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    Digital depression screening in HIV primary care in South Africa: mood in retroviral + application monitoring [MIR + IAM]

    Passchier, R. and Owens, S. and Wickremsinhe, M. and Bismilla, N. and Ebuenyi, Ikenna (2019) Digital depression screening in HIV primary care in South Africa: mood in retroviral + application monitoring [MIR + IAM]. Global Mental Health, 6 (E2). ISSN 2054-4251

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    Background. Integrating mental health care into HIV services is critical to addressing the high unmet treatment needs for people living with HIV and comorbid major depressive disorder. Introducing routine mental health screening at the primary health care level is a much needed diagonal approach to enhancing HIV care. In low-resource settings with a shortage of mental health care providers, eMental Health may provide a novel opportunity to attenuate this treatment gap and strengthen the health system. Objective. To conduct formative health systems research on the implementation of routine depression screening using a digital tool – Mood in Retroviral Positive Individuals Application Monitoring (MIR + IAM) – in an HIV primary care setting in South Africa. Methods. A Theory of Change (ToC) approach was utilised through individual and group session interviews to design an intervention that is embedded in the local context. Ten experts and local stakeholders were selected from the UK and South Africa. Data were analysed thematically using Atlas.ti to identify interventions, assumptions, barriers and facilitators of implementation. Findings. The participants considered digital depression screening in HIV care services relevant for the improvement of mental health in this population. The six main themes identified from the ToC process were: (1) user experience including acceptability by patients, issues of patient privacy and digital literacy, and the need for a patient-centred tool; (2) benefits of the digital tool for data collection and health promotion; (3) availability of treatment after diagnosis; (4) human and physical resource capacity of primary health care; (5) training for lay health care workers; and (6) demonstration of the intervention’s usefulness to generate interest from decision-makers. Conclusion. Digital depression screening coupled with routine mental health data collection and analysis in HIV care is an applicable service that could improve the mental and physical health outcomes of this population. Careful consideration of the local health system capacity, including both workers and patients, is required. Future research to refine this intervention should focus on service users, government stakeholders and funders.

    Item Type: Article
    Additional Information: © The Author(s) 2019. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Cite as: Passchier, R., Owens, S., Wickremsinhe, M., Bismilla, N., & Ebuenyi, I. (2019). Digital depression screening in HIV primary care in South Africa: Mood in retroviral application monitoring [MIR IAM]. Global Mental Health, 6, E2. doi:10.1017/gmh.2018.35
    Keywords: eMental Health; global mental health; HIV/AIDS; major depressive disorder; screening; primary care;
    Academic Unit: Faculty of Science and Engineering > Psychology
    Item ID: 15369
    Identification Number:
    Depositing User: Ikenna Ebuenyi
    Date Deposited: 31 Jan 2022 15:42
    Journal or Publication Title: Global Mental Health
    Publisher: Cambridge University Press
    Refereed: Yes
    Use Licence: This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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