title: Integrating Mental Health and HIV Services in Zimbabwean Communities: A Nurse and Community-led Approach to Reach the Most Vulnerable.
abstract: Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptoms and 29% were positive for alcohol and substance abuse. Findings indicated that stepped-care was acceptable and feasible for all provider types.
authors.forename: Malia
authors.initials: M
authors.lastname: Duffy
authors.forename: Melissa
authors.initials: M
authors.lastname: Sharer
authors.forename: Helen
authors.initials: H
authors.lastname: Cornman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pearson
authors.forename: Heather
authors.initials: H
authors.lastname: Pitorak
authors.forename: Andrew
authors.initials: A
authors.lastname: Fullem
mesh_terms: D019973:Alcohol-Related Disorders / Q000628:therapy; D000488:Allied Health Personnel; D003150:Community Health Workers; D003159:Community-Institutional Relations; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D009726:Nurses; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D019966:Substance-Related Disorders / Q000628:therapy*; D000078329:Workforce; D015030:Zimbabwe
keywords: HIV; Zimbabwe; alcohol use; integration; mental health; stepped-care; substance use