title: Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM.
abstract: 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.
authors.affiliation: Department of Psychiatry and Mental Health,Alan J Flisher Centre for Public Mental Health,University of Cape Town,46 Sawkins Road,Rondebosch,Cape Town,South Africa.
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authors.lastname: Lund
authors.affiliation: Department of Psychiatry,School of Medicine,College of Health Sciences,Addis Ababa University,Addis Ababa,Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Alem
authors.affiliation: Department of Psychiatry and Mental Health,Alan J Flisher Centre for Public Mental Health,University of Cape Town,46 Sawkins Road,Rondebosch,Cape Town,South Africa.
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authors.affiliation: Department of Psychiatry,School of Medicine,College of Health Sciences,Addis Ababa University,Addis Ababa,Ethiopia.
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authors.lastname: Hanlon
authors.affiliation: Department of Mental Health,College of Health Sciences,University of Malawi,Blantyre,Malawi.
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authors.lastname: Ahrens
authors.affiliation: Department of Mental Health,College of Health Sciences,University of Malawi,Blantyre,Malawi.
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authors.affiliation: Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore,USA.
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authors.affiliation: School of Applied Human Sciences,University of KwaZulu-Natal,Durban,South Africa.
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authors.affiliation: Department of Psychiatry,University of KwaZulu-Natal,Durban,South Africa.
authors.forename: J
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authors.lastname: Burns
authors.affiliation: Department of Psychiatry,College of Health Sciences,University of Zimbabwe,Harare,Zimbabwe.
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authors.lastname: Chibanda
authors.affiliation: Department of Psychiatry,College of Health Sciences,University of Zimbabwe,Harare,Zimbabwe.
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authors.initials: F
authors.lastname: Cowan
authors.affiliation: Department of Psychiatry and Mental Health,Alan J Flisher Centre for Public Mental Health,University of Cape Town,46 Sawkins Road,Rondebosch,Cape Town,South Africa.
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authors.lastname: Davies
authors.affiliation: Health Services and Population Research Department,Centre for Global Mental Health,Institute of Psychiatry,King's College London,London,UK.
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authors.lastname: Dewey
authors.affiliation: Department of Psychiatry,School of Medicine,College of Health Sciences,Addis Ababa University,Addis Ababa,Ethiopia.
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authors.lastname: Fekadu
authors.affiliation: Department of Health of the Government of South Africa,Pretoria,South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Freeman
authors.affiliation: Department of Psychiatry and Mental Health,Perinatal Mental Health Project,Alan J Flisher Centre for Public Mental Health,University of Cape Town,Cape Town,South Africa.
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authors.lastname: Honikman
authors.affiliation: Department of Psychiatry and Mental Health,University of Cape Town,Cape Town,South Africa.
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authors.lastname: Joska
authors.affiliation: Department of Psychology,Alan J Flisher Centre for Public Mental Health,Stellenbosch University,Stellenbosch,South Africa.
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authors.lastname: Kagee
authors.affiliation: Health Services and Population Research Department,Centre for Global Mental Health,Institute of Psychiatry,King's College London,London,UK.
authors.forename: R
authors.initials: R
authors.lastname: Mayston
authors.affiliation: Aklilu-Lemma Institute of Pathobiology,Addis Ababa University,Addis Ababa,Ethiopia.
authors.forename: G
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Department of Psychiatry,Faculty of Medicine,Makerere University,Kampala,Uganda.
authors.forename: S
authors.initials: S
authors.lastname: Musisi
authors.affiliation: School of Public Health and Family Medicine,University of Cape Town,Cape Town,South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Myer
authors.affiliation: BasicNeeds,Kampala,Uganda.
authors.forename: T
authors.initials: T
authors.lastname: Ntulo
authors.affiliation: Department of Psychiatry and Mental Health,Alan J Flisher Centre for Public Mental Health,University of Cape Town,46 Sawkins Road,Rondebosch,Cape Town,South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Nyatsanza
authors.affiliation: Department of Psychology,Faculty of Medicine,University of Ghana,Accra,Ghana.
authors.forename: A
authors.initials: A
authors.lastname: Ofori-Atta
authors.affiliation: School of Applied Human Sciences,University of KwaZulu-Natal,Durban,South Africa.
authors.forename: I
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Department of Health of the Government of South Africa,Pretoria,South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Phakathi
authors.affiliation: Health Services and Population Research Department,Centre for Global Mental Health,Institute of Psychiatry,King's College London,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Prince
authors.affiliation: Ontario Shores Center for Mental health Sciences,Ontario,Canada.
authors.forename: T
authors.initials: T
authors.lastname: Shibre
authors.affiliation: Department of Psychiatry and Mental Health,University of Cape Town,Cape Town,South Africa.
authors.forename: D J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Department of Psychology,Alan J Flisher Centre for Public Mental Health,Stellenbosch University,Stellenbosch,South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Swartz
authors.affiliation: Health Services and Population Research Department,Centre for Global Mental Health,Institute of Psychiatry,King's College London,London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Department of Psychology,Alan J Flisher Centre for Public Mental Health,Stellenbosch University,Stellenbosch,South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Tomlinson
authors.affiliation: Department of Health,Behavior,and Society,Johns Hopkins School of Public Health,Baltimore,MD,USA.
authors.forename: L
authors.initials: L
authors.lastname: Wissow
authors.affiliation: Mailman School of Public Health,Columbia University,New York,USA.
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authors.lastname: Susser
keywords: Mental health; multicultural; primary care; randomised controlled trials
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