Mental Health Care Gaps for Adolescents With HIV: Lessons From Tanzania and the United States.

BACKGROUND: There is a global adolescent mental health (MH) crisis that is largely unaddressed. Adolescents and young adults living with HIV (AYALWH) have an increased risk of mental distress that is known to compromise antiretroviral therapy adherence, leading to worse HIV outcomes. This study was designed to evaluate the MH needs, access to MH services, and propose reciprocal innovation from Tanzania to the United States to address the MH gap for AYALWH. METHODS: The Patient Health Questionnaire-9 (PHQ-9) was administered to AYALWH aged 13 to 24 years attending an HIV clinic. A PHQ-9 score of at least 5 was seen as screening positive for depressive symptoms. PHQ-9 screening is standard of care in the United States; those enrolled in a peer-led, group-based intervention called Sauti ya Vijana (SYV: The Voice of Youth) responded to the PHQ-9 as part of a research trial. In-depth interviews were conducted with HIV providers across both contexts to evaluate access to MH care and to consider whether SYV can address unmet MH needs. A patient-centered access to health care framework was used for rapid analysis. RESULTS: Over 20% of AYALWH in both the US and Tanzanian cohorts reported depressive symptoms. Providers who care for AYALWH reported their unmet needs and similar barriers to accessing MH care. Isolation, not seeking treatment services, and lack of integrated clinical services were notable barriers in both settings. Peer-led interventions (such as SYV) are noted as attractive treatment strategies. CONCLUSION: Depressive symptoms are common among AYALWH with limited access to MH care. Innovative solutions from low-income settings should be considered globally, including higher-resourced areas.

Duke Scholars

Author Blandina Mmbaga Duke Global Health Institute

Author Dorothy Elizabeth Dow Pediatrics, Infectious Diseases

Author Joy Noel Baumgartner Duke Global Health Institute