Differential Engagement by Race/Ethnicity in Experimental Trials of Mental Health Treatment Interventions: A Systematic Review.

Objective: Research on mental health interventions, largely from observational studies, suggests that individuals who are Black, Indigenous, and People of Color (BIPOC) have lower treatment engagement than non-Latino Whites. This systematic review focuses on prospective, experimental treatment trials, which reduce variability in patient and intervention characteristics and some access barriers (eg, cost), to examine the association of race/ethnicity and engagement.Data Sources: A systematic search of PubMed and PsycINFO through May 2020 using terms covering mental health treatment, engagement, and race/ethnicity.Study Selection: US-based, English-language, prospective experimental (including quasi-experimental) trials of adults treated for DSM-defined mental disorders were included. Studies had to compare engagement (treatment initiation and retention, medication adherence) across 2 or more ethnoracial groups. Fifty-five of 2,520 articles met inclusion criteria.Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Collaboration bias-risk assessment tool were used to report study findings.Results: Twenty-nine articles (53%) reported significant ethnoracial engagement differences, of which 93% found lower engagement among BIPOC groups compared largely to non-Latino Whites. The proportion of significant findings was consistent across quality of studies, covariate adjustments, ethnoracial groups, disorders, treatments, and 4 engagement definitions. Reporting limitations were found in covariate analyses and disaggregation of results across specific ethnoracial groups.Conclusions: Prospective experimental treatment trials reveal consistently lower BIPOC engagement, suggesting persisting disparities despite standardized study designs. Future research should improve inclusion of understudied groups, examine covariates systematically, and follow uniform reporting and analytic practices to elucidate reasons for these disparities.

The implementation of safe abortion services in Ethiopia.

In 2005, a new criminal code was established to align Ethiopia's laws with its new Constitution. Following a period of intense activism and debate, abortion remained criminalized, but several significant exceptions were made, allowing for the expansion and integration of services within the public health system. The passage of the law and the establishment of technical guidelines each served as essential steps in determining the extent to which services were implemented. The integration of safe abortion services expanded the scope of practice for multiple cadres of healthcare providers, including emergency surgical officers, nurses, and health extension workers. The political will of the Ministry of Health, the research produced by the Ethiopian Society of Obstetricians and Gynecologists, and the expertise of nongovernmental organizations were essential to the implementation of services.

Implementing and expanding safe abortion care: An international comparative case study of six countries.

We conducted a comparative case study-based investigation of health sector strategies that were useful in expanding or establishing new abortion services. We selected geographically diverse countries from across the human development index if they had implemented new abortion laws, or changed interpretations of existing laws or policies, within the past 15 years (Colombia, Ethiopia, Ghana, Portugal, South Africa, and Uruguay). Factors facilitating the expansion of services include use of a public health frame, situating abortion as one component of a comprehensive reproductive health package, and including country-based health and women's rights organizations, medical and other professional societies, and international agencies and nongovernment organizations in the design and rollout of services. Task sharing and the use of techniques that do not require much infrastructure, such as manual vacuum aspiration and medical abortion, are important for rapid establishment of services, especially in low-resource settings. Political will emerged as the key factor in establishing or expanding access to safe abortion services.