Enhanced m-health mental health screening for adolescents living with HIV transitioning into adult care (EMMATAC Study)

Growing evidence indicates that around half of all adolescents and young adults living with HIV experience mental health difficulties in Africa. The transition into adult care and psycho-social stressors may augment mental health illness symptoms and contribute to poor viral suppression. Despite this, less than 1% of adolescents and young adults living with HIV (AYALHIV) receive mental health screening as part of routine care in resource-limited settings that often have a scarcity of healthcare workers. Little is known about the determinants of mental health in this population.

Through a three-year study funded by EDCTP2 at 147,450 euros, under the mentorship of Prof. Elizabeth Bukusi RCTP-KEMRI and Prof. Lukoye Atwoli-AKUH, clinical research scientist Dr. Nyawira Gitahi seeks to address this mental health gap in this vulnerable population. The study investigates the feasibility, acceptability, and adoptability of a self-administered m-health-based mental health screening tool among 765 adolescents and young adults living with HIV in eight research sites in Nairobi County.

Between August 2022 and January 2023, AYA aged 15-24 were enrolled. They were accessing care from 8 clinics within Nairobi, Kenya. AYA who were pregnant were excluded from those who had not received disclosure of their HIV status, AYA who had pre-existing or known mental health illness, and those with acute stage 3 or 4 HIV diseases.

We utilized a self–self-administered survey tool that screened for 1) General anxiety disorder- seven-item screen (GAD7), 2) Depressive illness screening tool- (Patient health questionnaire- 9 items screen (PHQ9), and 3) Post-traumatic stress disorder screened using Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). 4) Screening to Brief Intervention (S2BI) for substance use. We also collected socio-demographic data and clinical and psychosocial data.

Results: We enrolled 462 AYA; 53.1% were female, with a mean age of 19.2 (S.D;2.6), while the mean age at HIV-disclosure was 12.8 (S.D;3.4). PTSD illness was most prevalent at 78%, followed by Depressive disease at 40.4 % and generalized anxiety substance at 33.7%. Factors independently associated with mental health illness at 95%CI were late disclosure (later than 12 years) p=0.01, AYA with ART treatment interruptions (p=0.009), and stigma (p=0.007).

The feasibility of the Intervention measure was reported at 83%, while the acceptance of the intervention measure was at 80%. The AYA reported the feasibility and acceptability of at least 88% of the AYA indicated that they would like to be screened again, and out of these, at least 61% of the AYA expressed that the routine screening frequency should be at least annually.

For implementation, science outcomes reach was at 120.3%; for effectiveness, 62.5 % of participants identified to have moderate to severe using validated mental health tools, 87% of program components implemented (screening of moderate to severe and referral for mental health assessment and management), with regards to adoptability of the intervention,87.5% of the sites participated (7/8 sites).

Conclusion: Self-screening was implemented successfully with high feasibility and acceptance. The high prevalence rates for mental health illness and high acceptability among AYAs living with HIV further indicate the need to implement routine mental health screening, as demonstrated in this study.

CONTACT INFORMATION

Phone: +254 722 387 231
Name: Dr. Nyawira Gitahi

This project is part of the EDCTP2 Programme supported by the European Union