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MH and HIV: The Missing L ink?

“ There is no Health without Mental Health”: Promising models of integration Melissa Sharer AIDSTAR-One. MH and HIV: The Missing L ink?. Overall PLHIV with positive MH have improved adherence, improved retention, and improved QoL Two directions:

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MH and HIV: The Missing L ink?

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  1. “There is no Health without Mental Health”: Promising models of integrationMelissa SharerAIDSTAR-One

  2. MH and HIV: The Missing Link? • Overall PLHIV with positive MH have improved adherence, improved retention, and improved QoL • Two directions: • PLHIV have higher rates of depression and other CMD. • Those with MI are more at risk for HIV • Three connections: • Reduced adherence • Reduced retention • Higher mortality and morbidity • WHO 2008

  3. In December 2009, AIDSTAR-One produced a technical brief which summarizes the evidence on MH issues of PLHIV and provide clear guidance for programmers in resource-limited countries. Available at: http://www.aidstar-one.com Mental Health and HIV Timeline

  4. Framework for Mental Health Services

  5. Vietnam: FHI360 • Integration of Mental Health into HIV Care and Support • September 2010: Documents the process of integrating stronger mental health services into an existing HIV treatment, care and support program

  6. Protocol: Vietnam Mental Health and Social Support • 2. Counselor • Complete intake form • Assess for depression/anxiety using SRQ20 • Develop care plan • Provide counseling; referrals for social support • Refer to physician if treatment needed • Identification • (refer through Doctor, • CHBC and • PLHIV Support Group) 3. CHBC/PLHIV SG *Screen and refer clients with MH problems to Doctor and or Counselor • 4. Follow-up visits • *Re-assess for emotional and social problems • Provide one-on-one counseling • Refer for social support • 6. Discharge • (When clients are better • and no longer need • support) 5. Group counseling *Refer clients with mental health and Social problems to group counseling sessions

  7. Northern Uganda: Peter C Alderman Foundation • Integration of HIV INTO MH services • January 2011: MH professionals working in trauma clinics are trained to provide appropriate services for PLHIV living in post-conflict settings

  8. Common themes, challenges, recommendations and lessons learned • Starting small • Using data to inform practice • Struggling to meet the needs of men • Quality assurance • Country Ownership • Referral systems

  9. Zimbabwe 2012: Pushing the Envelope Forward July 2012: Stepped care model where simple interventions are first utilized and more complicated interventions are reserved for clients who have not improved through simple interventions. Intensive psychotherapy, medication therapy and potential hospitalization for stabilization Clients with Suicidal Ideation and Alcohol and Substance Use emergencies require immediate care Medication Therapy A client with a positive screen Simple counseling intervention, referral to CBO, health provider for further management More intensive counseling therapy Increasing treatment intensity

  10. Step 1: Screen

  11. Step 2: Therapeutic Intervention-Evidence Based • Reinforced 1) education; 2) therapeutic advice; 3) counseling for behavior change (psycho-education) • Motivational Interviewing reinforcing OARS (open ended, affirmations, reflections, summaries) • Readiness Ruler (importance and confidence) • Counseling tips specific for harmful substance use

  12. Step 3: Refer

  13. Step 3: Refer In-Patient: When a client can no longer be safely managed within the community (a danger to self or others) Psychosocial Services and Support within the community for all clients (inclusive of registered traditional healers) Clinician: Provides routine mental health care to client including counseling and medication where appropriate Family Support where appropriate for all clients An SSQ ≥10, suicidal ideation or acute alcohol withdrawal should receive an immediate referral to best qualified health care provider for further care. Health Facility: Client has a positive SSQ (≥ 8) or CAGE (≥ 1) Community and Traditional Healers: A score of 7 or greater to the sad or worry questions or a “yes” to the alcohol and substance use question. The CBO should assess for suicidal ideation and acute alcohol withdrawal. If either is present, the client should receive an immediate referral to a health care provider.

  14. “There is no Health without Mental Health”-DrSekaiNhiwatiwa, 2012 “Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible.” -St Francis of Assisi, 12th century

  15. For more information, go to www.aidstar-one.com

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