{"doi":"10.1016/j.jad.2020.12.123","title":"Effectiveness of a task-sharing collaborative care model for identification and management of depressive symptoms in patients with hypertension attending public sector primary care clinics in South Africa: pragmatic parallel cluster randomised controlled trial.","abstract":"BACKGROUND: We tested the real-world effectiveness of a collaborative task-sharing model on depressive symptom reduction in hypertensive Primary Health Care (PHC) patients in South Africa. METHOD: A pragmatic parallel cluster randomised trial in 20 clinics in the Dr Kenneth Kaunda district, North West province. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Control clinics received care as usual (CAU), involving referral to PHC doctors and/or mental health specialists. Intervention clinics received CAU plus enhanced mental health training and a lay counselling referral service. Participant inclusion criteria were ≥ 18 years old, Patient Health Questionnaire-9 (PHQ-9) score ≥ 9 and receiving hypertension medication. Primary superiority outcome was ≥ 50% reduction in PHQ-9 score at 6 months. Statistical analyses comprised mixed effects regression models and a non-inferiority analysis. TRIAL REGISTRATION NUMBER: NCT02425124. RESULTS: Between April 2015 and October 2015, 1043 participants were enrolled (504 intervention and 539 control); 82% were women; half were ≥ 55 years. At 6 and 12 months follow-up, 91% and 89% of participants were interviewed respectively. One control group participant committed suicide. There was no significant difference in the primary outcome between intervention (N=256/456) and control (N=232/492) groups (55.9% versus 50.9%; adjusted risk difference = -0.04 ([95% CI = -0.19; 0.11], p = 0.6). The difference in PHQ-9 scores was within the defined equivalence limits at 6 and 12 months for the non-inferiority analysis. LIMITATIONS: The trial was limited by low exposure to depression treatment by trial participants and by observed co-intervention in control clinics CONCLUSIONS: Incorporating lay counselling services within collaborative care models does not produce superior nor inferior outcomes to models with specialist only counselling services. FUNDING: This work was supported by the UK Department for International Development [201446] as well as the National Institute of Mental Health, United States of America, grant number 1R01MH100470-01. Graham Thornicroft is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College London and King's College Hospital NHS Foundation Trust.","journal":"Journal of Affective Disorders","year":2020,"id":94547,"datarank":1.0452996274524924,"base_score":3.6635616461296463,"endowment":3.6635616461296463,"self_citation_contribution":0.5495342469194471,"citation_network_contribution":0.49576538053304525,"self_endowment_contribution":0.5495342469194471,"citer_contribution":0.49576538053304525,"corpus_percentile":null,"corpus_rank":null,"citation_count":38,"citer_count":22,"citers_with_citation_signal":19,"citers_with_endowment":19,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.93,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02425124"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":377276,"name":"Lara Fairall","orcid":"0000-0002-7460-4670","position":1,"is_corresponding":false},{"id":471161,"name":"Babalwa Zani","orcid":"0000-0002-6452-0246","position":2,"is_corresponding":false},{"id":5054,"name":"Arvin Bhana","orcid":"0000-0003-4235-0108","position":3,"is_corresponding":false},{"id":445033,"name":"Carl Lombard","orcid":"0000-0002-2136-6533","position":4,"is_corresponding":false},{"id":471162,"name":"Naomi Folb","orcid":"0000-0002-2667-0956","position":5,"is_corresponding":false},{"id":471163,"name":"Oné Selohilwe","orcid":"0000-0002-2692-5605","position":6,"is_corresponding":false},{"id":471164,"name":"Daniella Georgeu-Pepper","orcid":"0000-0003-2745-7820","position":7,"is_corresponding":false},{"id":471165,"name":"Ruwayda Petrus","orcid":"0000-0002-0963-7812","position":8,"is_corresponding":false},{"id":471166,"name":"Ntokozo Mntambo","orcid":"0000-0002-3056-0944","position":9,"is_corresponding":false},{"id":471167,"name":"Tasneem Kathree","orcid":"0000-0002-8451-9197","position":10,"is_corresponding":false},{"id":471168,"name":"Max Bachmann","orcid":"0000-0003-1770-3506","position":11,"is_corresponding":false},{"id":39490,"name":"Naomi Levitt","orcid":"0000-0001-6480-8066","position":12,"is_corresponding":false},{"id":232314,"name":"Graham Thornicroft","orcid":"0000-0003-0662-0879","position":13,"is_corresponding":false},{"id":5093,"name":"Crick Lund","orcid":"0000-0002-5159-8220","position":14,"is_corresponding":false},{"id":6028,"name":"Inge Petersen","orcid":"0000-0002-3573-4229","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-18T22:33:00.770265Z","pmid":"33412490","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}