Integrating depression management into HIV primary care in central Malawi: the implementation of a pilot capacity building program

• Published in: BMC health services research 2018-07, Vol.18 (1), p.593-593, Article 593
• Main Authors: Udedi, Michael, Stockton, Melissa A, Kulisewa, Kazione, Hosseinipour, Mina C, Gaynes, Bradley N, Mphonda, Steven M, Mwagomba, Beatrice Matanje, Mazenga, Alick C, Pence, Brian W
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antidepressants; Capacity Building; Care and treatment; Community health care; Delivery of Health Care - methods; Depression; Depression (Mood disorder); Depressive Disorder - diagnosis; Depressive Disorder - therapy; Early Diagnosis; Feasibility Studies; Health facilities; Health services; Health services administration; HIV; HIV Infections - drug therapy; HIV Infections - psychology; HIV patients; HIV/AIDS; Human immunodeficiency virus; Humans; Integration; Malawi; Management; Medical screening; Medication Adherence; Mental depression; Mental disorders; Mental health; Mental health services; Methods; Objectives; Pilot Projects; Primary care; Primary health care; Primary Health Care - methods; Psychological aspects; Public Health; Retrospective Studies; Risk factors; Site selection; Sub-Saharan Africa; Workers
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3388-z

In Malawi, early retention in HIV care remains challenging. Depression is strongly associated with reduced anti-retroviral therapy (ART) adherence and viral suppression. Appropriate depression care for people initiating ART is likely to be supportive of early and continued engagement in the HIV care continuum. This paper aims to provide an overview of a task-shifting program that integrates depression screening and treatment into HIV care and the strategy used to evaluate this program, describes the implementation process, and discusses key challenges and lessons learned in the first phase of program implementation. We are implementing a program integrating depression screening and treatment into HIV care initiation at two clinics in Lilongwe District, Malawi. The program's effect on patients' depression and HIV outcomes will be evaluated using a multiple baseline pre-post study. In this manuscript, we draw from our experiences as program implementers and some of the quantitative data to describe the process of implementation and key lessons learned. We successfully implemented the screening phase of this program at both clinics; 88.3 and 93.2% of newly diagnosed patients have been screened for depression at each clinic respectively. 25% of enrolled patients reported symptoms of mild-to-severe depression and only 6% reported symptoms of moderate-to-severe depression. Key lessons learned from the process show the importance of utilizing existing processes and infrastructure and focusing on iterative and collaborative learning. We continued to face challenges around establishing a sense of program ownership among providers, developing capacity to diagnose and manage depression, and ensuring the availability of appropriate medication. Our efforts to address these challenges provide insight into the technical and managerial support needed to prepare for, roll out, and sustain integrated models of mental health and HIV care. This activity demonstrates how a depression screening program can successfully be integrated into HIV care within the public health system in Malawi. While this program focuses on integrating depression management into HIV care, most of the lessons learned could apply to integration of mental health into any non-psychiatric specialist setting. ClinicalTrials.gov ID [ NCT03555669 ]. Retrospectively registered on 13 June 2018.