Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effectiveness of Technology Assisted Cascade Training and Supervision of Community Health Workers in Delivering Thinking Healthy Program for Perinatal Depression in a Post-conflict Area of Pakistan- Protocol of a Randomized Controlled Trial
Brief Summary: The Thinking Healthy Program is evidence based psychological intervention, delivered by non-specialists, with proven impact on maternal depression. A major challenge in the scale-up of this intervention, especially where health systems are weak, is providing quality training and supervision at scale. Women living in post-conflict areas are at a higher risk of depression than the general population.The key innovation proposed is the development and evaluation of a technology-assisted cascade training and supervision system to assist scale-up of the Thinking Healthy Programme in a post conflict area of Pakistan.


Options:
A: Inclusion Criteria:

Clinics

* Twenty (20) largest clinics providing chronic care Patients
* Receiving hypertensive treatment at time of enrolment
* Depressive symptoms as indicated by total score of 9 or more on PHQ-9
* Planning to reside in area for the next year
* Capable of actively engaging in interviewer-administered questionnaire at time of recruitment, 6 months and 12 months later
* Written consent to participate in the study

Exclusion Criteria:

Clinics

* Clinics that do not provide Integrated Chronic Disease Management
* Small (\<10 000 attendances/ year)
* Mobile or satellite
* Participated in piloting of intervention \& data collection. Patients
* Inability to meet the above inclusion criteria
B: Inclusion Criteria:

* Age ≥35 years
* Confirmed diagnosis of diabetes (documented glucose tolerance test or 2 venous glucose levels)
* PHQ-9 score≥10
* ≥1 poorly-controlled CVD risk factor (either HbA1c≥8.0% or SBP≥140 mmHg or LDL≥130 mg/dl), irrespective of medications used
* Willingness to consent to randomization.

Exclusion Criteria:

* The patient reports a "3" on the PHQ-9 questionnaire suicide item (Item No:9) which reflects very high suicide risk or the patient's PHQ-9 score is above 23 indicating severe depression requiring immediate referral
* Any participant reporting a "2" on the PHQ-9 suicide item (Item No:9) will be reviewed carefully and if considered too high risk, the participant will be excluded from enrollment in the trial and referred for more intensive psychiatric care.
* Already in psychiatrist's care or using antipsychotic or mood stabilizer medication or diagnosed dementia or bipolar disorder or schizophrenia (based on bipolar and schizophrenia modules of the MINI)
* Diabetes secondary to uncommon causes (e.g., chronic pancreatitis)
* Pregnancy or breastfeeding
* Documented CVD event (MI, stroke) in past 12 months
* End-stage renal disease awaiting transplant
* Malignancy or life-threatening disease with death probable in 3 years
* Alcohol or drug abuse
* No fixed address or contact details.
C: Inclusion Criteria:

* Lady health workers currently working in Swat district

Exclusion Criteria:

* Physically unwell, lady health workers on leave
D: Inclusion Criteria:

Clinics:

1) 40 nurse-led primary care clinics providing ART in the Dr Kenneth Kaunda and Bojonala districts of the North West Province, South Africa

Patients:

1. Age ≥ 18 years and
2. Receiving ART at the time of enrollment and
3. Depressive symptoms, as indicated by a total score of 9 or more on the PHQ-9 and
4. Planning to reside in the area for the next year and
5. Capable of actively engaging in an interviewer-administered questionnaire at the time of recruitment, six and twelve months later and
6. Written consent to participate in the study

Exclusion Criteria:

Clinics:

1) Clinics which participate in the formative research and piloting of the intervention

Patients:

1) Inability to meet the above inclusion criteria

Answer: C