HIV Insight: Integrating Mental Health and HIV Services in Zimbabwean Communities: A Nurse and Community-Led Approach to Reach the Most Vulnerable

Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptoms and 29% were positive for alcohol and substance abuse. Findings indicated that stepped-care was acceptable and feasible for all provider types.

...Provision of mental health services for PLWH is critical to provide appropriate, long-term care and support, and to improve HIV-related morbidity and mortality. To address the mental health needs of adolescent and pediatric populations living with HIV, the stepped-care approach outlined in our study should be adapted and extended to sites serving these groups. Methods to reach specific sub-populations of PLWH who are at an increased risk for mental health disorders and harmful alcohol and substance use, including pregnant and postpartum women and other key populations, with integrated services should be identified. Effective means to increase provider skills to screen for and address harmful alcohol and substance use should also be identified. Given the high rates of suicidal ideation in clients screening positive for mental health disorders, further research should also be conducted to identify high-risk periods for PLWH to experience suicidality and effective interventions to use prior to those points in time. Future research should also examine how mental health and HIV integration impact adherence to treatment, retention in care, and clinical outcomes, including CD4+ T cell count, viral load, and HIV disease progression.

Below: Integrated stepped-care model