Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts.

BACKGROUND: The South African National Mental Health Policy Framework and Strategic Plan 2013-2020 was adopted to address the country's substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. METHODS: Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. RESULTS: A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. CONCLUSIONS: Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.

Characteristics of Global Rapid Response Team Deployers and Deployment, United States, 2019-2022.

The Centers for Disease Control and Prevention's (CDC's) Global Rapid Response Team (GRRT) was created in 2015 to efficiently deploy multidisciplinary CDC experts outside the United States for public health emergencies. The COVID-19 pandemic dramatically increased the need for domestic public health responders. This study aimed to follow up on previously published data to describe the GRRT surge staffing model during the height of the COVID-19 response. We conducted descriptive analyses to assess GRRT deployment characteristics during April 1, 2019-March 31, 2022, and characteristics of responders rostered in 2021 and 2022. We analyzed data on response events, remote versus in-person work, and international versus domestic deployment location. We also examined the number of responders on call per month, language proficiency, and technical skills. During the study period, 1725 deployments were registered, accounting for 82 058 person-days deployed. Of all person-days deployed during the study period, 82% were related to COVID-19. Eighty-seven percent of all person-days deployed were domestic. Virtual deployments that were not in person accounted for 51% of deployments registered, yet these resulted in 67% of person-days deployed. The median deployment duration was 31 days. We found a median of 79 surge responders on call each month. Among 608 responders rostered in 2021 and 2022, 35% self-reported proficiency in a second language. Epidemiology was the most common technical skill (38%). GRRT transitioned to primarily remote, domestic deployments to support the COVID-19 pandemic response. The GRRT model demonstrates how response structure shifted to address the global health threat of a pandemic.

Test-to-Stay Implementation in 4 Pre-K-12 School Districts.

OBJECTIVES: Globally, coronavirus disease 2019 (COVID-19) has affected how children learn. We evaluated the impact of Test to Stay (TTS) on secondary and tertiary transmission of severe acute respiratory syndrome coronavirus 2 and potential impact on in-person learning in 4 school districts in the United States from September 13 to November 19, 2021. METHODS: Implementation of TTS varied across school districts. Data on index cases, school-based close contacts, TTS participation, and testing results were obtained from 4 school districts in diverse geographic regions. Descriptive statistics, secondary and tertiary attack risk, and a theoretical estimate of impact on in-person learning were calculated. RESULTS: Fifty-one schools in 4 school districts reported 374 coronavirus disease COVID-19 index cases and 2520 school-based close contacts eligible for TTS. The proportion participating in TTS ranged from 22% to 79%. By district, the secondary attack risk and tertiary attack risk among TTS participants ranged between 2.2% to 11.1% and 0% to 17.6%, respectively. Nine clusters were identified among secondary cases and 2 among tertiary cases. The theoretical maximum number of days of in-person learning saved by using TTS was 976 to 4650 days across jurisdictions. CONCLUSIONS: TTS preserves in-person learning. Decisions to participate in TTS may have been influenced by ease of access to testing, communication between schools and families, testing logistics, and school resources. Tertiary attack risk determination became more complicated when numbers of close contacts increased. Minimizing exposure through continued layered prevention strategies is imperative. To ensure adequate resources for TTS, community transmission levels should be considered.

Antimicrobial Resistance, Food Safety, and One Health: The Need for Convergence.

Antimicrobial resistance is a complex, multifaceted, urgent global health problem. There is increasing concern about the emergence of multidrug-resistant superbugs. These superbugs result in infections responsive to treatment with few if any currently available antimicrobial agents, reviving memories of the preantibiotic era and evoking concerns about a postantibiotic era. Use of antibiotics exerts selective pressure on pathogens as well as on commensal organisms that are part of the normal flora of humans, animals, and the environment; this favors the emergence of resistant strains and sometimes involves the food supply. Addressing this urgent threat requires implementation of a multifaceted strategy that has been articulated in the past few years; implementation will require sustained political will, investment in systems and research, and a One Health approach involving improved communication, cooperation, and collaboration among the many professional disciplines and organizations with important roles to play at the intersection of human, animal, and environmental health. Priorities include strengthened human and animal health surveillance and monitoring for resistant organisms, antimicrobial stewardship programs, infection-control programs, development and approval of new antimicrobial agents, research on innovative therapeutic approaches, development of rapid diagnostic tests and new vaccines, and educational programs that target professional groups and the public.