Integration of Mental Health Services in HIV Care for Adolescents and Youth in Kenya

Project Summary/Abstract Common mental disorders like depression, anxiety and trauma disproportionately affect adolescents and youth with HIV (AYH), and are associated with antiretroviral treatment (ART) non-adherence and poor viral suppression. The integration of mental health services in HIV care for AYH is recommended. However, there

are gaps in integrated mental health assessments, care and referral to mental health specialists. Non-specialist providers form the bulk of providers in HIV clinics. In previous studies, they reported limited competence to comprehensively assess and manage mental disorders, heavy workloads and few mental health specialists in

the clinics. There is an urgent need for implementation strategies to support consistent assessments, treatment and an effective interface between the HIV clinic and mental health specialists. Regarding treatment for mental disorders within the HIV clinic, adaptation and evaluation of the treatments is required considering the unique

HIV care context before implementation work is relevant. In this project, we propose to develop, pilot and cost implementation strategies for integrating assessments and effective referrals for common mental conditions among AYH ages 15-24-years. Aim 1 will identify barriers and facilitators for integrated assessments and

successful referral of AYH in need to specialists. We will conduct focus group discussions with providers and AYH, and in-depth interviews with mental health specialists, HIV program and policy leaders in Kenya. Aim 2 will identify strategies that address barriers to the implementation of assessments for common mental

disorders, and successful referral for those in need to specialists. We will hold two stakeholder workshops with providers, mental health specialists, program leaders, AYHIV and their caregivers. They will validate barriers and conduct barrier prioritization using novel methods that allow stakeholder collaboration in assessing barrier

criticality, ubiquity, frequency and equity. Using implementation roadmaps, we will match strategies to prioritized barriers, specifying the causal chain from implementation strategy to implementation outcomes. Aim 3 will determine whether the strategies identified improve implementation of assessments and successful

referral to specialists for those in need. We will pilot two top-rated implementation strategies in 6 HIV clinics, and assess their effect on reach of the assessments and successful referral of AYH using an interrupted series design, fidelity of assessments and acceptability of the strategies. Further, we will conduct a time-driven,

activity-based micro-costing analysis to inform the scale-up of the implementation strategy by the HIV program, and assess contextual determinants of implementation with providers and AYHIV. This research matches with Dr. Mugo’s training goals to build competence in advanced implementation science methods, qualitative and

mixed methods, stakeholder engagement methods and economic evaluation, and skills in scientific leadership in order to transition to an independent research career that advances high quality mental health care for AYH.