Feasibility of integrating mental health screening into youth HIV Care
in a Low-Middle Income Country Setting
Abstract
Introduction: Youth living with HIV (YLWH) experience higher
rates of mental illness than their peers. Holistic care for YLWH may
involve adopting mental health screening programs into comprehensive HIV
care to help identify and address mental health concerns in young
people. We explored various contexts, procedures, and safety measures
throughout the integration and maintenance of a mental health screening
program for adolescents attending an HIV referral clinic in Gaborone,
Botswana. Methods: Implementation goals included a safety goal
of 100% appropriate referral rate for emergency cases, and a screening
goal of 70% of the approximately 1100 adolescent and young adults who
were clients of the clinic at least once in the one year review period.
Frequent meetings with the behavioral health team and relevant clinic
staff were conducted to determine when, where and how to screen the
clients. Referral procedures and an emergency protocol for certain “red
flag” behaviors was developed to facilitate a warm handing off to
trained mental health professionals along with a backup for non-mental
health clinicians to assist in the absence of the PSS team. Every other
week severe score case reports were produced by the screening team to
prevent loss to follow up of suicidal ideation, hallucination or very
high scores. Mild to moderate cases were referred to clinicians trained
in brief intervention therapy. Results: Of the 846 clients
screened, 191 (19.2%) had severe scores. Eight (4.1%) of these 191
severe case scores were either not immediately reported, or were
inappropriately referred. Two of those eight had suicidal ideation and
were not immediately referred but were appropriately followed up after
being identified during bimonthly implementation team meetings.
Identifying a specific trained person tasked with facilitating the
screening was found to be most helpful. As was training the clinicians
in methods to respond to mild to moderate results, particularly during
unavailability of PSS team members. A clear and detailed protocol for
severe cases was also noted as a key element in keeping the screening
program safe. Conclusions: Establishing a universal screening
program in an LMIC is possible with the consideration of various
contextual factors.