Opportunities and challenges to integrating mental health into HIV programs in a low- and middle-income country: insights from the Nigeria implementation science Alliance

BMC Health Services Research

Prosper Okonkwo¹  John Oko²  Ibrahim Gobir³  Bolanle Oyeledun⁴  Ijeoma Uchenna Itanyi⁵  Echezona E. Ezeanolue⁶  Babayemi Olakunde⁷  Ayodotun Olutola⁸  Theddeus Iheanacho⁹  Godfrey Woelk^1,10  Timothy Akinmurele^1,11  Andy Eyo^1,12  Obinna Oleribe^1,13  Hadiza Khamofu^1,14  Rachel Sturke^1,15  Dina Patel^1,16  Patrick Dakum^1,17  Gambo Aliyu^1,18  Isaac A. Adedeji^1,19  Muyiwa Aina^2,20  George Siberry^2,21  Gregory Aarons^2,22  Michael Obiefune^2,23  Muktar H. Aliyu^2,24 

[1]APIN Prevention Initiative, Abuja, Nigeria

[2]Catholic Caritas Foundation Nigeria, Abuja, Nigeria

[3]Center for Global Health Practice and Impact, Georgetown University, Washington, USA

[4]Center for Integrated Health Programs, Abuja, Nigeria

[5]Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria

[6]Department of Community Medicine, University of Nigeria, Enugu, Nigeria

[7]Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria

[8]Healthy Sunrise Foundation, Las Vegas, NV, USA

[9]Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria

[10]National Agency for Control of AIDS, Abuja, Nigeria

[11]Centre for Clinical Care and Clinical Research, Abuja, Nigeria

[12]Department of Psychiatry, Yale University School of Medicine, Yale University, 300 George Street, 06511, New Haven, CT, USA

[13]Elizabeth Glaser Pediatric AIDS Foundation, Washington, USA

[14]Enhanced Health Access Initiatives, Abuja, Nigeria

[15]Excellence Community Education Welfare Scheme, Abuja, Nigeria

[16]Excellence and Friends Management Consult, Abuja, Nigeria

[17]Family Health International, Abuja, Nigeria

[18]Fogarty International Center, National Institutes of Health, Bethesda, MD, USA

[19]Healthy Sunrise Foundation, Las Vegas, NV, USA

[20]Institute of Human Virology, University of Maryland, Baltimore, MD, USA

[21]Institute of Human Virology, Abuja, Nigeria

[22]National Agency for Control of AIDS, Abuja, Nigeria

[23]Olabisi Onabanjo University, Ago-Iwoye, Nigeria

[24]Solina Health, Abuja, Nigeria

[25]United States Agency for International Development, Washington, USA

[26]University of California San Diego, San Diego, CA, USA

[27]University of Maryland, Baltimore, MD, USA

[28]Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA

关键词: Mental health;    Nigeria;    Low and middle-income countries;    HIV;    Mental health policy;    Health services integration;   

DOI  :  10.1186/s12913-020-05750-0

来源: Springer

【 摘 要 】

BackgroundIn Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes.This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria.MethodAttendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis.ResultsThe two major theoretical themes from the study were – opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps).ConclusionsPotential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians’ training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.

【 授权许可】

CC BY