***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Growing evidence supports the use of Western therapies for the treatment of depression , trauma , and stress delivered by community health workers ( CHWs ) in conflict-affected , re source -limited countries . A recent r and omized controlled trial ( Bolton et al. 2014a ) supported the efficacy of two CHW-delivered interventions , cognitive processing therapy ( CPT ) and brief behavioral activation treatment for depression ( BATD ) , for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq . Methods . This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial ( Bolton et al. 2014a ) , informed by the Assessment –Decision – Administration-Production – Topical experts – Integration – Training – Testing ( ADAPT – ITT ) framework for intervention adaptation ( Wingood & DiClemente , 2008 ) . Cultural modifications , adaptations for low-literacy , and tailored training and supervision for non-specialist CHWs are presented , along with two clinical case examples to illustrate delivery of the adapted intervention in this setting . Results . Eleven CHWs , a study psychiatrist , and the CHW clinical supervisor were trained in BATD . The adaptation process followed the ADAPT – ITT framework and was iterative with significant input from the on-site supervisor and CHWs . Modifications were made to fit Kurdish culture , including culturally relevant analogies , use of stickers for behavior monitoring , cultural modifications to behavioral contracts , and including telephone-delivered sessions to enhance feasibility . Conclusions . BATD was delivered by CHWs in a re source -poor , conflict-affected area in Kurdistan , Iraq , with some important modifications , including low-literacy adaptations , increased cultural relevancy of clinical material s , and tailored training and supervision for CHWs . Barriers to implementation , lessons learned , and recommendations for future efforts to adapt behavioral therapies for re source -limited , conflict-affected areas are discussed Background — Evidence on economically efficient strategies to lower  blood pressure ( BP )  from low- and middle-income countries remains scarce . The Control of Blood Pressure and Risk Attenuation ( COBRA ) trial r and omized 1341 hypertensive subjects in 12 r and omly selected communities in Karachi , Pakistan , to 3 intervention programs : ( 1 ) combined home health education ( HHE ) plus trained general practitioner ( GP ) ; ( 2 ) HHE only ; and ( 3 ) trained GP only . The comparator was no intervention ( or usual care ) . The reduction in BP was most pronounced in the combined group . The present study examined the cost-effectiveness of these strategies . Methods and Results — Total costs were assessed at baseline and 2 years to estimate incremental cost-effectiveness ratios based on ( 1 ) intervention cost ; ( 2 ) cost of physician consultation , medications , diagnostics , changes in lifestyle , and productivity loss ; and ( 3 ) change in systolic BP . Precision of the incremental cost-effectiveness ratio estimates was assessed by 1000 bootstrapping replications . Bayesian probabilistic sensitivity analysis was also performed . The annual costs per participant associated with the combined HHE plus trained GP , HHE alone , and trained GP alone were $ 3.99 , $ 3.34 , and $ 0.65 , respectively . HHE plus trained GP was the most cost-effective intervention , with an incremental cost-effectiveness ratio of $ 23 ( 95 confidence interval , 6–99 ) per mm Hg reduction in systolic BP compared with usual care , and remained so in 97.7 of 1000 bootstrapped replications . Conclusions — The combined intervention of HHE plus trained GP is potentially affordable and more cost-effective for BP control than usual care or either strategy alone in some communities in Pakistan , and possibly other countries in Indochina with similar healthcare infrastructure . Clinical Trial Registration — http://www . clinical trials.gov . Unique identifier : NCT00327574 Background There is limited evidence that interventions for depression and other common mental disorders ( CMD ) can be integrated sustainably into primary health care in Africa . We aim ed to pilot a low-cost multi-component ' Friendship Bench Intervention ' for CMD , locally adapted from problem-solving therapy and delivered by trained and supervised female lay workers to learn if was feasible and possibly effective as well as how best to implement it on a larger scale . Method We trained lay workers for 8 days in screening and monitoring CMD and in delivering the intervention . Ten lay workers screened consecutive adult attenders who either were referred or self-referred to the Friendship Bench between July and December 2007 . Those scoring above the vali date d cut-point of the Shona Symptom Question naire ( SSQ ) for CMD were potentially eligible . Exclusions were suicide risk or very severe depression . All others were offered 6 sessions of problem-solving therapy ( PST ) enhanced with a component of activity scheduling . Weekly nurse-led group supervision and monthly supervision from a mental health specialist were provided . Data on SSQ scores at 6 weeks after entering the study were collected by an independent research nurse . Lay workers completed a brief evaluation on their experiences of delivering the intervention . Results Of 395 potentially eligible , 33 ( 8 % ) were excluded due to high risk . Of the 362 left , 2 % ( 7 ) declined and 10 % ( 35 ) were lost to follow-up leaving an 88 % response rate ( n = 320 ) . Over half ( n = 166 , 52 % ) had presented with an HIV-related problem . Mean SSQ score fell from 11.3 ( sd 1.4 ) before treatment to 6.5 ( sd 2.4 ) after 3 - 6 sessions . The drop in SSQ scores was proportional to the number of sessions attended . Nine of the ten lay workers rated themselves as very able to deliver the PST intervention . Conclusion We have found preliminary evidence of a clinical ly meaningful improvement in CMD associated with locally adapted problem-solving therapy delivered by lay health workers through routine primary health care in an African setting . There is a need to test the effectiveness of this task-shifting mental health intervention in an appropriately powered r and omised controlled trial . Trial registration IS RCT N : IS RCT Traumatic stress due to conflict and war causes major mental health problems in many re source -poor countries . The objective of this study was to examine whether trained lay counselors can carry out effective treatment of  posttraumatic stress disorder ( PTSD )  in a refugee settlement . In a r and omized controlled dissemination trial in Ug and a with 277 Rw and an and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors . Strictly manualized narrative exposure therapy ( NET ) was compared with more flexible trauma counseling ( TC ) and a no-treatment monitoring group ( MG ) . Fewer participants ( 4 % ) dropped out of NET treatment than TC ( 21 % ) . Both active treatment groups were statistically and clinical ly superior to MG on PTSD symptoms and physical health but did not differ from each other . At follow-up , a PTSD diagnosis could not be established anymore in 70 % of NET and 65 % TC participants , whereas only 37 % in MG did not meet PTSD criteria anymore . Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement Background Despite harmful drinking causing a significant burden on global health , there is a large treatment gap , especially in low‐ and middle‐income countries . A major barrier to care is the lack of adequately skilled human re sources to deliver context ually appropriate treatments . This paper describes the systematic process used to develop Counselling for Alcohol Problems ( CAP ) , a brief psychological treatment ( PT ) for delivery by lay counselors in routine primary care setting s to men with harmful drinking in India . Methods CAP was developed using a methodology involving 3 sequential steps : ( i ) identifying potential treatment strategies ; ( ii ) developing a theoretical framework for the treatment ; and ( iii ) evaluating the acceptability and feasibility of the treatment . Results CAP is a 3‐phase treatment delivered over 1 to 4 sessions based on a motivational interviewing ( MI ) stance and involves the following strategies : assessment and personalized feedback , family engagement , drink refusal skills , skills to address drinking urges , problem‐solving skills and h and ling difficult emotions , and relapse prevention and management . Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment , for example expansion of the target group to include alcohol‐dependent patients and the extension of the delivery setting s to include home‐based delivery . There was preliminary evidence of the effectiveness of CAP . Conclusions CAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a r and omized controlled trial based in primary care in Goa , India OBJECTIVE To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-re source setting s. METHODS Two geographically distant regions in two countries ( China and Nigeria ) were selected and 10 pairs of primary care facilities in each region were r and omly selected and matched . Regions were then r and omly assigned to a control group , which received usual care , or to an intervention group , which applied the cardiovascular risk management package . Each facility enrolled 60 consecutive patients with hypertension . Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event , according to a st and ardized treatment algorithm . Systolic blood pressure change from baseline to 12 months was the primary outcome measure . FINDINGS The study included 2397 patients with baseline hypertension : 1191 in 20 intervention facilities and 1206 in 20 control facilities .  Systolic and diastolic blood pressure decreased more in intervention patients than in controls . However , at 12 months more than half of patients still had uncontrolled hypertension ( systolic blood pressure > 140 mmHg and /or diastolic blood pressure > 90 mmHg ) . Behavioural risk factors had improved among intervention patients in Nigeria but not in China . Only about 2 % of hypertensive patients required referral to the next level of care . CONCLUSION Even in low-re source setting s , hypertensive patients can be effectively assessed and managed in primary care facilities Background The Healthy Activity Programme ( HAP ) , a brief behavioural intervention delivered by lay counsellors , enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural setting s in India . We evaluated the sustainability of the effects after treatment termination , the cost-effectiveness of HAP over 12 months , and the effects of the hypothesized mediator of activation on clinical outcomes . Methods and findings Primary care attendees aged 18–65 years screened with moderately severe to severe depression on the Patient Health Question naire 9 ( PHQ-9 ) were r and omised to either  HAP plus enhanced usual care ( EUC ) ( n = 247 ) or EUC alone ( n = 248 ) , of whom 95 % completed assessment s at 3 months , and 91 % at 12 months . Primary outcomes were severity on the Beck Depression Inventory – II ( BDI-II ) and remission on the PHQ-9 .  HAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up ( difference in mean BDI-II score between 3 and 12 months = −0.34 ; 95 % CI −2.37 , 1.69 ; p = 0.74 ) , with lower symptom severity scores than participants who received EUC alone ( adjusted mean difference in BDI-II score = −4.45 ; 95 % CI −7.26 , −1.63 ; p = 0.002 ) and higher rates of remission ( adjusted prevalence ratio [ aPR ] = 1.36 ; 95 % CI 1.15 , 1.61 ; p < 0.009 ) . They also fared better on most secondary outcomes , including recovery ( aPR = 1.98 ; 95 % CI 1.29 , 3.03 ; p = 0.002 ) , any response over time ( aPR = 1.45 ; 95 % CI 1.27 , 1.66 ; p < 0.001 ) , higher likelihood of reporting a minimal clinical ly important difference ( aPR = 1.42 ; 95 % CI 1.17 , 1.71 ; p < 0.001 ) , and lower likelihood of reporting suicidal behaviour ( aPR = 0.71 ; 95 % CI 0.51 , 1.01 ; p = 0.06 ) . HAP plus EUC also had a marginal effect on WHO Disability Assessment Schedule score at 12 months ( aPR = −1.58 ; 95 % CI −3.33 , 0.17 ; p = 0.08 ) ; other outcomes ( days unable to work , intimate partner violence toward females ) did not statistically significantly differ between the two arms . Economic analyses indicated that HAP plus EUC was dominant over EUC alone , with lower costs and better outcomes ; uncertainty analysis showed that from this health system perspective there was a 95 % chance of HAP being cost-effective , given a willingness to pay threshold of Intl$16,060—equivalent to GDP per capita in Goa — per quality -adjusted life year gained . Patient-reported behavioural activation level at 3 months mediated the effect of the HAP intervention on the 12-month depression score ( β = −2.62 ; 95 % CI −3.28 , 
    Output:
    
Conclusions and Relevance Although the health system barriers to NPHW screening , treatment , and control of NCDs and their risk factors are numerous and complex , a diverse set of care models has demonstrated strategies to address nearly all of these challenges .