BACKGROUND: People living with HIV (PLHIV) bear a disproportionate burden of mental health conditions. Worldwide, PLHIV frequently encounter mental health challenges at an elevated rate compared to the general population. These mental health conditions can significantly affect adherence to HIV treatment and retention in care. To address this concern, we integrated a mental health screening initiative at the Anti-Retroviral Treatment (ART) center in Delhi. This approach involves collaboration between lay healthcare workers and clinicians, aiming to seamlessly integrate mental health services into the routine care provided at the ARTCs.
DESCRIPTION: This ongoing initiative involves systematically screening all adult PLHIV aged = 18 years during their routine visits. A screening protocol, following current national guidelines, was established, and the staff at the ART center received specialized training to screen and identify mental health conditions. The trained lay healthcare workers conducted initial screenings using a designated mental health screening tool, specifically Patient Health Questionnaire-2 (PHQ-2). Subsequently, individuals identified as positive for PHQ-2 underwent a comprehensive screening using PHQ-9. Those testing positive on PHQ-9 are referred to trained clinical mental health experts for further assessment, diagnosis, and treatment. Depending on the results, ART clients identified with mild disorders received counseling from ARTC counselors, those with moderate disorders were referred to psychologists for counseling, and individuals with moderate to severe disorders were linked with the Department of Psychiatry for initiation of treatment.
LESSONS LEARNED: During the initial three-month implementation phase (November-2023 to January-2024), healthcare staff at ARTC screened 1500 PLHIV for mental health. Among those screened, 11.7% (171/1500) identified positive on the PHQ-2 and underwent the PHQ-9 assessment. On the PHQ-9, 87.7% (150/171) were identified as likely to have mild to severe mental health conditions. Among these, 64.7% (97/150) individuals received individual counseling at the ARTC, while 35.3% (53/150) with suspected moderate to severe mental health condition were referred to psychiatrists for further evaluation and management.
CONCLUSIONS: Routine screening of PLHIV for mental health helps to proactively identify and manage PLHIV with co-morbidities. The integration of mental health services into HIV care through a task-sharing approach is a feasible strategy that could increase access to mental health services among PLHIV.