This document discusses integrating mental health services into HIV care. It provides examples of JSI's work on mental health and HIV integration projects in Vietnam, Uganda, Zimbabwe, and internally. Key points include: - Mental health is underprioritized in many countries' health budgets. - Depression is more common among people living with HIV. - JSI piloted a simplified three-step approach to integration in Zimbabwe involving screening, brief interventions, and referral. - The pilot showed reduced stigma among healthcare workers and an effective referral system, though challenges remain in addressing substance use and accepting all referrals.

1. MENTALHEALTH&HIVINTEGRATION
October 2016
Action and Organizational Buy-in

2. 2010: MH
and HIV
Policy
Brief
2011:
HIV/MH
Integration
Case Study
Vietnam
2012 HIV/MH
Integration
Case Study N
Uganda
2013-2015
HIV/MH Pilot:
Zimbabwe
2015-2016
MH
Prioritization
within JSI
Background: JSI and HIV and MH

3. Why now?

4. MH-GAP-
2016
​Gaps highlighted by presenters
​ Focus on Integration
​ Human resources gaps
​ Stigma from healthcare workers and
community a REAL ISSUE.
Geneva Monday 10/10/2016
103 partners
18 WHO collaborating centers
40 member states
5 other UN agencies
250 total attendees

5. Ecological Frame
Macro/Policy:
• The majority of countries allocate less
than 2% of health budgets to mental
health4
• 76 - 85% of people with MH problems in
LMIC, do not receive treatment³

6. Ecological Frame
Macro/Policy
Micro/Community:
Depression affects > 350 million people globally
PLHIV 2-10x’s more likely to experience
depression¹

7. Ecological Frame
Macro/Policy
Micro/Community
Individual/PLHIV:
Prevalence of depression
72%²

8. Mental Health and HIV:The
Missing Link?
​↑ risk taking behaviors, ↑ ↓ self-care bx.
​ART side effects can mimic depression symptoms
​Stress of managing chronic illness
​Stigma and Marginalization
​Depression and non-adherence = 6 fold mortality risk²
​Pregnant/post-partum, PLHIV in Option B+
experiencing drop off!!
¹ Endeshaw et al. 2014, ²Simoni et al. 2011

9. MH Gap in Zimbabwe
•Link between mental illness and traditional beliefs
•Dual stigma surrounding HIV and MH
•MH system uncoordinated with other health
systems, poor infrastructure
•Recognition that services should be integrated
•Shortage of trained professionals
1 Chibanda et al. 2011; Patel et al. 1997; Ministry of Health and Child Welfare 2012.

10. Zimbabwe
MH and HIV
Pilot
-lowest care level
-stepped care
-MOH leadership
-feasible and
acceptable

11. Simplified-The 3 StepApproach
WHO 2011

12. VT Domestic Simplified-3 Steps
WHO 2011

13. STEP 1: SCREEN
3. Wakambotanga nekumwa doro, kuputa kana kushandisa zvinodhaka uchangobva
mukumuka mangwanani kuti unzwe zvakanaka kana kuti upedze bhabharasi?
Have you ever had a drink or drug first thing in the morning to steady your nerves or
get rid of a hangover (an "eye-opener")
Ehe Yes Aiwa No

14. Shona Symptom Questionnaire
STEP 1: SCREEN

15. The CAGE-AID Screen
STEP 1: SCREEN

16. •Mental Health Screens
–Wellness Recovery Action Plan (WRAP)¹
–Helps the client to identify symptoms when they are mentally
healthy and when nearing a crisis
–A collaborative process to build a toolkit of actions to take
to maintain mental health and to prevent and address a crisis.
•Alcohol and Substance use Screens
–Readiness to Change Rulers
¹ Copeland, 2013
STEP 2: Brief Therapeutic
Interventions

17. STEP 2: Brief Therapeutic
Interventions

18. STEP 3: Refer

19. Achievements
• Decreased MH stigma among health care providers
– 80% of respondents/trained staff (n=30) agreed that stigma was
reduced in facilities following the training (pilot 1)
• Developed a referral system between levels of care, including
traditional healers
– 100% of clients with positive SSQ were referred
• Standard Operating Procedures developed for integration at
the national level
• MOHCW is committed and seeking funding to scale-up efforts

20. Challenges
​Addressing alcohol and substance use
​Acceptance of referrals from Traditional Healers to sites
outside of pilot study
​Local funding limitations to scale-up

21. Other JSI MH Focus
​Examining Mobile Technology for MH interventions among
PLHIV
​Integrating MH into ANC to examine Maternal and neonatal
MH and clinical outcomes
​Ethiopia SEUHP – MH Curricula for UHE-p
​MH and perinatal women living with HIV

22. JSI Next
Internal Steps
 Test andTreat Gaps:
 Focus on drop off in trx retention
of positive women post birth
 Maximize skills of existing staff
 Include MH in all proposals
 Promote MH at all
opportunities as it is critical for
all PH programs
#MHIntegration

23. Global
upcoming
tools available:
​Challenges:
• MH-GAP implementation
guidance (2.0) will soon be
available.
• Contextual adaptations
• Stigma-beliefs/attitudes of
HW
• MH Gap Intervention Guide
2.0
• A CHW version of the IG
guide
• Electronic IG guide via
mobile app.
• Training and Operations
Manual
• Global Action Plan for
Dementia
• Community Suicide Action
Plan

24. thank you