Project Title

Enhanced m-health mental health screening for adolescents living with HIV transitioning into adult care.

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

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 among Kenyan adolescents living with HIV.

Study Design

Study Design and Methods Relevant to Specific Aims Aim 1:To determine feasibility and user acceptance of implementing an m-health screening intervention among older adolescents transition to adult care Rationale: Several mental health screening tools designed to be self –administered have been validated in sub-Saharan adolescent populations including Kenya among them those screening for anxiety –,Depressive illness –and PTSD However despite this, their use has been limited to clinician based administration and often when there are underlying behavioural related indicators such as poor adherence to ART among PLWHIV. While data indicates that presence of mental health illness is disproportionally higher among ALWHIV, there are several barriers towards universal mental health screening of ALWHIV among them inadequate mental health trained health professionals and high patient-health care worker ratios Therefore the implementation of an m-health digital tool among transitioning adolescents regardless of their virological or adherence status would help identify the three commonest mental health conditions among ALWHIV. This would be a precursor to stepped care models that would intervene in progression and provide treatment for those with severe illness. The inclusion of adolescents in the assessment of the intervention will increase our understanding of their insights gained into their own mental health during the assessment and on the level of acceptability of the m-health screening tool. The primary endpoint of aim one will be the level of comfort in using the tool, and willingness to complete the tool again during routine visits. Methods: We will use a ready- for- use M-health ODK based self–administered survey tool that consists of three mental health screening tools; 1)general anxiety disorder- seven-item screen (GAD7), 2)Depressive illness screening tool- (Patient health questionnaire- 9 item screen (PHQ9) and 3) The Primary Care PTSD Screen for DSM-5 (PC-

Project Summary

Background :Growing evidence indicates that at least 49% adolescents living with HIV(ALWHIV) experience mental health difficulties in Africa.The transition into adult care and presence of psycho-social stressors may augment mental health illness symptoms and contributes to poor viral suppression Despite this, less than 1% of ALWHIV receive mental health screening as part of routine care in resource-limited settings that often have scarcity of health care workers. Little is known, about the determinants of mental health in this population.The overall objective of this study is to address this mental health gap in this vulnerable population by investigating the feasibility, acceptability and adoptability of a self-administered m-health based mental health screening tool among Kenyan ALWHIV. We will also investigate the psycho-social determinants of mental health illnesses and resulting virological outcomes among older adolescents. Methods: We will enroll 768 adolescents living with HIV from 8 urban HIV clinics in Nairobi Kenya aged 15-19 years of age. We will exclude pregnant ALWHIV who are pregnant, have not received disclosure of their HIV status, have a pre-existing mental health illness, and those with acute stage 3 or 4 diseases. We will collect socio-demographic (Family members living with HIV, life events such death of a parent or sibling and timing of disclosure of HIV status) , psycho-social (experienced stigma, adherence self-efficacy and self-esteem ) and viral suppression data from chart abstraction and semi-structured interviews at enrollment. We will use a ready- for- use m-health ODK based self–administered tool that consists of three mental health screening tools; 1)general anxiety disorder- seven-item screen (GAD7), 2)Depressive illness screening tool- (Patient health questionnaire- 2 and 9 item screens (PHQ2 and PHQ9) and 3)The Primary Care Post Trauma Stress Disorder Screen for DSM-5 (PC-PTSD-5). We will also assess the response rates and respondents’ acceptance of the m-health tool for a subset of participants (n = 384). We will also use Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators of adoptability and scale up of m-health screening by conducting qualitative interviews (a minimum of 30 interviews with health care workers and policy makers.) Anticipated outcomes: Based on previous studies from high-income countries we expect a high level of acceptability and a high prevalence of mental illness. This study will also illuminate health facility (organizational), health care provider, policy maker and intervention-related barriers and facilitators to m-health mental health screening intervention scale-up and adoptability.

Host Organisation

Current Organisation

Kenya Medical Research Institute (KEMRI)

Current Job Title

clinical research scientist

Biography