Stakeholders’ perspectives on integrating the management of depression into routine HIV care in Uganda: qualitative findings from a feasibility study

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Date
2021Author
Rutakumwa, Rwamahe
Ssebunnya, Joshua
Mugisha, James
Mpango, Richard Steven
Tusiime, Christine
Kyohangirwe, Leticia
Taasi, Geoffrey
Sentongo, Hafsa
Kaleebu, Pontiano
Patel, Vikram
Kinyanda, Eugene
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Show full item recordAbstract
HIV/AIDS continues to be a major global public health problem with Eastern and Southern Africa
being the regions most affected. With increased access to effective antiretroviral therapy, HIV has become a chronic
and manageable disease, bringing to the fore issues of quality of life including mental wellbeing. Despite this, the
majority of HIV care providers in sub-Saharan Africa, including Uganda’s Ministry of Health, do not routinely provide
mental health care including depression management. The purpose of this paper is to explore stakeholders’ perspectives
on the feasibility and acceptability of integrating depression management into routine adult HIV care. The paper
addresses a specific objective of the formative phase of the HIV + D study aimed at developing and evaluating a
model for integrating depression management into routine HIV care in Uganda.
Methods: This was a qualitative study. Data were collected through in-depth interviews with 11 patients at enrollment
and follow-up in the pilot phase, and exit interviews with 11 adherent patients (those who completed their
psychotherapy sessions) and six non-adherent patients (those missing at least two sessions) at the end of the pilot
phase. Key informant interviews were held with four clinicians, five supervisors and one mental health specialist, as
were three focus group discussions with lay health workers. These were purposively sampled at four public health
facilities in Mpigi District. Data were analysed thematically.
Results: Patients highlighted the benefits of treating depression in the context of HIV care, including improved
adherence to antiretroviral therapy, overcoming sleeplessness and suicidal ideation, and regaining a sense of selfefficacy.
Although clinicians and other stakeholders reported benefits of treating depression, they cited challenges in
managing depression with HIV care, which were organisational (increased workload) and patient related (extended
waiting time and perceptions of preferential treatment). Stakeholders generally shared perspectives on how best to
integrate, including recommendations for organisational level interventions–training, harmonisation in scheduling
appointments and structural changes–and patient level interventions to enhance knowledge about depression. Conclusions: Integrating depression management into routine HIV care in Uganda is acceptable among key stakeholders,
but the technical and operational feasibility of integration would require changes both at the organisational
and patient levels.
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- Medical and Health Sciences [3670]