Global push to integrate HIV and mental health services

The World Health Organization (WHO) and UNAIDS have released new guidelines on integrating HIV and mental health services.

What are the guidelines about?

The new guidelines provide tools, best practices, case studies and recommendations for integrating HIV and mental health services.

Alongside mental health, the guidelines cover drug and alcohol dependence. They also cover neurological conditions like cognitive impairment and dementia. People with HIV can develop these conditions if they are not on HIV treatment or are not taking it properly.

Why are the guidelines important?

Having a mental health condition puts people more at risk of HIV. And people with HIV are more at risk of mental health conditions. People with HIV who have a mental health condition are less likely to test for HIV. They are also less likely to start or stay on antiretroviral treatment (ART).

What do the guidelines say?

The guidelines recommend that healthcare providers should be trained to offer counselling and psychosocial support. They should also be trained to recognise and treat mental health, neurological and substance use conditions. This includes people working in HIV services.

Mental health services should provide access to HIV prevention and testing services. They should also provide psychosocial support for people at increased risk of HIV.

There are different ways to integrate services. For example:

• A non-physician, such as a peer worker or a social worker, can develop an HIV/mental health care plan and arrange referrals.
• ‘One-stop shops’ where HIV and mental health services are provided in one place.
• Multi-facility: where services are integrated through referrals to other clinics, providers or community organisations.

Some people need special attention in relation to mental health. This is due to connecting factors that influence their health, such as gender inequality and age discrimination. These groups include key populations, women and girls, adolescents and people with disabilities.

Community-led organisations should be involved in delivering and monitoring integrated HIV/mental health services. This is the best way to make sure services work for the people they are intended for.

What does this mean for HIV services?

The HIV treatment cascade provides different entry points for providing mental health services.

HIV prevention

HIV prevention is often available in a wide range of places, such as antenatal care, family planning and community settings. So it provides the opportunity to reach a wide range of people with mental health support. This includes mental health education, assessment, support and referrals.

HIV testing

HIV testing can also be combined with mental health support. This includes screening, psychosocial support, information on self-care and referrals. This may be particularly effective if it is offered through community-based testing, social network testing and self-testing schemes.

For people diagnosed with HIV, post-test counselling should include coping skills, mental health education, and assessment for drug and alcohol dependence.

HIV treatment

Ideas for integrating mental health support with HIV treatment include:

• A dedicated care manager who screens for mental health conditions, offers psychosocial support and monitors care.
• Co-counselling for HIV, mental health, substance use conditions and sexual and reproductive health.
• Access to psychosocial support, such as cognitive-behavioural therapy and support groups.
• ART, delivered alongside other medication, such as opioid substitution therapy.

People with HIV who have severe mental health conditions should get extra mental health support. This can help them adhere to ART.

Mental health screening is strongly recommended for adolescents with HIV, regardless of their treatment status. It is also advised for people who are not virally suppressed, who are lost to follow-up, or who have difficulty staying in HIV care.