mental health & hiv integration - melissa sharer and malia duffy
TRANSCRIPT
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