Interventions and approaches to integrating HIV and mental health services: a systematic review

Abstract

BackgroundThe frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services.MethodsThis review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias.ResultsForty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach.ConclusionThis review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden.

Experienced HIV-Related Stigma and Psychological Distress in Peruvian Sexual and Gender Minorities: A Longitudinal Study to Explore Mediating Roles of Internalized HIV-Related Stigma and Coping Styles

“…In relation to current and future intervention research, addressing HIV-related stigma and coping strategies is common in mental health programs for PLWH (69–72), including in Peru. We believe our study suggests a priority focus to mitigate the adverse effects of societal HIV-related stigma to reduce maladaptive coping strategies, including substance use, denial, and behavioral disengagement.…”

HIV-Related Stress Experienced by Newly Diagnosed People Living with HIV in China: A 1-Year Longitudinal Study

“…These results suggest the critical importance of being aware of the psychological health consequences among PLWH. Integrating mental health services into HIV primary care medical appointments may be necessary considering the high burden of mental illness experienced by PLWH [41,42].…”

Opportunities and challenges to Integrating mental health into HIV programs in a Low- and Middle-Income Country: Insights from the Nigeria Implementation Science Alliance

“…Different integrative, task-sharing approaches involving lay health workers have been used to deliver antidepressants in Cameroon (17), to provide psychosocial interventions to PLHIV in South Africa (14), for problem solving therapy for depression and common mental disorders in Zimbabwe (21), and to improve lay health workers' knowledge and self-e cacy in managing mental disorders in Malawi (22). The integrated care approach is a promising, acceptable and feasible strategy for improving both mental health and HIV treatment outcomes in low and middle-income countries (LMIC) (23)(24)(25). However these approaches to integrate HIV and mental health services remain limited by research gaps in cost-effectiveness and long-term impact of different models on patient outcomes and by barriers to their adoption in LMIC (25).…”

“…The integrated care approach is a promising, acceptable and feasible strategy for improving both mental health and HIV treatment outcomes in low and middle-income countries (LMIC) (23)(24)(25). However these approaches to integrate HIV and mental health services remain limited by research gaps in cost-effectiveness and long-term impact of different models on patient outcomes and by barriers to their adoption in LMIC (25). Implementation scientists are well positioned to identify the challenges and opportunities in LMIC for integration of mental health services into existing HIV programs.…”