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BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Human Immunodeficiency Virus | Research

Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers’ perspectives

Authors: Kathryn E. L. Grimes, Peter Vanes Ebasone, Anastase Dzudie, Denis Nash, Milton L Wainberg, Brian W. Pence, Clare Barrington, Eric Pefura, Marcel Yotebieng, Kathryn Anastos, Denis Nsame, Rogers Ajeh, Annereke Nyenti, Angela M. Parcesepe

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study’s objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon.

Methods

We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study.

Results

Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers’ ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon.

Conclusions

Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.
Appendix
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Literature
1.
Brandt R. The mental health of people living with HIV/AIDS in Africa: a systematic review. Afr J AIDS Res. 2009;8(2):123–33. PubMedCrossRef
2.
Bernard C, Dabis F, de Rekeneire N. Prevalence and factors associated with depression in people living with HIV in sub-saharan Africa: a systematic review and meta-analysis. PLoS ONE. 2017;12(8): e0181960.PubMedPubMedCentralCrossRef
3.
Wykowski J, Kemp CG, Velloza J, Rao D, Drain PK. Associations between anxiety and adherence to antiretroviral medications in low- and Middle-Income countries: a systematic review and Meta-analysis. AIDS Behav. 2019;23:2059–71.PubMedPubMedCentralCrossRef
4.
Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, et al. Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon. PLoS ONE. 2022;17(6): e0270042.PubMedPubMedCentralCrossRef
5.
Lang R, Hogan B, Zhu J, McArthur K, Lee J, Zandi P, et al. The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum. AIDS. 2023;37(2):259–69.PubMedCrossRef
6.
Mayston R, Frissa S, Tekola B, Hanlon C, Prince M, Fekadu A. Explanatory models of depression in sub-saharan Africa: synthesis of qualitative evidence. Soc Sci Med. 2020;246: 112760.PubMedPubMedCentralCrossRef
7.
Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-saharan Africa: a systematic review. AIDS Behav. 2012;16(8):2101–18.PubMedCrossRef
8.
Mayston R, Kinyanda E, Chishinga N, Prince M, Patel V. Mental Disorder and the outcome of HIV/AIDS in low-income and middle-income countries: a systematic review. AIDS. 2012;26(2):117–35.CrossRef
9.
Memiah P, Shumba C, Etienne-Mesubi M, Agbor S, Hossain MB, Komba P, et al. The effect of depressive symptoms and CD4 count on adherence to highly active antiretroviral therapy in sub-saharan Africa. J Int Assoc Provid AIDS Care. 2014;13(4):346–52.PubMedCrossRef
10.
Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Wainberg M, et al. Gender, Mental Health, and Entry Into Care with Advanced HIV among people living with HIV in Cameroon under a National treat all policy. AIDS Behav. 2021;25:4018–28.PubMedPubMedCentralCrossRef
11.
Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, et al. Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national treat all policy: a cross-sectional analysis. J Int AIDS Soc. 2021;24:e25842.PubMedPubMedCentralCrossRef
12.
Parcesepe AM, Mugglin C, Nalugoda F, Bernard C, Yunihastuti E, Althoff K, et al. Screening and management of mental health and substance use disorders in HIV treatment settings in low- and middle‐income countries within the global IeDEA consortium. J Int AIDS Soc. 2018;21:e25101.PubMedPubMedCentralCrossRef
13.
Parcesepe AM, Lancaster K, Edelman EJ, DeBoni R, Ross J, Atwoli L, et al. Substance use service availability in HIV treatment programs: data from the global IeDEA consortium, 2014–2015 and 2017. PLoS ONE. 2020;15(8): e0237772.PubMedPubMedCentralCrossRef
14.
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Worldwide Use of Mental Health Services for Anxiety, Mood, and Substance disorders: results from 17 countries in the WHO World Mental Health (WMH) surveys. Lancet. 2007;370(9590):841–50.PubMedPubMedCentralCrossRef
15.
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370:878–89.PubMedCrossRef
16.
Petersen I, Lund C, Stein DJ. Optimizing mental health services in low-income and middle-income countries. Curr Opin Psychiatry. 2011;24(4):318–23.PubMedCrossRef
17.
Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet. 2007;370:1164–74.PubMedCrossRef
18.
