1 / 17

Using task shifting to integrate mental health services in HIV/AIDS care in Zimbabwe

Dixon Chibanda. Using task shifting to integrate mental health services in HIV/AIDS care in Zimbabwe . Background.

medea
Download Presentation

Using task shifting to integrate mental health services in HIV/AIDS care in Zimbabwe

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dixon Chibanda Using task shifting to integrate mental health services in HIV/AIDS care in Zimbabwe

  2. Background • In sub-Saharan Africa the result of poor adherence to HAART includes poor treatment outcomes and the emergence of virus resistant to first line treatment regimens. (Bangsberg 2008). • In sub-Saharan Africa depression is associated with poor adherence to ART . (Nakimuli-Mpungu 2011)

  3. Background • Depression, which is part of a wider group of conditions referred to as common mental disorders(CMD) marked by symptoms of depression, anxiety, and somatization increase the risk of HIV disease progression and mortality (Antelman 2007) • Non-pharmacological interventions for depressive disorders have shown promising results in developing countries. (Bolton 2003; Araya 2003; Ali 2003; Rahman 2008;Patel 2011; Petersen 2012)

  4. Background: The challenges • High migration rate of health professionals from poor to rich countries. (Dovlo 2005) • In Zimbabwe it is estimated that in the past 15 years over 50% of health professionals have migrated to South Africa, UK, Australia, and USA.

  5. Rationale for task Shifting • In the absence of health professionals we have had to resort to task-shifting. • ….the delegation of medical and health service responsibilities from higher to lower cadres of health staff, sometimes non-professionals. (Zachariah 2009)

  6. Rationale for task shifting • There is evidence supporting the use and efficacy of using lay health workers in primary and community health care. (lewin 2005) • Task shifting is now widespread in HIV/AIDS care in sub-Saharan Africa. (Zachariah 2009) • ……but with poorly defined mental health packages under the term psychosocial support/ counselling.

  7. Lay health workers in Zimbabwe • There are over 5000 lay health workers involved in HIV/AIDS care in Zimbabwe. (Zimbabwe Aids Network-ZAN). • Most of them (85%) acknowledge the need to address depression (kufungisisa) among PLWH but lack the knowledge. (ZAN)

  8. Integrating Mental health in HIV/AIDS care

  9. Mental health in PMTCT program • Postnatal psychological morbidity is high in Zimbabwe. (Nhiwatiwa 1998; Stranix -Chibanda 2005) • In 2009 PND among women attending PMTCT was 30% (Chibanda 2009) • We validated the Edinburgh Postnatal Depression Scale (EPDS). (Chibanda 2009) • Trained HIV + peer counselors on how to administer EPDS & provide group problem solving therapy . (Chibanda 2011)

  10. PMTCT • Group problem solving therapy was significantly better (p=0.009) than usual care (medication) after 6 weeks. ( Chibanda in press JIAPAC) • Lay health workers are able to screen treat and refer mothers with PND within the PMTCT program . (Stranix-Chibanda 2005; Shetty 2008; Chibanda 2010 )

  11. Primary care mental health • Prevalence of CMD in PHC clinics 24%-30% (Patel 1997; Abas 2000; Chibanda 2011) • The City Health Department in Harare employs ~ 800 lay health workers who are involved in the provision of HIV/AIDS care at community level. • We have successfully trained lay health workers involved in HIV/AIDS care to screen for CMD and provide Problem Solving Therapy (Mynors-Wallis 2001) for depression in Mbare. (Chibanda 2011). Recently added Behavioral Activation – another simple evidenced based intervention for depression - to the skill base of lay workers (Abas, Chibanda, Wingrove, in progress)

  12. The friendship bench

  13. The Friendship bench • Over 4000 people have utilized the friendship bench since its’ inception in 2006, most of these being PLWH. • Using lay health workers who are already involved in routine HIV/AIDS care to provide mental health care appears to be less stigmatizing than seeing a psychiatrist or clinical psychologist. (Chibanda 2011)

  14. Pyramid for mental health integration in HIV/AIDS care

  15. Why it seems to be working • High literacy rate in Zimbabwe (90%) (UNDP 2010) • Existing tools; SSQ-14; SSQ-8 (Patel 1994) Multiple symptoms card with 7-step intervention (Abas 1994) HAqoL(Taylor 2008) EPDS(Chibanda 2009) • A referral system that is accepted by stakeholders. • By end of 2012 will begin a cluster randomized controlled trial of this brief psychological intervention delivered by LHW

  16. Recommendations for integrating mental health in HIV/AIDS care • Guidelines for recognition and care (MhGap) • Development of standardized protocols, including simplified guidelines. (Zachariah 2009; WHO 2007) • Mental health interventions must be implemented into existing programs. ( Collins 2006) • Need to explore how to bring on board traditional healers (Taylor 2008) • Mental health professionals should assume the role of public health consultants (Patel 2000)

  17. Acknowledgement • City Health Department Harare, Dr Chonzi, Dr Mungofa • University of Zimbabwe, Department of psychiatry • University of Zimbabwe Dept comm med • Wake forest University, (Dr Avi Shetty) • Institute of Psychiatry, London Dr. Melanie Abas

More Related