Integrating mental health care into primary HIV care treatment programs in Zambia using telemedicine: Challenges and opportunities

BACKGROUND: Zambia has made substantial progress towards ending the HIV epidemic due to investments in effective prevention and treatment initiatives. However, these investments will not end the HIV epidemic without addressing mental health (MH) disorders. There is compelling evidence regarding the link between MH conditions and poor health outcomes at every stage of the HIV care continuum, necessitating the inclusion of universal MH screening and linking those with identified MH conditions to specialized care.
DESCRIPTION: We worked with the Ministry of Health and implemented a Telemedicine program using a hub-and-spoke model in Lusaka, Zambia. We integrated MH screening and treatment into the Telemedicine workflow. We ensured continuity of care for recipients of care (RoC) on antiretroviral therapy (ART) in one tertiary and four secondary hospitals serving as hubs and eight primary healthcare clinics serving as spokes. From July 2021 to January 2022, we screened 89 adults and three adolescent girls on ART for MH services. Of these, 23 adults and two adolescent girls received MH services via Telemedicine. The MH screening was conducted in partnership with Lusaka Provincial Health mental health specialists.
LESSONS LEARNED: There are limited human resources for mental health care in the Lusaka district and a scarcity of data to inform programmatic planning and action. Telemedicine has the potential to expand access to MH specialists for RoC in settings with limited trained MH specialists.Mental health specialists have self-reported that Telemedicine is an effective, useful, and acceptable way to deliver treatment, especially during the COVID-19 pandemic. Clients have also self-reported advantages such as privacy, convenience, and accessibility.
CONCLUSIONS: Depression and anxiety was the primary mental health diagnosis in adults and both adolescent girls were diagnosed with substance misuse after multiple telemedicine sessions. Zambia has the potential to integrate MH services into primary HIV care programs. These opportunities include capacity building for clinicians to screen for MH and to effectively deliver care via Telemedicine. Multiple barriers and challenges exist at the patient-, community-, and system-level, including stigma, limited human resources, policy gaps, and research gaps. Telemedicine has potential to address these gaps.

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