Kaaya S, Eustache E, Lapidos-Salaiz I, Musisi S, Psaros C, Wissow L. Grand challenges: improving HIV Treatment outcomes by integrating interventions for Co-morbid Mental illness. PLoS Med. 2013;10(5): e1001447.PubMedPubMedCentralCrossRef
19.
Remien RH, Patel V, Chibanda D, Abas MA. Integrating mental health into HIV prevention and care: a call to action. J Int AIDS Soc. 2021;24(S2): e25748.PubMedPubMedCentralCrossRef
20.
Parcesepe AM, Stockton M, Remch M, Wester CW, Bernard C, Ross J, et al. Availability of screening and treatment for common mental disorders in HIV clinic settings: data from the global International epidemiology databases to Evaluate AIDS (IeDEA) Consortium, 2016–2017 and 2020. J Int AIDS Soc. 2023;26(8): e26147.PubMedPubMedCentralCrossRef
21.
UNAIDS. Country Factsheets: Cameroon. 2021 .Available from: https://​www.​unaids.​org/​en/​regionscountries​/​countries/​cameroon . Cited 2022 Dec 8.
22.
Cameroon Population-based HIV Impact Assessment (CAMPHIA), Yaounde. 2017–2018: final report. Cameroon: Republic of Cameroon Ministry of Health, Division of Health Operations Research; 2020 Dec. pp. 1–291.
23.
Mama Fouda A, Hayatou A, Koulla-Shiro S, Kingue S, Matsezou J, Nzima Nzima V, Mfouapon Njouomshetku H, Ndougsa Etoundi G. Strategie Sectorielle de Santé 2016–2027. Yaoundé: Republic of Cameroon Ministry of Public Health; 2016 p. 1–200.
24.
Toguem M, Kumar M, Ndetei D, Njiengwe FE, Owiti F. A situational analysis of the mental health system of the West Region of Cameroon using the World Health Organization’s assessment instrument for mental health systems (WHO-AIMS). Int J Ment Health Syst. 2022;16:1–11.CrossRef
25.
Mulango ID, Atashili J, Gaynes BN, Njim T. Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon. BMC Psychiatry. 2018;18:66.PubMedPubMedCentralCrossRef
26.
Chammartin F, Dao Ostinelli CH, Anastos K, Jaquet A, Brazier E, Brown S, et al. International epidemiology databases to evaluate AIDS (IeDEA) in sub-saharan Africa, 2012–2019. BMJ Open. 2020;10: e035246.PubMedPubMedCentralCrossRef
27.
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for Qualitative Data Collection and Analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42:533–44.PubMedPubMedCentralCrossRef
28.
Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med 1982. 2022;292:114523.
29.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
30.
Campbell JL, Quincy C, Osserman J, Pedersen OK. Coding In-depth semistructured interviews: problems of unitization and intercoder reliability and agreement. Sociol Methods Res. 2013;42(3):294–320.CrossRef
31.
32.
Chaudoir SR, Dugan AG, Barr CH. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci. 2013;8(1): 22.PubMedPubMedCentralCrossRef
33.
Elliott J. The researcher as narrator: reflexivity in qualitative and quantitative research. In: Using narrative in Social Research: qualitative and quantitative approaches. London: SAGE Publications Ltd; 2005. p. 152–70.CrossRef
34.
35.
Oduguwa AO, Adedokun B, Omigbodun OO. Effect of a mental health training programme on Nigerian school pupils’ perceptions of mental illness. Child Adolesc Psychiatry Ment Health. 2017;11:19.PubMedPubMedCentralCrossRef
36.
Sow A, Van Dormael M, Criel B, Conde S, Dewez M, de Spiegelaere M. Stigmatisation de la maladie mentale par les étudiants en médecine en Guinée. Conakry Santé Publique. 2018;30(2):253–61.PubMedCrossRef
37.
Burns JK, Tomita A. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2015;50(6):867–77.PubMedCrossRef
38.
Pham TV, Koirala R, Wainberg ML, Kohrt BA. Reassessing the Mental Health Treatment gap: what happens if we include the impact of Traditional Healing on Mental Illness? Community Ment Health J. 2021;57(4):777–91.PubMedCrossRef
39.
Duffy M, Sharer M, Cornman H, Pearson J, Pitorak H, Fullem A. Integrating Mental Health and HIV services in Zimbabwean communities: a nurse and community-led Approach to Reach the most vulnerable. J Assoc Nurses AIDS Care. 2017;28(2):186–98.PubMedCrossRef
40.
Murray LK, Dorsey S, Skavenski S, Kasoma M, Imasiku M, Bolton P, et al. Identification, modification, and implementation of an evidence-based psychotherapy for children in a low-income country: the use of TF-CBT in Zambia. Int J Ment Health Syst. 2013;7: 24.PubMedPubMedCentralCrossRef
41.
Wang K, Link BG, Corrigan PW, Davidson L, Flanagan E. Perceived provider stigma as a predictor of mental health service users’ internalized stigma and disempowerment. Psychiatry Res. 2018;259:526–31.PubMedCrossRef
42.
