Perceived barriers and opportunities for implementing integrated psychological intervention for depression in adolescents living with HIV in Tanzania

Abstract Background Adolescents living with Human Immunodeficiency Virus (HIV) have an increased risk of depression that may affect their adherence to antiretroviral therapy (ART) and, therefore, their treatment outcomes. Integrating mental health care in HIV care and treatment settings may help to improve access to comprehensive care. This remains a challenge in Tanzania and other countries with similar contexts. We, therefore, explored challenges to accessing mental health care and opportunities for implementing an integrated, evidence-based psychological intervention to manage adolescent depression in HIV care and treatment centers (HIV-CTC) in Dar es Salaam, Tanzania. Methods This cross-sectional study utilizing a qualitative design through a phenomenological approach was conducted among adolescents living with HIV, health care providers (HCP), and caregivers. Forty-five in-depth interviews were conducted in three HIV-CTC in Kinondoni Dar es salaam. Audio records were transcribed verbatim and analyzed with NVIVO computer software aided data analysis. Results We found a low level of mental health awareness to be a cross-cutting challenge among the caregivers, adolescents, and the HCPs, limiting access to mental healthcare and the quality of care received. Psychological health caregiving was challenged by mental disorders stigma, poor communication between adolescents and HCPs, limited knowledge and skills to manage depression among HCPs, and limited information on treatment coverage for mental disorders. Nevertheless, health system opportunities for integration were apparent. In each HIV-CTC, there were available counseling rooms, nurse counselors delivering HIV and adherence counseling, and well-organized youth clubs indicating a potential for utilizing the existing structures. In addition, positive attitudes about psychological interventions in all groups of participants provide further opportunities to provide mental health care. Conclusion Despite several modifiable barriers to accessing mental health care for adolescents living with HIV, there were evident opportunities for implementing an integrated, evidence-based psychological intervention to address depression in adolescents living with HIV in Kinondoni Dar es Salaam Tanzania.