PRIME-SA: PRogramme for Improving Mental health CarE

LEAD:
Professor Inge Petersen
TIMELINE:
May 2011-March 2017 (extended to April 2019)
UKZN BUDGET:
£676 706 (Approx. R12 180 708) Budget extension £299 634 (Approx R4 985 909)
FUNDER:
Department for International Development (DFID)
COLLABORATORS:
University of Cape Town is the Coordinating entity. University of KwaZulu-Natal; Knowledge Translation Unit, UCT, Medical Research Council, University of KwaZulu-Natal, University of Cape Town, Institute of Psychiatry, King’s College, London, London School of Hygiene and Tropical Medicine, Public Health Foundation, India, Transcultural Psychosocial Organization, Nepal, Butabika National Mental Hospital Uganda, Addis Ababa University Ethiopia, World Health Organization, National Department of Health, North West Provincial Department of Health

Outline:

The purpose of PRIME was to generate world-class research evidence on the implementation and scaling up of treatment programmes of priority mental disorders which can be widely adopted by policy makers and practitioners in low and middle-income countries, by addressing three major objectives in three overlapping phases across the 6 years of the research programme.

PRIME-South Africa Background
Research site was Dr Kenneth Kaunda District (DR KKD), North West province. PRIME-SA developed collaborative care models for depression, alcohol misuse and schizophrenia. Accompanying tools have been developed.

Progress:

Inception phase (years 1- 2.5) complete: DR KKD 4 facilities

Service user and service provider engagement using qualitative interviews and Theory of Change (TOC) workshops to develop district mental health care plans (MHCP) for depression, alcohol used disorders (AUD) and serious mental disorders.
Piloting of the MHCPs for service users with depression and psychosocial rehabilitation for schizophrenia.

Implementation phase (years 2.5 – 5) complete: DR KKD 4 facilities

Refinement of the MHCPs to implement a collaborative care model for depression.
Facility Detection Survey to assess detection of depression and AUD at baseline
Facility Detection Survey to assess detection of depression and AUD at end line
Facility profiles
Cohort study
Chronic care service users with depression
Psychosocial rehabilitation for stable patients with schizophrenia
Qualitative cohort –service user and service provider process evaluations

Scale up (years 5- 6): Complete

The MHCP was scaled up to 2 districts in North West province, Dr Kenneth Kaunda District and Bojanala Platinum District.

A cluster RCT (chronic care patients with hypertension and co-morbid depression) was conducted in 20 facilities (10 control; 10 intervention) in DR KKD April 2015 – 31 November 2016. The trial was conducted in parallel to the COBALT trial (chronic care HIV + patients with comorbid depression).
The training of behaviour change counsellors to administer the psychosocial intervention for depression was scaled up to 10 facilities in the COBALT trial in the Bojanala Platinum District.
Facility profiles completed in DRKKD trial sites; (ongoing)in Bojanala Platinum District
Service user and service provider process evaluations complete
Quality of care study (100 participants) using chart review and HMIS data to track quality of care at 10 intervention clinics in DR KKD.
Training in providing psychosocial counselling provided to healthcare workers in Zambia, and materials shared.
Additional activity: Additional cohort in 1 facility at implementation site: Feasibility study-Collaborative care plan for perinatal depression (PhD study).

Extension (years 7 and 8)

A two year extension was granted by the funder to:

Complete outstanding activities including data analysis and publication
Provide technical support to additional two local sites and selected international sites
Publish the research.

The extension phase is complete. The PRIME intervention is being used as a model by the Mental Health Integration project (MHINT) in KwaZulu-Natal. Outstanding publications are in progress as per the PRIME publications list.