Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives.

BACKGROUND: Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS: We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS: Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS: Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.

Mindfulness, Mental Health and HIV Outcomes Among Female Sex Workers in the Dominican Republic and Tanzania.

We examined the relationship between mindfulness, mental health and HIV outcomes among female sex workers (FSW) from the Dominican Republic (DR) (n = 201) and Tanzania (n = 208) using cross-sectional survey and biologic data. We employed stratified multivariate linear and logistic regression. Depression was associated with lower odds of ART adherence in the DR (AOR 0.25, 95% CI: 0.08-0.78) and of viral suppression in Tanzania (AOR 0.49, 95% CI: 0.24-0.97). In both countries, mindfulness was associated with lower odds of moderate to severe depression (AOR 0.82, 95% CI: 0.76-0.88 for the DR; AOR 0.85, 95% CI: 0.77-0.95 for Tanzania). In the DR, mindfulness was associated with lower odds of anxiety (AOR 0.83, 95% CI: 0.77-0.89), lower HIV stigma (ß = - 0.28 per unit change, 95% CI: - 0.37 to - 0.19) and greater odds of viral suppression (AOR 1.09, 95% CI: 1.02-1.15). Findings demonstrate the potential of tailored mindfulness interventions to improve mental health and HIV outcomes among FSW.

RESUMEN: Examinamos la relación entre la atención plena, la salud mental y los resultados del VIH entre las trabajadoras sexuales (TRSX) de la República Dominicana (RD) (n = 201) y Tanzania (n = 208) utilizando una encuesta transversal y datos biológicos. Empleamos regresión lineal multivariada estratificada y regresión logística. La depresión se asoció con menores probabilidades de adherencia al terapia antiretroviral (TAR) en la República Dominicana (AOR 0.25, IC del 95%: 0.08­0.78) y de supresión viral en Tanzania (AOR 0.49, IC del 95%: 0.24­0.97). En ambos países, la atención plena se asoció con menores probabilidades de depresión moderada a grave (AOR 0.82, IC del 95%: 0.76­0.88 para la República Dominicana; AOR 0.85, IC del 95%: 0.77­0.95 para Tanzania). En la República Dominicana, la atención plena se asoció con menores probabilidades de ansiedad (AOR 0.83, IC del 95%: 0.77­0.89), menor estigma del VIH (ß = − 0.28 por unidad de cambio, IC del 95%: − 0.37 to − 0.19) y mayores probabilidades de supresión viral (AOR 1.09, 95% CI: 1.02­1.15). Los hallazgos demuestran el potencial de las intervenciones de atención plena para mejorar la salud mental y los resultados del VIH entre las TRSX.

Transnationalism and health: A systematic literature review on the use of transnationalism in the study of the health practices and behaviors of migrants.

Transnationalism explores social, economic and political processes that occur beyond national borders and has been widely used in migration studies. We conducted a systematic review to explore if and how transnationalism has been used to study migrants' health and what a transnational perspective contributes to understanding health practices and behaviors of transnational migrants. We identified 26 empirical studies published in peer-reviewed journals that included a transnational perspective to study migrants' health practices and behaviors. The studies describe the ways in which migrants travel back and forth between countries of destination to countries of origin to receive health care, for reasons related to cost, language, and perceptions of service quality. In addition, the use of services in countries of origin is related to processes of social class transformation and reclaiming of social rights. For those migrants who cannot travel, active participation in transnational networks is a crucial way to remotely access services through phone or email, and to acquire medical supplies and other health-related goods (traditional medicine, home remedies). We conclude with recommendations for future research in this area.

'HIV and work don't go together': Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic.

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n = 16) and transgender women (n = 5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.

Migration and HIV risk: life histories of Mexican-born men living with HIV in North Carolina.

Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina, a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early-life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV-prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health.

A qualitative exploration of individuals' motivators for seeking substance user treatment.

Substance abuse continues to greatly impact the US population. The purpose of this study is to improve understanding of the reasons why individuals seek substance user treatment. Qualitative interviews were conducted with 50 men (n = 25) and women (n = 25) across eight substance user treatment programs in Durham, North Carolina, in 2010. We identify six motivating themes regarding reasons for seeking treatment and explore how these themes vary by the participants' mode of entry into treatment. Findings provide a holistic understanding of how and why individuals come into treatment that can enhance the quality and impact of substance user services.