2020 Articles

Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence-Based Practices (PRIDE) in Mozambique

Wainberg, Milton L.; Lovero, Kathryn L.; Duarte, Cristiane S.; Fiks Salem, Andre; Mello, Milena; Bezuidenhout, Charl; Mootz, Jennifer J.; Feliciano, Paulino; Suleman, Antonio; Fortunato dos Santos, Palmira; Weissman, Myrna M.; Cournos, Francine; Horvath Marques, Andrea; Fumo, Wilza; Mabunda, Dirceu; Alves Bradford, Jean-Marie; Mello, Marcelo F.; Mari, Jair de Jesus; Ngwepe, Phuti; Cidav, Zuleyha; Mocumbi, Ana O.; Medina-Marino, Andrew; Wall, Melanie M.; Gouveia, Lidia; Oquendo, Maria A.

ABSTRACT
Background: Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs' mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interventions (EBIs). This article discusses the protocol for the first study implementing comprehensive mental health services in LMICs.

Methods: In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial will evaluate implementation, patient, and service outcomes of three task-shifting delivery pathways in 20 Mozambican districts (population 4.7 million). In pathway 1 (usual care), community health workers (CHWs) and primary care providers (PCPs) refer patients to district-level mental health clinics. In pathway 2 (screen, refer, and treat), CHWs screen and refer patients to PCPs for behavioral and pharmacological EBIs in community clinics. In pathway 3 (community mental health stepped care), CHWs screen patients and deliver behavioral EBIs in the community and refer medication management cases to PCPs in clinics. Mixed-methods process evaluation will be used to examine factors affecting pathway implementation, adoption, and sustainability. Clinical activities will occur without research team support. Ministry of Health personnel will coordinate training and supervision.

Results: The most cost-effective pathway will be scaled up in all districts for 12 months.