COVID-19 Pandemic and Stepped Care Model for Perinatal Depression in Rural India: Lessons Learned and the Way Forward

A mentored hands-on training model for scaling up implementation and intervention research in India: "connecting the dots"

Despite the high burden of mental disorders in low- and middle-income countries (LMICs), less than 25% of those in need have access to appropriate services, in part due to a scarcity of locally relevant, evidence-based interventions and models of care. To address this gap, researchers from India and the United States and the Indian Council of Medical Research (ICMR) collaboratively developed a "Grantathon" model to provide mentored research training to 24 new principal investigators (PIs). This included a week-long didactic training, a customized web-based data entry/analysis system and a National Coordination Unit (NCU) to support PIs and track process objectives. Outcome objectives were assessed via scholarly output including publications, awards received and subsequent grants that were leveraged. Multiple mentorship strategies including collaborative problem-solving approaches were used to foster single-centre and multicentre research. Flexible, approachable and engaged support from mentors helped PIs overcome research barriers, and the NCU addressed local policy and day-to-day challenges through informal monthly review meetings. Bi-annual formal review presentations by all PIs continued through the COVID-19 pandemic, enabling interim results reporting and scientific review, also serving to reinforce accountability. To date, more than 33 publications, 47 scientific presentations, 12 awards, two measurement tools, five intervention manuals and eight research grants have been generated in an open-access environment. The Grantathon is a successful model for building research capacity and improving mental health research in India that could be adopted for use in other LMICs.

COVID-19 vaccine confidence project for perinatal women (CCPP)-Development of a stepped-care model to address COVID-19 vaccine hesitancy in low and middle-income countries

Background

COVID-19 vaccine hesitancy (CVH) is common among perinatal women in low and middle-income countries (LMICs), but it is often unaddressed. This could be due to a lack of feasible, scalable, and acceptable interventions and models for CVH in LMICs. Our study aimed to develop a CVH intervention model that can be implemented in LMICs using existing human healthcare resources.

Methods

A literature review was conducted on aspects of vaccine hesitancy, pre-existing interventions, and models for addressing vaccine hesitancy (COVID-19 and non-COVID-19). The lead authors (RR and PKuk) formed a team consisting of vaccinators, experts, and stakeholders. Members shared their perspectives and proposals for various models and interventions that could be implemented in LMICs. A CVH intervention model was developed using a logic model, a WHO implementation toolkit, experts' feedback, and consensus.

Results

A consensus was reached to develop a COVID-19 Vaccine Confidence Project for Perinatal Women (CCPP), which is a primary health care worker (HCWs)-based stepped-care model. The CCPP model includes HCW training, integration into ongoing COVID-19 vaccination programs, CVH screening, CVH intervention, and referral services suitable for implementation in LMICs.

Conclusion

The CCPP project/model provides a practical approach that can help in the early detection and management of CVH. The model can be tailored to different healthcare settings to improve COVID-19 vaccine uptake among perinatal women in LMICs.

Training and education in digital psychiatry: A perspective from Asia-Pacific region

BACKGROUND

Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a cost-effective solution in those circumstances in which the current mental health services and infrastructure are not able to properly accommodate the patients' needs. However, mental health workforce is often poorly theoretical/practical trained in digital psychiatry and in delivering remote consultations safely and effectively, not being common to own curricula-specific training requirements in digital psychiatry and skills.

METHODS

A web-based international cross-sectional survey was carried out by a working group constituted by one or two national representative(s) of each WHO South-East Asia and Western Pacific Regions (APAC), with the aim to evaluate the level of training, knowledge, experience, and perception regarding the topic of digital psychiatry in a sample constituted by medical students, psychiatry trainees, and early career psychiatrists from APAC.

RESULTS

An overall lack of theoretical and/or practical training on new digital tools and digital health interventions in psychiatry was observed. The level of training influences knowledge background, which, in turns, influences young professionals' perceptions and opinions regarding digital psychiatry and interventions in mental health.

CONCLUSION

Implementing psychiatry training programs may significantly improve the level of knowledge and use of digital tools in mental healthcare. Moreover, mental health services and infrastructures should be properly adapted to the digital era, considering the overall weak and heterogeneous technical support and equipment, issues of internet connectivity, and other administrative-related challenges observed in APAC.