Implementing enhanced m-health mental health screening for adolescents living with HIV transitioning into adult care

Abstract

Abstract Background Growing evidence indicates that around half of all adolescents and young adults living with Human Immunodeficiency Virus (AYALWHIV) experience mental health difficulties in Africa. Despite this, less than 1% of AYALWHIV receive mental health screening as part of routine care in resource-limited settings. 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 AYALWHIV. We will also investigate the psycho-social determinants of mental illnesses and resulting virological outcomes. Methods This study proposes to use a mixed methods design. We will enroll AYALWHIV aged 15–24 years from eight urban HIV clinics in Nairobi Kenya. We will collect socio-demographic, psycho-social, and viral suppression data from chart abstraction and semi-structured interviews at enrollment. We will use a ready-for-use m-health Open Data Kit (ODK) based self-administered tool that consists of four mental health and substance use screening tools to measure the prevalence and severity of General Anxiety Disorder, Depressive illness, Post-Traumatic Stress Disorder, and substance use. We will assess acceptance of the m-health tool using a brief questionnaire. In-depth interviews will be used to investigate individual-level factors that influence acceptance by AYALWHIV of the self-administered m-health tool and its integration within routine HIV care, and to identify health system barriers and facilitators towards the integration of a digital mental health screening approach as perceived by health care workers. Discussion We hypothesize a high level of acceptability of the m-health mental health screening intervention and a high prevalence of mental health difficulties linked to psycho-social factors in this population. We anticipate this study will generate evidence on the rapid, scale-up and sustainable implementation of the tool and illuminate organizational, health care provider, policy maker and intervention-related barriers and facilitators to adoptability. If the intervention is found to be acceptable and feasible, the clinical implication would be to increase the use of the m-health screening tool in routine HIV care among AYALWHIV in Kenya.