PRIDE-sSA: Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence-Based Practices in sub-Saharan Africa

About The Program

Background

Scale-up Component:

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).

In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial evaluates 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.

A digital mobile training and services platform is used to train and help providers deliver EBIs. Mixed-methods process evaluation examines factors affecting pathway implementation, adoption, and sustainability. Clinical activities will occur without research team support. Ministry of Health personnel will coordinate training and supervision. The most cost-effective pathway will be scaled up in all districts.

This novel first ever study, integrating comprehensive mental health for all disorders services into primary care using EBIs and psychotropic medications addressing severe, common, and substance use disorders, and suicide risk using a digital mobile training and services platform will inform a toolkit to help the Mozambican Ministry of Health scale up the most cost-effective pathway for mental health services and can be a template for other LMICs and low resource settings in the U.S and other high-income countries.

Capacity Building Component:

The global mental health (MH) dissemination and implementation (D&I) research gap in low and middle income countries (LMICs) is vast, with a dearth of local researchers trained to conduct such research and few policy-makers versed in developing new policies using scientific data and studying their outcomes. The goal of PRIDE sSA’s Capacity Building Component (CBC) – Seeds to PRIDE – is to train in-country teams to conduct trans-diagnostic community MH D&I and policy research in sSA. Seeds to PRIDE builds on our US-Mozambique-Brazil Fogarty/NIMH-funded MH capacity-building program PALOP (Países Africanos de Lingua Oficial Portuguesa) MH Implementation Research Training Program (D43 TW009675; PIs: Wainberg, Oquendo, Noormahomed), which has trained local senior and mid-level faculty and fellows in MH implementation science since 2014. In Seeds to PRIDE, we will work with five SSA countries: Botswana, Malawi, Mozambique, South Africa, and Zambia. The Seed Teams will receive didactic, mentor-based, consultative, and field research training with a two-fold focus: (1) dissemination and implementation (D&I) research and (2) policy research.

By training Seed Teams in each of the five countries, PRIDE sSA will launch MH D&I research-ready teams that can improve clinical services and policy making by conducting local research relevant for LMICs developing a MH care system. Seeds to PRIDE will provide a critical opportunity for development of regional networks to amplify the potential of lesson learning and sharing of expertise.