3 - (SYM 43) Multilevel Stakeholder Engagement to Design Sustainable Strategies for Implementation of Adolescent Depression Services Integrated Within Mozambican Primary Care Clinics

Background: Globally, psychiatric disorders are the largest contributor to the burden of disease in adolescents. However, most adolescents in low- and middle-income countries (LMIC), do not have access to treatment, and contextually appropriate strategies for delivering evidence-based care are needed to expand services to these areas. Working with local stakeholders, we co-designed a multilevel strategy for sustainable integration of adolescent depression services within primary care clinics of Maputo, Mozambique. 

Methods: We first conducted a qualitative investigation of implementation determinants with adolescents, caregivers, policymakers, mental health specialists, and primary care providers, guided by the Consolidated Framework for Implementation Research (CFIR). In a series of workshops with policymakers, providers, and NGO staff implementing adolescent primary healthcare, we used principles of Human Centered Design to select, prioritize, and specify strategies for implementing depression services for adolescents in primary care. Adaptation to the intervention (Group Interpersonal Therapy for Adolescents) was conducted iteratively throughout supervision of four therapy groups (N=22 adolescents; N= four providers).

Results: We identified determinants to implementation across all levels of the CFIR, 25% of which were unique to LMIC adolescent-specific services. We developed 42 potential strategies to target these determinants, of which 33 were prioritized as important and feasible and subsequently included in the final implementation plan. Modifications to the intervention included adapted methods for caregiver engagement and group composition; adaptations to core elements of the intervention were not required.

Conclusion: Findings from this study will inform scale-up of integrated adolescent mental health services in Mozambican primary care clinics and may serve as a model for efforts in other LMIC and low-resource settings.