scholarly journals Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM

2015 ◽  
Vol 24 (3) ◽  
pp. 233-240 ◽  
Author(s):  
C. Lund ◽  
A. Alem ◽  
M. Schneider ◽  
C. Hanlon ◽  
J. Ahrens ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Health Care ◽  
Cost Effectiveness ◽  
Mental Disorders ◽  
Intervention Research ◽  
Sub Saharan Africa ◽  
Task Sharing ◽  
Treatment Gap ◽  
Sub Saharan

There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.

scholarly journals 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 ◽  
2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Charlotte Hanlon ◽  
Atalay Alem ◽  
Girmay Medhin ◽  
Teshome Shibre ◽  
Dawit A. Ejigu ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Cost Effectiveness ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Low Income ◽  
Psychiatric Nurse ◽  
Task Sharing ◽  
Low Income Country ◽  
Randomised Controlled

Abstract Background Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. Methods/Design A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18 months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12 months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and cost-effectiveness will be further evaluated at 18 months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. Discussion Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation’s mental health Gap Action Programme to scale-up mental health care globally. Trial registration NCT02308956 (ClinicalTrials.gov). Date of registration: 3 December 2014.

scholarly journals Acceptance and Commitment Therapy in a Low-Income Country in Sub-Saharan Africa: A Call for Further Research

2021 ◽  
Vol 9 ◽  
Author(s):  
Yonas E. Geda ◽  
Janina Krell-Roesch ◽  
Yaphet Fisseha ◽  
Aida Tefera ◽  
Teferra Beyero ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Acceptance And Commitment Therapy ◽  
Mental Health Professionals ◽  
Sub Saharan Africa ◽  
Task Sharing ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Sub Saharan

A worsening trend of critical shortages in senior health care workers across low- and middle-income countries (LMICs) in sub-Saharan Africa has been documented for decades. This is especially the case in Ethiopia that has severe shortage of mental health professionals. Consistent with the WHO recommended approach of task sharing for mental health care in LMICs, Acceptance and Commitment Therapy (ACT), which is an empirically validated psychological intervention aimed at increasing psychological flexibility, may be delivered by trained laypersons who have a grassroots presence. In this paper, we discuss the need for and potential role of ACT to be delivered by health extension workers (HEWs) to address mental health care needs across Ethiopia. To this end, we also reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries including in Nigeria, Sierra Leone, Uganda, and South Africa. All studies revealed significant improvements of various mental health-related outcome measures such as decreased psychological distress and depressive symptoms, or increased subjective wellbeing and life satisfaction in the groups that received an ACT-based intervention. However, to date, there is no study that applied ACT in Ethiopia. Thus, more research is warranted to examine the effectiveness and, if proven successful, to scale up a task sharing approach of an ACT-based intervention being delivered by trained HEWs at a grassroots level, possibly paving the way for an innovative, sustainable mental health service in Ethiopia as well as other African LMICs.

scholarly journals Scaling up public mental health care in Sub-Saharan Africa: insights from infectious disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Susan M. Meffert ◽  
Collene Lawhorn ◽  
Linnet Ongeri ◽  
Elizabeth Bukusi ◽  
Holly R. Campbell ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Mental Healthcare ◽  
Public Mental Health ◽  
Sub Saharan Africa ◽  
Care Needs ◽  
Public Mental Health Care ◽  
Sub Saharan

Abstract Introduction Models estimate that the disability burden from mental disorders in Sub-Saharan Africa (SSA) will more than double in the next 40 years. Similar to HIV, mental disorders are stigmatized in many SSA settings and addressing them requires community engagement and long-term treatment. Yet, in contrast to HIV, the public mental healthcare cascade has not been sustained, despite robust data on scalable strategies. We draw on findings from our International AIDS Society (IAS) 2020 virtual workshop and make recommendations for next steps in the scale up of the SSA public mental healthcare continuum. Discussion Early HIV surveillance and care cascade targets are discussed as important strategies for HIV response in SSA that should be adopted for mental health. Advocacy, including engagement with civil society, and targeted economic arguments to policymakers, are reviewed in the context of HIV success in SSA. Parallel opportunities for mental disorders are identified. Learning from HIV, communication of strategies that advance mental health care needs in SSA must be prioritized for broad global audiences. Conclusions The COVID-19 pandemic is setting off a colossal escalation of global mental health care needs, well-publicized across scientific, media, policymaker, and civil society domains. The pandemic highlights disparities in healthcare access and reinvigorates the push for universal coverage. Learning from HIV strategies, we must seize this historical moment to improve the public mental health care cascade in SSA and capitalize on the powerful alliances ready to be forged. As noted by Ambassador Goosby in our AIDS 2020 workshop, ‘The time is now’.

scholarly journals Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yulia Shenderovich ◽  
Mark Boyes ◽  
Michelle Degli Esposti ◽  
Marisa Casale ◽  
Elona Toska ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Cohort Study ◽  
Mental Health Problems ◽  
Health Problems ◽  
Sub Saharan Africa ◽  
Depression Symptoms ◽  
Sub Saharan ◽  
Positive Caregiving ◽  
Living With Hiv

Abstract Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

scholarly journals The Use of Antidepressants, Anxiolytics, Sedatives and Hypnotics in Europe: Focusing on Mental Health Care in Portugal and Prescribing in Older Patients

