ObjectiveTo report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.Design and SettingThe Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications.Main outcome measuresWe examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPsParticipantsPsychiatric technicians and primary care providers trained in the EBPs.ResultsPRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment.ConclusionsThe future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.

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Context: Neuro-psychiatric disorders are the world's highest cause of incapacity. Mental disease in Africa is taboo and stigmatized, making it a challenge of a silent even hidden epidemy. In Sub-Saharan Africa it is estimated that 20% of patients with mental disorders are treated in primary health care centres and 50-75% are not detected in health facilities. In Mozambique, the prevalence of mental disorders and the frequency with which mental patients are treated at health facilities are not known. Objective: To estimate mental and neurologic disorders burden in Mozambique and evaluate access to mental health care services. Methods: A systematic review of research published in Portuguese, English, French and Spanish during 2017 and 2018 was carried out. We also consulted hospital and outpatient clinical files and yearly reports in the health units of national health system. Quantitative and mixed methods articles were subjected to quantitative meta-analysis and the qualitative and mixed methods articles were submitted to thematic and ethnographic analysis for qualitative meta-synthesis. Results: After selecting 130 articles meeting the search criteria we applied eligibility conditions and reviewed 17 quantitative, 6 mixed-methods and 7 qualitative articles. Population perception about mental illness shows that it is considered a consequence of spiritual problems and patients mainly seek out traditional health practitioners. Epilepsy, a neurologic disorder, is referred in Mozambique as the most prevalent mental disorder. The provision of care for the mentally ill by the national health service is far below the needs. The Mozambican Ministry of Health has a good development program for future mental health services. Discussion: We find scarcity of research in the area of mental health, but progress over time. Studies, though mostly of low quality, show a high burden of mental illness in the Mozambican population, which uses traditional medicine due to lack of conventional health services and cultural adaptation of therapeutic procedures. Conclusion: This study contributes to reveal the beliefs and main mental health problems in the Mozambican population and health system. We propose recommendations for preventive activities and the development of mental health services. This review was registered at www.crd.york.ac.uk/prospero (CRD42018103923).

Background: Hazardous drinking imposes a major public health burden worldwide, especially in low-income countries such as Mozambique. Implementation of the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach to address problem drinking is recommended. However, evidence regarding the best strategies to implement SBIRT at scale is needed.Methods: Guided by the Reach Effectiveness Adoption Implementation Maintenance model, the authors will conduct a 2-year, cluster-randomized, hybrid type-2 implementationeffectiveness trial in 12 districts in Mozambique evaluating implementation, clinical effectiveness, outcomes, and cost. Eight districts will be randomly assigned to a mobile applicationbased health SBIRT condition and four to SBIRT-Conventional Training and Supervision. Interventions will be delivered by clinic-based community health workers. The Consolidated Framework for Implementation Research will guide the authors' mixed-methods assessments throughout the study. Results:The study arm showing better cost-effectiveness will be scaled up in the other arms' districts. During this 12-month scale-up phase, Ministry of Health personnel will be charged with providing training, clinical activities, and supervision in all 12 districts without research team support. The SBIRT scale-up phase is critical to identify facilitators and barriers for tracking internal and external factors in clinics that continue using the superior arm and those that switch to it.Next steps: In a multistep process with stakeholders from multiple sectors, outcomes and lessons learned from this study will inform the development of an implementation tool kit to guide SBIRT scale-up of community services addressing hazardous drinking in other low-and middleincome countries and low-resource settings in highincome countries.