Jenkins R, Kiima D, Njenga F, Okonji M, Kingora J, Kathuku D, et al. Integration of mental health into primary care in Kenya. World Psychiatry. 2010;9(2):118–20.PubMedPubMedCentralCrossRef
43.
Makanjuola V, Doku V, Jenkins R, Gureje O. Impact of a one-week intensive ‘training of trainers’ workshop for community health workers in south-west Nigeria. Ment Health Fam Med. 2012;9:33–8.PubMedPubMedCentral
44.
Corrigan PW. Strategic Stigma Change (SSC): five principles for Social Marketing campaigns to reduce Stigma. Psychiatr Serv. 2011;62(8):824–6.PubMedCrossRef
45.
Kohrt BA, Jordans MJD, Turner EL, Rai S, Gurung D, Dhakal M, et al. Collaboration with people with lived experience of Mental Illness to Reduce Stigma and improve primary care services. JAMA Netw Open. 2021;4(11):e2131475.PubMedPubMedCentralCrossRef
46.
Kaiser BN, Gurung D, Rai S, Bhardwaj A, Dhakal M, Cafaro CL, et al. Mechanisms of action for stigma reduction among primary care providers following social contact with service users and aspirational figures in Nepal: an explanatory qualitative design. Int J Ment Health Syst. 2022;16:37.PubMedPubMedCentralCrossRef
47.
Sow A, Van Dormael M, Criel B, de Spiegelaere M. Intégration de la santé mentale dans les centres de santé communautaires en Guinée Conakry. Santé Publique. 2019;31(2):305–13.PubMedCrossRef
48.
Nakimuli-Mpungu E, Musisi S, Smith CM, Isenburg MV, Akimana B, Shakarishvili A, et al. Mental health interventions for persons living with HIV in low‐ and middle‐income countries: a systematic review. J Int AIDS Soc. 2021;24(S2):e25722.PubMedPubMedCentralCrossRef
49.
Udedi M, Stockton MA, Kulisewa K, Hosseinipour MC, Gaynes BN, Mphonda SM, et al. Integrating depression management into HIV primary care in central Malawi: the implementation of a pilot capacity building program. BMC Health Serv Res. 2018;18:593.PubMedPubMedCentralCrossRef
50.
Chuah FLH, Haldane VE, Cervero-Liceras F, Ong SE, Sigfrid LA, Murphy G, et al. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy Plan. 2017;32(Suppl 4):iv27-47.PubMedPubMedCentralCrossRef
51.
Pence BW, Gaynes BN, Atashili J, O’Donnell JK, Kats D, Whetten K, et al. Feasibility, Safety, Acceptability, and preliminary efficacy of measurement-based Care Depression Treatment for HIV patients in Bamenda, Cameroon. AIDS Behav. 2014;18:1142–51.PubMedPubMedCentralCrossRef
52.
Gaynes BN, Pence BW, Atashili J, O’Donnell JK, Njamnshi AK, Tabenyang ME, et al. Changes in HIV outcomes following Depression Care in a Resource-Limited setting: results from a pilot study in Bamenda, Cameroon. PLoS ONE. 2015;10(10): e0140001.PubMedPubMedCentralCrossRef
53.
54.
Keynejad R, Spagnolo J, Thornicroft G. WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact. Evid Based Ment Health. 2021;24:124–30.PubMedPubMedCentralCrossRef
55.
Keynejad RC, Spagnolo J, Thornicroft G. Mental healthcare in primary and community-based settings: evidence beyond the WHO Mental Health Gap Action Programme (mhGAP) intervention guide. Evid Based Ment Health. 2022;0:1–7.CrossRef
56.
Gómez-Carrillo A, Lencucha R, Faregh N, Veissière S, Kirmayer LJ. Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice. BMJ Glob Health. 2020;5: e002689.PubMedPubMedCentralCrossRef
57.
Lovero KL, Basaraba C, Khan S, Suleman A, Mabunda D, Feliciano P, et al. Brief Screening Tool for stepped-Care Management of Mental and Substance Use disorders. Psychiatr Serv. 2021;72(8):891–7.PubMedPubMedCentralCrossRef
58.
Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-saharan Africa. Nature. 2015;528(7580):77–85.CrossRef
59.
Gwaikolo WS, Kohrt BA, Cooper JL. Health system preparedness for integration of mental health services in rural Liberia. BMC Health Serv Res. 2017;17:508.PubMedPubMedCentralCrossRef
60.
Passchier RV, Abas MA, Ebuenyi ID, Pariante CM. Effectiveness of depression interventions for people living with HIV in Sub-saharan Africa: a systematic review & meta-analysis of psychological & immunological outcomes. Brain Behav Immun. 2018;73:261–73.PubMedCrossRef
61.
Mason J. Qualitative researching. 2nd ed. London: SAGE Publications Ltd; 2002.
Metadata
Title
Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers’ perspectives
Authors
Kathryn E. L. Grimes
Peter Vanes Ebasone
Anastase Dzudie
Denis Nash
Milton L Wainberg
Brian W. Pence
Clare Barrington
Eric Pefura
Marcel Yotebieng
Kathryn Anastos
Denis Nsame
Rogers Ajeh
Annereke Nyenti
Angela M. Parcesepe
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-10775-w

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