2020 ◽  
Vol 17 (22) ◽  
pp. 8612
Author(s):  
Marta Estrela ◽  
Maria Teresa Herdeiro ◽  
Pedro Lopes Ferreira ◽  
Fátima Roque
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Older Patients ◽  
Common Mental Disorders ◽  
Health Policies ◽  
Depression And Anxiety ◽  
Treatment Gap ◽  
Mental Health Policies

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.

scholarly journals 1673. Gendered Patterns of HIV, TB, and Other Primary Care Referrals in Rural South Africa

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S612-S613
Author(s):  
Koeun Choi ◽  
Anthony Moll ◽  
Sheela Shenoi
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Care ◽  
Community Health ◽  
Health Workers ◽  
Hazardous Drinking ◽  
Sub Saharan Africa ◽  
Running Water ◽  
Health Concerns ◽  
Sub Saharan

Abstract Background Men’s lack of engagement in healthcare hinders HIV efforts in sub-Saharan Africa. Masculine norms and lack of accessibility in a female-dominated healthcare system deter male health-seeking behavior. Community interventions combat the gender gap. In South Africa (SA), alcohol-based venues (ABV) are common locales for men. We created an ABV community health screening to determine the need. Methods Community Health Workers targeted ABV in rural SA, offering screenings for HIV, TB, Isoniazid Preventive Therapy, STI, hypertension, diabetes, circumcision, with referral to primary care services (PCS) for any positive screenings. Participants completed questionnaires, including socioeconomic (SE), healthcare use, and alcohol use evaluated by AUDIT scores. Multivariable logistic regression identified factors associated with referral to PCS. Results From July 2018 to March 2019, 1356 were screened, 74% were men, median age was 30 (IQR 22–46), 26% employed and 30% had running water. Men are more likely to have never gone to a PCS compared with women (15.9% vs. 9.7%, P = 0.004) and have lengthier time since the last clinic visit (1.4 years vs. 0.6 years, P < 0.001). Men are significantly more likely than women to report hazardous drinking (49% vs. 28%, P < 0.001) Overall, positive screenings were noted in 537 (53.9%) community members, and χ 2 analysis show men more likely to require referrals after screening (P = 0.08). Multivariate analysis shows among men, referrals were associated with older age, hazardous drinking, any health concerns; while higher SE was protective. For women, only age and health concerns were associated with referral. Similarly, alcohol contributed to HIV and TB referrals for men, while higher SE was protective of TB referrals for men (Table 1). Conclusion ABV males in this rural community, although disengaged from health care, required more referrals than women. HIV, TB, and any referrals for men screened at ABV in rural SA were associated with lower SE and hazardous drinking, highlighting the challenges that this population faces in seeking health care. Differentiated and targeted community-based services may facilitate care for these hard to reach men in sub-Saharan Africa. Next steps include determining clinical outcomes of referrals. Disclosures All authors: No reported disclosures.

scholarly journals Two Birds with One Stone: Health Care Providers’ Perspectives about Prevention Technologies in Kenya and South Africa

2019 ◽  
Vol 18 ◽  
pp. 232595821984136 ◽  
Author(s):  
Alexandra Lutnick ◽  
Mary Kate Shapley-Quinn ◽  
Kgahlisho Nozibele Manenzhe ◽  
Jacob Onyango ◽  
Kawango Agot ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Care Providers ◽  
Qualitative Interviews ◽  
Training Needs ◽  
Health Needs ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Single Product ◽  
Sub Saharan

To meet the reproductive health needs of women, especially those in sub-Saharan Africa, multipurpose prevention technologies (MPTs) that combine pregnancy and HIV prevention into a single product could be highly beneficial. This qualitative study with health care providers in Kenya and South Africa examined health system factors that may facilitate or inhibit the delivery of these MPTs. Twelve qualitative interviews were conducted with health care providers at each site (24 interviews total). Providers were presented with pictures and actual placebo prototypes of 4 MPTs: a vaginal ring, an oral pill, an injectable, and an implant. Four themes emerged related to health care providers’ reported interest in offering the proposed MPTs: (1) perceptions of young women’s interest in the MPTs, (2) considerations about product administration, (3) feedback about product attributes, and (4) providers’ training needs. Overwhelmingly, health care providers are eager to offer a product that prevents both HIV and unintended pregnancy in young women.

Mental disorders as a worldwide public health issue

2012 ◽  
pp. 10-13
Author(s):  
Benedetto Saraceno
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Substance Use ◽  
Mental Disorders ◽  
Communicable Diseases ◽  
Health Priorities ◽  
Public Health Issue ◽  
Treatment Gap ◽  
Brain Disorder

The twentieth century has witnessed significant improvements in somatic health in most countries. A number of key public health threats have been eradicated or brought under control under the leadership of WHO. Priority was given to communicable diseases in view of their inherent potential to spreading. At the present time, a focus on non-communicable diseases and mental health would now appear as the next natural step in public health priorities. In the case of mental health, this is due to the capacity of mental disorders to proliferate not only as a result of complex and multiple biological, psychological but also social determinants. WHO estimates that at any given time 450 million people suffer from some form of mental or brain disorder, including alcohol and substance use disorders. In other words, one in four of the world’s population suffer from different forms of mental, behavioural, and neurological disorders. This chapter looks at the economic and social costs of mental disorders, global resources for mental health, the treatment gap for mental disorders, and improving mental health care.

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