Research Update as PRIME enters 5th grant year
PRIME has made good progress in the first half of the 5th grant year. The country teams have continued to implement the PRIME Mental Healthcare Plans (MHCPs) in all five PRIME districts as well as conduct the evaluation of implementation using the four main study designs. Four of the five PRIME countries have committed to scale up and the relevant PRIME teams are working towards this. We continue to make progress with respect to research uptake and capacity building.
The implementation of the PRIME MHCPs has continued in all countries supported by the PRIME research teams. These are country specific as determined by the PRIME MHCPs. They include training of trainers for mhGAP/PC101, healthcare workers in mhGAP/PC101, healthcare workers in psychosocial interventions and community health workers in detection and initial treatment and referral of people with priority disorders. In addition, supervision structures have been put in place
to provide ongoing supervision for the above health workers. Interventions at the community level include community sensitisation and awareness activities and community detection strategies. At the district level, meetings and workshops have been held to strengthen management systems.
The evaluation of the implementation has primarily been focused on recruitment for the PRIME cohorts in the last 6 months. These are longitudinal studies intended to evaluate the impact of the PRIME MHCP interventions on the clinical, social and economic outcomes of people receiving care through the PRIME MHCPs. Some cohorts (depression cohorts in India, Nepal and South Africa and alcohol use disorder cohorts in Nepal and India) also have a control arm where people screened positive for depressive symptoms or alcohol use but are not diagnosed nor receiving treatment.
The use of handheld devices to enter data in real time during field work in India, Nepal, South Africa and Uganda has meant that we have been able to keep a close eye on recruitment into the cohort as well as data quality in the cohorts. A part time data manager based at UCT, Emily Baron, has been overseeing this task.
The cohort recruitment has now been completed. Midline assessments are underway in all countries and endline assessments have begun in Nepal, India and South Africa. An additional maternal depression cohort will be starting in Uganda in the next few weeks to follow up women in the perinatal period who are identified with depressive symptoms.
There have been some challenges in the recruitment for the PRIME cohort, particularly in reaching the target numbers for some cohorts. We are exploring these issues, particularly in relation to psychosis in Uganda, India and Ethiopia, using a brief survey of people with probable psychosis identified in the community. In addition, we are conducting qualitative interviews with service users
who have engaged or drop out of care to understand some of the factors affecting access to services. Additional data collection during this period has included interviews with service providers (ongoing), training and supervision evaluation as well as the collection of facility, district and community information related to the implementation of the PRIME MHCPs. We have recently employed another data manager, Deepak Soowamber, who is currently in the process of collating this data centrally at UCT. He will also be involved in monitoring and managing the data for the endline community and facility surveys.
By Erica Breuer