Integration of Mental Health Services in HIV Care for Adolescents and Youth in Kenya - Project Summary/Abstract Common mental disorders like depression, anxiety and trauma disproportionately affect adolescents and youth with HIV (AYH), majority of whom reside in sub-Saharan Africa (SSA), and are associated with antiretroviral treatment (ART) non-adherence and poor viral suppression. However, there are gaps in integrated mental health assessments, care and referral to specialists. Developing countries have limited facilities and competence, and heavy workload to comprehensively assess and manage mental disorders, while siloed HIV care services in the United States have resulted in similar gaps in mental health service access. There is an urgent need for implementation strategies to support consistent assessments, treatment and an effective interface between the HIV clinic and mental health specialists. We propose to develop, pilot and cost implementation strategies for integrating assessments and effective referrals for common mental conditions among AYH ages 15-24 years. Aim 1 will identify barriers and facilitators for integrated assessments and successful referral of AYH in need to specialists. We will conduct focus group discussions with providers, AYH, mental health specialists and HIV program and policy leaders in Kenya. Aim 2 will identify strategies that address barriers to the implementation of assessments for common mental disorders, and successful referral for those in need to specialists. We will hold two stakeholder workshops with providers, mental health specialists, program leaders, AYHIV and their caregivers. They will validate barriers and conduct barrier prioritization using novel methods that allow stakeholder collaboration in assessing barrier criticality, ubiquity, and frequency. Using implementation roadmaps, we will match strategies to prioritized barriers, specifying the causal chain from implementation strategy to implementation outcomes. Aim 3 will determine whether the strategies identified improve implementation of assessments and successful referral to specialists for those in need. We will pilot top-rated implementation strategies in 6 HIV clinics, and assess their effect on reach of the assessments and successful referral of AYH using an interrupted series design, fidelity of assessments and acceptability of the strategies. We will conduct a time-driven, activity-based micro-costing analysis to inform the scale-up of the implementation strategy by the HIV program, and assess contextual determinants of implementation with providers and AYHIV. The significantly larger HIV burden among adolescents, especially those perinatally-infected, and the uniform HIV care system throughout the country makes Kenya the more appropriate place to develop and test the strategies, with the strategies adapted for US and other settings where similar mental health integration is required in HIV care. Dr. Mugo’s transition to independence will benefit the USA-Kenya research collaboration he is part of to generate evidence in the co-shared priority areas of HIV and mental health. He will be an important resource to students and early career researchers in Public Health, Psychology/ Psychiatry at UW as well as Kenyan academic institutions.
