Integrating a mental health referral system within adolescent HIV clinics in Tanzania

To evaluate the acceptability and feasibility of integrating a mental health stepped-care referral pathway for young people with HIV (YPWH) who screened positive for mental health distress using task-sharing and stepped-care approaches.

This is a longitudinal nested study within the Sauti ya Vijana (SYV: The Voice of Youth) randomized controlled trial, describing an integrated referral pathway created within adolescent HIV clinics. SYV is a peer-led, group-based mental health intervention for YPWH. The study includes youth enrolled between March and September 2023 who completed a 6-month visit by March 2024.

YPWH who knew their HIV status, received antiretroviral therapy, and could attend 10-weekly intervention sessions were included. Enrolled youth responded to interviewer-guided mental health screening questionnaires at every study visit. Automatic referral alerts were generated if a YPWH had a total score ≥10 on the Patient Health Questionnaire (PHQ-9) or General Anxiety Disorder (GAD-7) Questionnaire, reported sexual abuse, self-harm, or suicidal ideation. An interviewer could self-refer a participant if they had a separate mental health concern. Site-specific mental health referrals were tracked using a REDCap database. Data were analyzed for incidence of mental health referrals, attendance to referral appointment, and outcome.

Of 349 YPWH included in this study, 62 (18%) generated referral alerts. Most attended their appointment ( n  = 50, 81%) and many ( n  = 28, 56%) experienced resolution of distress after one visit. Eight participants required stepped-up care to a mental health professional.

The integration of a mental health stepped-care referral pathway was acceptable and feasible for YPLW within existing primary adolescent HIV clinics in Tanzania.