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Depression And Primary-care Partnership for Effectiveness-implementation Research (DAPPER)

Award Number: R01MH115512
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/06/2018
PERIOD OF PERFORMANCE END DATE: 06/30/2024

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Depression And Primary-care Partnership for Effectiveness-implementation Research (DAPPER) - Project Abstract Dominated by depression, mental disorders are a leading cause of global disability. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Despite nearly 15 years of efficacy studies showing that local non-specialists can provide evidence-based care for depression in LMICs, few studies have advanced to implementation research. As emphasized by a recent World Health Organization (WHO) initiative, integration of depression treatment into existing systems of care is critical to achieving public health impact. Our research team has worked in western Kenya for 5 years with a UCSF-Kenya collaboration that supports integrated HIV services at over 70 primary healthcare facilities in Kisumu County (Family AIDS Care and Education Services [FACES]). With high prevalence of Major Depressive Disorder (MDD) in Kenyan primary care populations (26.3%, 3-5 times higher than in the U.S.), treatment for depression is a top concern for Kenyan mental health leaders. Kenyan leaders recently launched a government-funded initiative to scale- up treatment for mental disorders in primary healthcare, prioritizing depression. Yet, they lack an evidence base for the two essential treatments –psychotherapy and second generation antidepressants—without which Kenyan care scale-up will fall short of its potential. The proposed research responds to this need. We propose to partner with local and national mental health stakeholders in Kenya to evaluate: (1) non- specialist delivery of evidence-based depression treatment integrated within existing healthcare centers in regards to clinical effectiveness and implementation parameters; including (2) costs and cost-benefit ratios for depression care. Given that evidence-based psychotherapy and second-generation antidepressants are the two leading first-line treatments for depression and are feasible to deliver in Kenya, our goal is to test an implementation strategy for improving equitable access to these treatments by integrating them with primary care. Our proposed study uses an effectiveness-implementation hybrid design type I to assess outcomes of non-specialist delivered Interpersonal Psychotherapy (IPT) compared to fluoxetine, including assessment of the service delivery mechanism. Our approach differs from most prior work in our field because it uses an effectiveness-implementation design, compares outcomes for IPT versus second generation antidepressant, integrates depression treatment into primary care, and analyses depression care costs and cost-benefit ratios for each treatment arm. The results of the proposed research will be significant in two ways: (1) they will produce a scalable strategy for delivering depression treatments in sub-Saharan Africa using non-specialists integrated within existing primary care structures and (2) they will produce a policy maker “menu” of short and long-term cost-benefit options for integrated depression care with corresponding effectiveness and implementation values.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$1 )
2025	2022	UNIVERSITY OF NAIROBI	UNIVERSITY WAY IN NAIROBI CENTRAL BUSINESS DISTRICT.	NAIROBI				KEN	Mental Health Research Grants	000	5	11/27/2024	NON-COMPETING CONTINUATION	-$1
														Subtotal = -$1

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	000	5	10/26/2022	NON-COMPETING CONTINUATION	$0
2023	2022	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	001	5	11/4/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $633,817 )
2022	2022	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI	NULL			KEN	Mental Health Research Grants	002	5	8/11/2022	NON-COMPETING CONTINUATION	$633,817
2022	2021	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI	NULL			KEN	Mental Health Research Grants	000	4	4/15/2022	NON-COMPETING CONTINUATION	$0
2022	2021	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI	NULL			KEN	Mental Health Research Grants	001	4	6/22/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $633,817

Issue Date FY: 2021 ( Subtotal = $621,863 )
2021	2021	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	000	4	8/6/2021	NON-COMPETING CONTINUATION	$621,863
														Subtotal = $621,863

Issue Date FY: 2020 ( Subtotal = $621,969 )
2020	2020	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	001	3	8/6/2020	NON-COMPETING CONTINUATION	$621,969
2020	2019	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	000	2	4/6/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $621,969

Issue Date FY: 2019 ( Subtotal = $620,625 )
2019	2019	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	003	2	7/23/2019	NON-COMPETING CONTINUATION	$620,625
2019	2018	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	000	1	10/24/2018	NEW	$0
2019	2018	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	001	1	5/27/2019	NEW	$0
2019	2018	UNIVERSITY OF NAIROBI	UNIVERSITY WAY	NAIROBI				KEN	Mental Health Research Grants	002	1	6/13/2019	NEW	$0
														Subtotal = $620,625

Grand Total All Awards = $2,498,273

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Depression And Primary-care Partnership for Effectiveness-implementation Research (DAPPER)

Award Number: R01MH115512

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/06/2018

PERIOD OF PERFORMANCE END DATE: 06/30/2024

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