Myers 2018.

Study name	Comparing dedicated and designated models of integrating mental health into chronic disease care
Methods	Cluster‐randomised trial with 3 arms
Participants	Clusters are primary healthcare facilities in Western Cape Province of South Africa. Participants are patients with HIV or diabetes attending these clinics Inclusion criteria 1. ≥ 18 years of age From HIV clinics: 1. ≥ 18 years old 2. Taking ART for their HIV disease 3. Screen at risk for depression, with CES‐D score ≥ 16 and/or screen at risk for hazardous or harmful alcohol use (with AUDIT score ≥ 8) 4. Providing written informed consent to participate in the study 5. Agree to comply with all study requirements From diabetes clinics: 1. ≥ 18 years old 2. Taking medication for diabetes disease (type 1 or type 2) 3. Screening at risk for depression, with CES‐D score ≥ 16 and/or screening at risk for hazardous or harmful alcohol use (with AUDIT score ≥ 8) 4. Providing written informed consent to participate in the study 5. Agreeing to comply with all study requirements Exclusion criteria 1. Currently receiving treatment (counselling or medication) for a mental disorder 2. Participating in another research study
Interventions	Intervention 1 Dedicated arm ‐ a 3‐session blended motivational interviewing‐problem‐solving therapy (MI‐PST) intervention delivered by community health workers who will work across both HIV and diabetes clinics. They will be dedicated staff who will have no other chronic disease duties and who will be responsible only for delivering this mental health intervention package.1 hour per session Intervention 2 Designated arm ‐ in clinics allocated to this arm, participants will receive a 3‐session blended MI‐PST intervention delivered by community health workers who will work across both HIV and diabetes services. They will be designated to provide this mental health care package and referrals to additional specialised services (if indicated) in addition to their other chronic disease‐related duties. 1 hour per session Control Screening and referral ‐ in CHCs assigned to the TAU arm, participants will receive the standard package of care when a health provider suspects a patient may have a common mental disorder. This includes screening for a common mental disorder and referring patients for further assessment and treatment to onsite or offsite mental health nurses or social workers for further assessment and treatment. One 1‐hour session
Outcomes	Primary outcomes 1. Depression score (CES‐D) 2. Hazardous alcohol use (AUDIT) Secondary outcomes 1. HBA1C 2. HIV RNA viral load
Starting date	26/7/2017
Contact information	Bronwyn Myers, bmyers@mrc.ac.za
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