A Mixed-Methods Process Evaluation: Integrating Depression Treatment Into HIV Care in Malawi

Area of Science:

• Global Health
• Mental Health Integration
• Implementation Science

Background:

• Depression is common in people living with HIV (PLHIV) in Malawi, impacting HIV care engagement and outcomes.
• A pilot program integrated depression management into HIV care using measurement-based care and Friendship Bench psychotherapy.
• Early evaluations showed success in training, screening, diagnosis, and treatment initiation.

Purpose of the Study:

• To conduct a mixed-methods process evaluation of a pilot depression management program integrated into HIV care in Malawi.
• To assess implementation outcomes including fidelity, acceptability, and sustainability.
• To provide insights into the implementation experience for future integration efforts.

Main Methods:

• A mixed-methods approach using patient clinical data and qualitative interviews with patients and clinic staff.
• Focused on evaluating fidelity to the depression treatment protocol, patient and staff acceptability, and program sustainability.
• Collected data on implementation outcomes within two HIV clinics in Malawi.

Main Results:

• High fidelity was observed for depression screening and treatment initiation, but poor fidelity for follow-up treatment.
• Antidepressants and problem-solving therapy were acceptable to patients; however, staff faced challenges due to resource constraints.
• The program was not sustained post-project, with identified needs including supervision, capacity building, EMR integration, and counselor availability.

Conclusions:

• Sustained integration of depression treatment into HIV care faced significant challenges despite initial successes.
• Implementation science studies should consider the role of evaluation staff in clinical support and ensure adequate resources.
• Further research is needed on enhanced implementation strategies for sustainable mental health integration in low-resource settings.