Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial

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dc.contributor.authorMyers, Bronwyn
dc.contributor.authorLund, Crick
dc.contributor.authorLombard, Carl
dc.contributor.authorJoska, John
dc.contributor.authorLevitt, Naomi
dc.contributor.authorButler, Christopher
dc.contributor.authorCleary, Susan
dc.contributor.authorNaledi, Tracey
dc.contributor.authorMilligan, Peter
dc.contributor.authorStein, Dan J
dc.contributor.authorSorsdahl, Katherine
dc.date.accessioned2018-05-04T08:34:00Z
dc.date.available2018-05-04T08:34:00Z
dc.date.issued2018-03-16
dc.date.updated2018-04-09T15:12:08Z
dc.description.abstractBackground In low- and middle-income countries (LMIC), it is uncertain whether a “dedicated” approach to integrating mental health care (wherein a community health worker (CHW) has the sole responsibility of delivering mental health care) or a “designated” approach (wherein a CHW provides this service in addition to usual responsibilities) is most effective and cost-effective. This study aims to compare the effectiveness and cost-effectiveness of these two models of service integration relative to treatment as usual (TAU) for improving mental health and chronic disease outcomes among patients with HIV or diabetes. Methods/Design This is a cluster randomised trial. We will randomise 24 primary health care facilities in the Western Cape Province of South Africa to one of three study arms. Within each cluster, we will recruit 25 patients from HIV and 25 from diabetes services for a total sample of 1200 participants. Eligible patients will be aged 18 years or older, take medication for HIV or diabetes, and screen positive on the Alcohol Use Disorder Identification Test for hazardous/harmful alcohol use or depression on the Centre for Epidemiology Scale on Depression. Participants recruited in clinics assigned to the designated or dedicated approach will receive three sessions of motivational interviewing and problem-solving therapy, while those recruited at TAU-assigned clinics will be referred for further assessment. Participants will complete an interviewer-administered questionnaire at baseline, and at 6 and 12 months post-enrolment to assess change in self-reported outcomes. At these end points, we will test HIV RNA viral load for participants with HIV and HbA1c levels for participants with diabetes. Primary outcomes are reductions in self-reported hazardous/harmful alcohol use and risk of depression. Secondary outcomes are improvements in adherence to chronic disease treatment, biomarkers of chronic disease outcomes, and health-related quality of life. Mixed-effect linear regression models will model the effect of the interventions on primary and secondary outcomes. The cost-effectiveness of each approach will be assessed using incremental cost-effectiveness ratios. Discussion Study findings will guide decision-making around how best to integrate mental health counselling into chronic disease care in a LMIC setting. Trial registration Pan African Clinical Trials Registry, Trial registration number: ACTR201610001825403 . Registered 17 October 2016.
dc.identifier.apacitationMyers, B., Lund, C., Lombard, C., Joska, J., Levitt, N., Butler, C., ... Sorsdahl, K. (2018). Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial. <i>Trials</i>, http://hdl.handle.net/11427/27930en_ZA
dc.identifier.chicagocitationMyers, Bronwyn, Crick Lund, Carl Lombard, John Joska, Naomi Levitt, Christopher Butler, Susan Cleary, et al "Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial." <i>Trials</i> (2018) http://hdl.handle.net/11427/27930en_ZA
dc.identifier.citationTrials. 2018 Mar 16;19(1):185
dc.identifier.ris TY - Journal Article AU - Myers, Bronwyn AU - Lund, Crick AU - Lombard, Carl AU - Joska, John AU - Levitt, Naomi AU - Butler, Christopher AU - Cleary, Susan AU - Naledi, Tracey AU - Milligan, Peter AU - Stein, Dan J AU - Sorsdahl, Katherine AB - Background In low- and middle-income countries (LMIC), it is uncertain whether a “dedicated” approach to integrating mental health care (wherein a community health worker (CHW) has the sole responsibility of delivering mental health care) or a “designated” approach (wherein a CHW provides this service in addition to usual responsibilities) is most effective and cost-effective. This study aims to compare the effectiveness and cost-effectiveness of these two models of service integration relative to treatment as usual (TAU) for improving mental health and chronic disease outcomes among patients with HIV or diabetes. Methods/Design This is a cluster randomised trial. We will randomise 24 primary health care facilities in the Western Cape Province of South Africa to one of three study arms. Within each cluster, we will recruit 25 patients from HIV and 25 from diabetes services for a total sample of 1200 participants. Eligible patients will be aged 18 years or older, take medication for HIV or diabetes, and screen positive on the Alcohol Use Disorder Identification Test for hazardous/harmful alcohol use or depression on the Centre for Epidemiology Scale on Depression. Participants recruited in clinics assigned to the designated or dedicated approach will receive three sessions of motivational interviewing and problem-solving therapy, while those recruited at TAU-assigned clinics will be referred for further assessment. Participants will complete an interviewer-administered questionnaire at baseline, and at 6 and 12 months post-enrolment to assess change in self-reported outcomes. At these end points, we will test HIV RNA viral load for participants with HIV and HbA1c levels for participants with diabetes. Primary outcomes are reductions in self-reported hazardous/harmful alcohol use and risk of depression. Secondary outcomes are improvements in adherence to chronic disease treatment, biomarkers of chronic disease outcomes, and health-related quality of life. Mixed-effect linear regression models will model the effect of the interventions on primary and secondary outcomes. The cost-effectiveness of each approach will be assessed using incremental cost-effectiveness ratios. Discussion Study findings will guide decision-making around how best to integrate mental health counselling into chronic disease care in a LMIC setting. Trial registration Pan African Clinical Trials Registry, Trial registration number: ACTR201610001825403 . Registered 17 October 2016. DA - 2018-03-16 DB - OpenUCT DO - 10.1186/s13063-018-2568-9 DP - University of Cape Town J1 - Trials LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial TI - Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial UR - http://hdl.handle.net/11427/27930 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s13063-018-2568-9
dc.identifier.urihttp://hdl.handle.net/11427/27930
dc.identifier.vancouvercitationMyers B, Lund C, Lombard C, Joska J, Levitt N, Butler C, et al. Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial. Trials. 2018; http://hdl.handle.net/11427/27930.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDepartment of Psychiatry and Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceTrials
dc.source.urihttps://trialsjournal.biomedcentral.com/
dc.subject.otherCommon mental disorders
dc.subject.otherChronic disease care
dc.subject.otherIntegrated treatment
dc.subject.otherSouth Africa
dc.titleComparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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