MENTAL HEALTH & HIV INTEGRATION

October 2016

Action and Organizational Buy-in

2010: MH and HIV Policy Brief

2011: HIV/MH Integration Case Study Vietnam

2012 HIV/MH Integration Case Study N Uganda

2013-2015 HIV/MH Pilot: Zimbabwe

2015-2016 MH Prioritization within JSI

Background: JSI and HIV and MH

Why now?

MH-GAP-2016

Gaps highlighted by presenters

Focus on Integration

Human resources gaps

Stigma from healthcare workers and community a REAL ISSUE.

Geneva Monday 10/10/2016 103 partners 18 WHO collaborating centers 40 member states 5 other UN agencies 250 total attendees

Ecological Frame

Macro/Policy: • The majority of countries allocate less

than 2% of health budgets to mental health4

• 76 - 85% of people with MH problems in LMIC, do not receive treatment³

Ecological Frame

Macro/Policy

Micro/Community: Depression affects > 350 million people globally PLHIV 2-10x’s more likely to experience depression¹

Ecological Frame

Macro/Policy

Micro/Community

Individual/PLHIV:

Prevalence of depression 72%²

Mental Health and HIV: The Missing Link?

↑ risk taking behaviors, ↑ ↓ self-care bx.

ART side effects can mimic depression symptoms Stress of managing chronic illness Stigma and Marginalization Depression and non-adherence = 6 fold mortality risk² Pregnant/post-partum, PLHIV in Option B+ experiencing drop off!!

¹ Endeshaw et al. 2014, ²Simoni et al. 2011

MH Gap in Zimbabwe

•Link between mental illness and traditional beliefs

•Dual stigma surrounding HIV and MH

•MH system uncoordinated with other health systems, poor infrastructure

•Recognition that services should be integrated

•Shortage of trained professionals

1 Chibanda et al. 2011; Patel et al. 1997; Ministry of Health and Child Welfare 2012.

Zimbabwe MH and HIV Pilot -lowest care level -stepped care -MOH leadership -feasible and acceptable

Simplified-The 3 Step Approach

WHO 2011

VT Domestic Simplified-3 Steps

WHO 2011

STEP 1: SCREEN

3. Wakambotanga nekumwa doro, kuputa kana kushandisa zvinodhaka uchangobva mukumuka mangwanani kuti unzwe zvakanaka kana kuti upedze bhabharasi? Have you ever had a drink or drug first thing in the morning to steady your nerves or get rid of a hangover (an "eye-opener")

Ehe Yes Aiwa No

Shona Symptom Questionnaire

STEP 1: SCREEN

The CAGE-AID Screen

STEP 1: SCREEN

•Mental Health Screens

–Wellness Recovery Action Plan (WRAP)¹ –Helps the client to identify symptoms when they are mentally healthy and when nearing a crisis –A collaborative process to build a toolkit of actions to take to maintain mental health and to prevent and address a crisis.

•Alcohol and Substance use Screens

–Readiness to Change Rulers

¹ Copeland, 2013

STEP 2: Brief Therapeutic Interventions

\ STEP 2: Brief Therapeutic Interventions

STEP 3: Refer

Achievements • Decreased MH stigma among health care providers

– 80% of respondents/trained staff (n=30) agreed that stigma was reduced in facilities following the training (pilot 1)

• Developed a referral system between levels of care, including traditional healers

– 100% of clients with positive SSQ were referred

• Standard Operating Procedures developed for integration at the national level

• MOHCW is committed and seeking funding to scale-up efforts

Challenges Addressing alcohol and substance use

Acceptance of referrals from Traditional Healers to sites outside of pilot study

Local funding limitations to scale-up

Other JSI MH Focus

Examining Mobile Technology for MH interventions among PLHIV

Integrating MH into ANC to examine Maternal and neonatal MH and clinical outcomes

Ethiopia SEUHP – MH Curricula for UHE-p

MH and perinatal women living with HIV

JSI Next Internal Steps

Test and Treat Gaps:

Focus on drop off in trx retention of positive women post birth

Maximize skills of existing staff Include MH in all proposals Promote MH at all

opportunities as it is critical for all PH programs

#MHIntegration

Global upcoming tools available:

Challenges:

• MH-GAP implementation guidance (2.0) will soon be available.

• Contextual adaptations

• Stigma-beliefs/attitudes of HW

• MH Gap Intervention Guide 2.0

• A CHW version of the IG guide

• Electronic IG guide via mobile app.

• Training and Operations Manual

• Global Action Plan for Dementia

• Community Suicide Action Plan

thank you