A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study

Abstract

Background Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru. Methods ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services. Results Twenty-eight (11 female, 17 male) ALWH aged 15–21 years participated; n = 20 (71%) identified as heterosexual. Most (18/28) acquired HIV at birth. Baseline PHQ-9 scores were 0–4, n = 3 (11%); 5–9, n = 9 (32%); 10–14, n = 10 (36%); 15–19, n = 4 (14%); and 20–27, n = 2 (7%). Eleven participants (40%) reported SI. Among participants with PHQ-9 > 4, 92% (23/25) were not severe. Of the 21 (75%) of participants eligible for PFA, n = 9 (32%) accepted at least one session, of which n = 3 (33%) were linked to specialized care. Conclusions A simple care pathway operationalizing depression screening and non-specialist delivered emotional support is a first step toward integrated depression and HIV care for ALWH.

Development and Pilot-Testing of an Optimized Conversational Agent or “Chatbot” for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study (Preprint)

“…In Lima, Peru, we found evidence that depression care for adolescents living with HIV is an unmet health need unless symptoms are severe (e.g., depression with psychosis, suicidal ideation) [23]. At the same time, we also observed in a small pilot study that the majority (92%) of adolescents living with HIV with depression did not have severe symptoms [24]. Adolescents living with HIV with mild-to-moderate depression do not receive support services (education, self-help strategies to develop coping skills and community bonding, low-intensity care) as part of routine care that could help cushion the escalation to more severe depression and thereby sustain their commitment to HIV care.…”

Development and Pilot-Testing of an Optimized Conversational Agent or “Chatbot” for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study

“…In Lima, Peru, we found evidence that depression care for adolescents living with HIV is an unmet health need unless symptoms are severe (eg, depression with psychosis and suicidal ideation) [ 23 ]. At the same time, we also observed in a small pilot study that the majority (92%) of adolescents living with HIV with depression did not have severe symptoms [ 24 ]. Adolescents living with HIV with mild to moderate depression do not receive support services (education, self-help strategies to develop coping skills and community bonding, and low-intensity care) as part of routine care that could help cushion the escalation to more severe depression and thereby sustain their commitment to HIV care.…”

Community-based accompaniment for adolescents transitioning to adult HIV care in urban Peru: a pilot study

“…Adolescents screening positive for mild or greater depressive symptoms (PHQ-9 ≥ 10) or with suicidal ideation were evaluated by Socios En Salud’s mental health program and offered Psychological First Aid [ 47 ] and referrals as needed. Participants with severe depressive symptoms (PHQ-9 ≥ 20) or suicidal ideation were offered linkage to free, specialized mental health services provided by the Peru Ministry of Health and delivered at nearby community mental health centers [ 48 ].…”