Led by CIDRZ CEO, Dr. Izukanji Sikazwe, MH-CBT will address a critical barrier to scaling up mental health treatment in Zambia – the lack of local experts to train the existing workforce. The CIDRZ team, in partnership with JHU (led by Dr. Laura Murray) and education experts at Education Development Center (EDC) have developed a technology application that may more quickly allow MOH to ramp up the number of counsellors trained in evidence-based mental health treatments. Over 5 years, CIDRZ will both develop this innovative technology and then evaluate its effect in a randomized controlled trial.

The study has so far trained 8 counselors to become trainers in both face-to-face training and Technology-based training. Throughout the course of the study,160 counselors from various organizations that provide mental health services in Lusaka will be trained in a counseling approach known as Common Elements Treatment Approach (CETA), see more Here. The counselors will then provide counseling to approximately 1,600 adolescents and young adults living in various communities around Lusaka that have mental health problems.

Pilot Phase (Ensuring Quality in Psychosocial Support - Equip)

With additional funding from the World Health Organization, a pilot phase to the mental health Cognitive Behavioral Therapy (CBT) study is being implemented to develop and validate the competency tools that will be used to measure counselor competency. The first phase of the pilot involved adaptation, translation, and piloting of competency measures. Counselors have been trained on how to carry out competency ratings using the Enhancing Assessment of Common Therapeutic Factors tool (ENACT) developed by the World Health Organization. Inter-rater reliability trainings (final inter-rater reliability score > 0.8) have been conducted among the counselors responsible for rating the competency of the newly trained counselors. Forty-four counselors, some expert level providers and some lay providers, were recruited and trained in CETA. The ENACT tool was used to gather competency data from the counselors before their training, and at two other time points after their training.

The training utilized both face-to-face instruction and piloted the mobile application which will be used to train counselors using the technology strategy.

Qualitative data was collected to validate and ensure feasibility and acceptability of the competency tools. Feedback on the technology-based training was also collected which has helped to further improve the mobile application.

Led by CIDRZ Behavioral and Social Science Lead Dr. Anjali Sharma and with clinical input from HIV expert Dr. Michael Vinikoor, ZCAP focuses on the treatment of unhealthy alcohol use among persons living with HIV in Zambia. According to MOH, persons living with HIV who drink heavy amounts of alcohol are 25% less likely to navigate the HIV care cascade and achieve viral suppression with ARVs. Therefore, identifying and reducing unhealthy alcohol use within the HIV program will help to achieve the ‘last mile’ in HIV epidemic control. Unfortunately, most front-line health workers have not been trained or given the tools to adequately address these issues outside of certain specialized centers like Chainama Hills Hospital in Lusaka.

In ZCAP, CIDRZ trained 15 lay counsellors at Matero and Kanyama Level 1 Hospitals in the Common Elements Treatment Approach (CETA), a treatment developed by JHU and that was previously shown to be effective in Zambia and several other countries. The training involved 2 weeks in the classroom followed by 3 months of supervision in the facility. CETA is intensive, requiring multiple counselling sessions over several months. Therefore, the ZCAP team also developed and trained counsellors in a Brief Intervention (BI), which takes just ~30 minutes to deliver. Both CETA and the BI are now being pilot tested in a small clinical trial with 162 participants living with HIV.

The response to these new counselling approaches from patients and the staff has been strongly positive. To date, 91% of the patients referred to CETA have completed it, which is a major accomplishment. On 20th February 2020, the trained counsellors graduated from the program and are now certified CETA counsellors. This contributes directly to local capacity to treat various mental health problems in Zambia. About ZCAP, the Matero ART In-charge Nurse commented, “We are really glad that CIDRZ brought CETA to the ART clinic. We have seen a substantial improvement in retention and adherence to ARVs since the program started. We would want this program to continue and believe it will help us achieve the national 90:90:90 goals.”