Implementation and scale-up of integrated depression care in South Africa: An observational implementation research protocol

Inge Petersen, Christopher G. Kemp, Deepa Rao, Bradley H. Wagenaar, Kenneth Sherr, Merridy Grant, Max O. Bachmann, Ruanne V. Barnabas, Ntokozo Mntambo, Sithabisile Gigaba, Andre van Rensburg, Zamasomi Luvuno, Ishmael Amarreh, Lara Fairall, Nikiwe N. Hongo, Arvin Bhana

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Background: People with chronic general medical conditions who have comorbid depression experience poorer health outcomes. This problem has received scant attention in low- and middle-income countries. The aim of the ongoing study reported here is to refine and promote the scale-up of an evidence-based task-sharing collaborative care model, the Mental Health Integration (MhINT) program, to treat patients with comorbid depression and chronic disease in primary health care settings in South Africa.
Methods: Adopting a learning-health-systems approach, this study uses an onsite, iterative observational implementation science design. Stage 1 comprises assessment of the original MhINT model under real-world conditions in an urban subdistrict in KwaZulu-Natal, South Africa, to inform refinement of the model and its implementation strategies. Stage 2 comprises assessment of the refined model across urban, semiurban, and rural contexts. In both stages, population-level effects are assessed by using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework with various sources of data, including secondary data collection and a patient cohort study (N=550). The Consolidated Framework for Implementation Research is used to understand contextual determinants of implementation success involving quantitative and qualitative interviews (stage 1, N=78; stage 2, N=282).
Results: The study results will help refine intervention components and implementation strategies to enable scale-up of the MhINT model for depression in South Africa.
Next steps: Next steps include strengthening ongoing engagements with policy makers and managers, providing technical support for implementation, and building the capacity of policy makers and managers in implementation science to promote wider dissemination and sustainment of the intervention.
Original languageEnglish
Pages (from-to)1065-1075
Number of pages11
JournalPsychiatric Services
Issue number9
Early online date11 Mar 2021
Publication statusPublished - 1 Sep 2021


  • collaborative care
  • depression
  • implementation science
  • mental health
  • multi-morbidity
  • South Africa

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