australas Psychiatry 24:553-555 |
