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As described by Curran and colleagues, effectiveness-implementation hybrid designs blend clinical effectiveness and implementation research, and are composed of three categories which shift from an emphasis on effectiveness (type I) to an emphasis on implementation (type III). In order to move efficiently toward scale-up and implementation of mental health care, we will use an effectiveness-implementation hybrid type I design which has the potential to inform scale-up and implementation of mental health care. Given the large and growing global magnitude of disability related to mental disorders (a 45 % increase over the past 20 years, such research is not only the next logical step for translation, but is required to meet the need for services. Yet, for the most part, the field has not moved beyond the first (T1) stage of translational research (testing the clinical efficacy of treatments in new settings) to address treatment effectiveness with general populations and implementation strategies. Over the past decade, efficacy studies have shown that non-specialists can deliver many evidence-based psychotherapies for common mental disorders in LMICs, thereby addressing workforce barriers related to the scarcity of mental health professionals. The majority of those in need of care suffer from depression and anxiety disorders, illnesses for which treatments with strong efficacy have existed for decades and are widely used in high income countries (HICs). The mental health care gap in LMICs is well-established – 75 % of those with serious mental disorders never receive care. Global mental health treatment gap in in low and middle income countries (LMICs) and effectiveness-implementation hybrid trials Here, we describe an effectiveness-implementation hybrid study that evaluates non-specialist delivery of mental health treatment within an HIV clinic for HIV-positive (HIV+) women affected by gender- based violence (GBV) (HIV+ GBV+) in the Nyanza region of Kenya. However, most mental health treatment studies using non-specialist providers in LMICs deploy traditional efficacy designs (T1) without the benefit of integrated mental health treatment models shown to succeed over vertical interventions or methods derived from new implementation science to speed policy change. While the scarcity of mental health care providers is recognized as a major contributor to the magnitude of untreated disorders in LMICs, studies in LMICs find that evidence-based treatments for depression and anxiety disorders, such as brief, structured psychotherapies, are feasible, acceptable and have strong efficacy when delivered by local non-specialist personnel.
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Over half of mental illness is attributable to depression and anxiety disorders, both of which have known treatments.
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Mental disorders are the leading global cause of years lived with disability the majority of this burden exists in low and middle income countries (LMICs).