Demonstration project of a lay counselor delivered trans-diagnostic mental health intervention for newly diagnosed HIV patients in Mozambique

ABSTRACT

Common mental disorders (CMDs) are associated with poor HIV outcomes in low- and middle-income countries. The present study implemented a psychological therapy delivered in routine HIV care and examined its effects on HIV outcomes in Mozambique. The Common Elements Treatment Approach (CETA) was integrated into routine HIV care in Sofala, Mozambique for all newly-diagnosed HIV+ patients with CMD symptoms. HIV treatment initiation and retention were compared to overall facility averages (those enrolled in CETA + those not enrolled). Of 250 patients screened, 59% (n = 148 met the criteria for CETA enrollment, and 92.6 (n = 137) enrolled in CETA. After four CETA visits, CMD symptoms decreased >50% and suicidal ideation decreased 100%. Patients enrolling in CETA had an antiretroviral therapy initiation rate of 97.1%, one-month retention of 69.2%, and three-month retention of 82.4%. Patients in the comparison group had one-month retention of 66.0% and three-month retention of 68.0%. CETA may be a promising approach to reduce symptoms of CMDs and improve HIV care cascade outcomes in areas with high HIV prevalence.

KEYWORDS:

• Mozambique
• mental health
• HIV
• task-shifting
• implementation

Acknowledgements

This work was supported by the Health Resources and Services Administration. BHW was supported by grant number K01MH110599 from the U.S. National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Government or the U.S. National Institutes of Health.

Contributions

BHW and VFJC conceived the idea and led the implementation of the study. AM supervised study implementation and data collection in health facilities with input from NM, BHW, VFJC, WH, CM, and SD. SD served as the lead CETA supervisor and expert. LH and WH helped with overall study coordination. WH conducted analyses under supervision of BHW and with input from VFJC, AM, LH, SD, KEF, and NM. WH wrote the first draft of the manuscript under the supervision of BHW and with input from VFJC, AM, VFJC, CM, LH, SD, KEF, and NM. All authors read the final manuscript and provided key scientific inputs.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institute of Mental Health: [grant number K01MH110599].