Integrating depression management into HIV primary care in central Malawi: the implementation of a pilot capacity building program.

Autor:	Udedi M; NCDs & Mental Health Unit, Ministry of Health, Ministry of Health, P. O. Box 30377 Capital City, Lilongwe 3, Malawi., Stockton MA; Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA. stocktonmelissa@gmail.com., Kulisewa K; Ministry of Health, Kamuzu Central Hospital and Bwaila Psychiatric Hospital, Private Bag, 149, Lilongwe, Malawi., Hosseinipour MC; University of North Carolina Project-Malawi, Tidziwe Centre, Private Bag, A-104, Lilongwe, Malawi.; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27516, USA., Gaynes BN; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27516, USA., Mphonda SM; University of North Carolina Project-Malawi, Tidziwe Centre, Private Bag, A-104, Lilongwe, Malawi., Mwagomba BM; Lighthouse Trust, Kamuzu Central Hospital, P.O. Box 106, Lilongwe, Malawi., Mazenga AC; Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence, Kamuzu Central Hospital, Private Bag, B-397, Lilongwe, Malawi., Pence BW; Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
Jazyk:	angličtina
Zdroj:	BMC health services research [BMC Health Serv Res] 2018 Jul 31; Vol. 18 (1), pp. 593. Date of Electronic Publication: 2018 Jul 31.
DOI:	10.1186/s12913-018-3388-z
Abstrakt:	Background: In Malawi, early retention in HIV care remains challenging. Depression is strongly associated with reduced anti-retroviral therapy (ART) adherence and viral suppression. Appropriate depression care for people initiating ART is likely to be supportive of early and continued engagement in the HIV care continuum. This paper aims to provide an overview of a task-shifting program that integrates depression screening and treatment into HIV care and the strategy used to evaluate this program, describes the implementation process, and discusses key challenges and lessons learned in the first phase of program implementation. Methods: We are implementing a program integrating depression screening and treatment into HIV care initiation at two clinics in Lilongwe District, Malawi. The program's effect on patients' depression and HIV outcomes will be evaluated using a multiple baseline pre-post study. In this manuscript, we draw from our experiences as program implementers and some of the quantitative data to describe the process of implementation and key lessons learned. Results: We successfully implemented the screening phase of this program at both clinics; 88.3 and 93.2% of newly diagnosed patients have been screened for depression at each clinic respectively. 25% of enrolled patients reported symptoms of mild-to-severe depression and only 6% reported symptoms of moderate-to-severe depression. Key lessons learned from the process show the importance of utilizing existing processes and infrastructure and focusing on iterative and collaborative learning. We continued to face challenges around establishing a sense of program ownership among providers, developing capacity to diagnose and manage depression, and ensuring the availability of appropriate medication. Our efforts to address these challenges provide insight into the technical and managerial support needed to prepare for, roll out, and sustain integrated models of mental health and HIV care. Conclusions: This activity demonstrates how a depression screening program can successfully be integrated into HIV care within the public health system in Malawi. While this program focuses on integrating depression management into HIV care, most of the lessons learned could apply to integration of mental health into any non-psychiatric specialist setting. Trial Registration: ClinicalTrials.gov ID [ NCT03555669 ]. Retrospectively registered on 13 June 2018.
Databáze:	MEDLINE
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