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"'I'm a Health Worker' - Abduaraman Gidi" made by IntraHealth International.

Malia Duffy, Melissa Sharer, Helen Cornman, Jennifer Pearson, Heather Pitorak, Andrew Fullem

Globally, mental health disorders, including harmful alcohol and substance use, are the leading causes of years lost to disability, accounting for up to 189 million disability-adjusted life years annually. Depression accounts for up to 50% of disability-adjusted life years caused by mental health disorders, while alcohol and substance use accounts for up to 10%. It is estimated that people living with HIV (PLWH) are more than twice as likely to experience a mental health disorder.

In Zimbabwe, with an adult HIV prevalence rate of 14.7%, mental health and HIV comorbidity rates are high. A recent study found that of 395 patients screening positive for a mental health problem, nearly 50% were also accessing services for an HIV-related issue. Alcohol and substance use is on the increase, which may indicate it being used as a coping mechanism to deal with stress surrounding an HIV diagnosis. High rates of alcohol use, depression, and anxiety in PLWH are known to influence self-care and risk-taking behaviors, exacerbating the risk of contracting other sexually transmitted infections. he evidence shows that PLWH who experience depression have numerous risks that impact their health. They are more likely to initiate antiretroviral therapy at lower CD41 T cell counts and higher viral loads, have decreased adherence and retention, and delayed viral suppression leading to accelerated progression toward AIDS and AIDS-related mortality, compared to those PLWH who are not depressed. 

Limited programmatic findings available in the literature have revealed promising results for mental health and HIV care integration in low-resource settings. However, a significant shortage of mental health professionals in many low-income settings contributes to a treatment gap of as much as 76% of people with mental health disorders who do not receive treatment. 

To decrease the mental health service gap and to effectively address mental health comorbidities in PLWH, innovative programs that effectively use multiple levels of community service providers— including nurses, community health workers, and traditional medicine practitioners—should be considered to integrate mental health and HIV services.

The authors hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. This paper describes a 11⁄2-year pilot study with three distinct phases that examined the acceptability and feasibility of an integrated mental health and HIV stepped-care approach in nurses (facility-based), community health workers, and traditional medicine practitioners (community-based) in nine diverse urban and rural communities across Zimbabwe.  

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