Scaling Up The Task-Sharing Of An Evidence-Based Psychological Treatment For Depression In Rural India

BackgroundMajority evidence on task-sharing of psychological treatments for depression is focused on randomized controlled trials with project staff delivered treatment. Ours is a scaling up of a brief evidence-based psychological treatment (the Healthy Activity Program, HAP) by community health workers (ASHA) in rural India. Our objective was to test the acceptability, feasibility and effectiveness of ASHA delivered HAP. MethodASHA were recruited in three rural districts in Madhya Pradesh, India. During the study duration, 1001 ASHA completed training using the EMPOWER approach (digital curricula and supervision protocols); 458 ASHA went on to deliver the HAP to adults with depression screened opportunistically. This paper describes the delivery of the HAP over a one-year period (24-07-2022 till 30-06-2023). The primary outcomes were treatment completion, patient and ASHA satisfaction, and change in depression symptom scores on treatment completion; we also explored if treatment effects were sustained at long-term (i.e., 9 month) among a consecutively recruited sub-sample of 10% of the total participants (n=246). Results94.3% of the NSPs completed the full training. 2208 patients (12.1% of the total screened) had depression and all 2208 (100%) agreed to receive the treatment. A total of 13,008 sessions were delivered with a 97.82% completion rate. We found substantial reduction in depressive symptom severity from baseline to immediate post-treatment [Cohens d=2.52; CI: 2.44 to 2.61], which was sustained at 9-month follow-up [Cohens d=.96, 95% CI: .81 to 1.11]. Lower baseline depression, male gender, longer treatment duration, and higher educational status of the ASHA predicted better treatment outcome at endline. Both ASHA and patients reported high levels of satisfaction. ConclusionThe scaling up of a brief evidence based psychological treatment by existing frontline workers through digital platforms for training and supervision is associated with both high levels of satisfaction, treatment completion and remission rates.