# Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building - Scale-Up Component

> **NIH NIH U19** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $354,672

## Abstract

SCALE-UP STUDY – ABSTRACT
 Depression causes a heavy burden of death and disability in low- and middle-income countries (LMICs),
resulting in high societal, economic, and quality-of-life costs. Depression often co-occurs with chronic medical
conditions whose prevalence is dramatically increasing in LMIC, such as hypertension and diabetes, and is
associated with worse clinical outcomes for those comorbid conditions. This confluence has led to calls for
integration of mental health treatment with expanding chronic disease care systems in LMICs.
 Response to the urgent need for mental health care is hampered by the severe shortage of skilled mental
health professionals in LMICs. As a result, much attention in the global mental health community has focused
on task-sharing approaches that give non-specialists, such as primary care providers or community workers,
the skills and structure to address common mental health problems.
 The Malawi Ministry of Health has identified antidepressant treatment expansion in chronic diseases clinics
as a high priority. Algorithm-based care for depression (ABCD) is a resource-efficient, evidence-based, task-
sharing approach to antidepressant provision in non-psychiatric clinical settings involving systematic measures
and algorithm-guided antidepressant treatment decisions designed for non-specialists. The availability and
efficacy of low-cost antidepressants in many low-resource settings makes an approach like ABCD a highly
promising strategy for efficient integration of depression treatment into existing clinical care systems.
 A key knowledge gap impeding the scale-up of ABCD in low-resource settings is the level of resource
investment required to achieve acceptable fidelity and effectiveness in real-world clinics. Implementation
science research to identify optimal implementation strategies will be critical to advance scale-up efforts. The
overall objective of the Scale-Up Study Core is to identify the most efficient and effective design for the
integration of ABCD into existing chronic disease care in Malawi and similar settings. The Scale-Up Study
Core will conduct a clinic-randomized trial to compare the implementation, effectiveness, and cost-
effectiveness outcomes of two implementation strategies to facilitate ABCD scale-up. The scale-up study will
also generate information on whether clinics with certain characteristics will require additional resources in
order to achieve sufficient ABCD fidelity. In coordination with the Capacity-Building Core, the scale-up study
will provide invaluable “on the job” training opportunities for select SHARP trainees to contribute to the design
and conduct of a mental health-related implementation science research study. Finally, the results of the study
will guide the drafting of a detailed revision to the national Mental Health Action Plan, in collaboration with the
Ministry of Health and other SHARP partners. Overall, the activities of the Scale-Up Study Core will provid...

## Key facts

- **NIH application ID:** 9981504
- **Project number:** 5U19MH113202-04
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Brian W Pence
- **Activity code:** U19 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $354,672
- **Award type:** 5
- **Project period:** 2017-09-12 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9981504

## Citation

> US National Institutes of Health, RePORTER application 9981504, Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building - Scale-Up Component (5U19MH113202-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9981504. Licensed CC0.

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