Tabitha Nyawira Gitahi
|Dr. Nyawira Gitahi
|Prof. E. Bukusi
|Prof. L. Atwoli
The overall objective is to address the mental health gap in this vulnerable population in Kenya by establishing the feasibility, acceptability and adoptability of a self-administered m-health-based mental health screening tool for depressive illness, generalized anxiety disorder and post-traumatic stress disorder and substance abuse among Kenyan adolescents and young adults living with HIV SPECIFIC AIMS:
The specific objectives of the study are as follows:
Specific aim 1: Determine the feasibility, adoptability and acceptability of integrating a digital mental health screening approach within routine care for older adolescents and young adults living with HIV transitioning to adult care
Specifically, we will evaluate the following: 1) Experienced level of comfort and ease of understanding by adolescents and young adults living with HIV of the digital mental health screening approach among older HIV positive adolescents and young adults using a survey lasting 15 minutes; 2) Individual-level factors that influence acceptance by adolescents and young adults living with HIV of the self-administered m-health tool and its integration tool within routine HIV care among this population using qualitative interviews.
Specific aim 2: Determine the prevalence, severity, (socioeconomic and psychosocial) determinants- associated HIV virological outcomes of mental illness among older adolescents and young adults
Specific aim 3: Identify health system barriers and facilitators towards the integration of a digital mental health screening approach within routine care for adolescents and young adults living with HIV as perceived by health care workers
The study will take place in the following sites -Kenyatta National hospital and Coptic Hospital- Dagoretti subcounty, Lea Toto clinics -Kariobangi North and South), Gertrude's hospital -Westlands sub-county, Dream Centre, Mbagathi hospital and Kibera community hospital -Langata sub-counties and Mama Lucy -Embakasi West sub-county.
Between August 2022 and January 2023, we enrolled AYALWHIV, aged 15-24, accessing care from eight clinics within Nairobi, Kenya. We excluded AYA who were unaware of their HIV status, were pregnant, had a pre-existing mental health illness, and those with acute stage 3 or 4 HIV diseases. We utilized a administered survey tool that screened for general anxiety disorder (seven-item screen), a depressive illness screening tool (Patient health questionnaire-
Nine items screen); The Primary Care PTSD Screen for DSM-5; and a Screening to Brief Intervention(S2BI) for substance use. Post-survey, we conducted in-depth interviews (IDIs) and explored acceptability, comfort level, and comprehension of the tool. We also explored adolescents’ perspectives on mental health, facilitators, and barriers to seeking care. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the thematic analysis of transcripts and identification of critical considerations influencing participant observations about the acceptability and feasibility of the DMHST.
We conducted 21 IDIs and identified ten major emerging themes. Occasionally, the screening process evoked discomfort in some participants. However, overall, participants had positive experiences and were willing to self-screen for mental health at every clinic visit. The participants expressed stigmatization of mental illness, poor mental health literacy, and the concurrent lack of necessities as barriers to seeking care. Coping mechanisms for HIV-related stressors to status included substance use, hobbies, and support systems. Stigma affected access to information and mental health care.
The study found that a self-administered DMHST is feasible and was widely accepted for AYALWHIV. The study highlights the importance of addressing mental health in AYALWHIV and the need for strategies to overcome barriers to care, such as stigma and poor mental health literacy.