There is No Health Without Mental Health: Mental Health and HIV Service Integration in Zimbabwe

This 44-page situational analysis, published by the AIDSTAR-One programme, discusses the link between HIV/AIDS and mental health. According to the report, a coordinated and comprehensive response, particularly between HIV treatment, care, and support services and mental health care can improve health outcomes among people living with HIV. In collaboration with the PEPFAR Care and Support and Treatment Technical Working Groups, AIDSTAR-One is implementing a pilot activity that will integrate mental health and harmful substance use screening, counselling, and referral into HIV treatment and care sites in Zimbabwe. This country situational analysis was conducted as a first step in the pilot activity.
The report explains that there is recognition among key stakeholders of the importance of integrating mental health and HIV services in Zimbabwe; however, there are training, financial, and human resource constraints. According to a key informant, financial support is necessary to gather baseline data on mental illnesses and substance use (including information from remote areas) and to create materials for awareness campaigns.
It is added that moving forward with integration requires collaboration within the Ministry of Health and other partners. The limited human resources available reinforce the need for a two-prong focus: 1) building the capacity of key health and community workers to screen and provide basic care, and 2) standardising task-shifting (i.e. training and delegating responsibilities to lower level staff to build capacity and share workloads) and follow-up referrals to appropriate health and community care providers within the context of national guidelines. Because the majority of people initially seek traditional medicine, the role of the traditional healers must be included in the collaboration.
The report notes that learning from the limited existing HIV and mental health programmes is important in integrating services for HIV and mental health. Such examples provide a small evidence base which highlights that mental health and HIV integration is achievable for Zimbabwe. Steps to integrate mental health screening, basic care, and referrals into standard HIV care protocols can be made and, ultimately, aim to improve quality of life of PLHIV.
The report outlines the following recommendations.
Policy Recommendations:

• Coordinate HIV and mental health responses at the Ministry of Health and Child Welfare (MOHCW) to optimise services for PLHIV.
• Further align traditional medicine practitioners into the formal health system.
• Strengthen strategies for bidirectional referral systems — between communityand facility-level care for mental health and HIV — incorporating traditional medicine practitioners.
• Develop clear policies and devote resources to improve treatment and drug supplies for mental health.

Capacity Assistance and Training Recommendations:

• Strengthen and increase human resources that deliver integrated services, including task-shifting key activities to nurses, social workers, lay health workers, and community health workers.
• Incorporate guidelines for mental health and HIV integration via task shifting into national policies and in guidance documents.
• Train different cadres of health care professionals in mental health screening and basic therapeutic services to increase basic mental health services and referrals.

Practice Recommendations:

• Develop services that provide continuous and holistic care.
• Strengthen linkages and referrals between mental health and HIV services.
• Collaborate with key stakeholders in HIV and mental health. For example, MOHCW departments should strive to align programmes and build partnerships with nongovernmental organisations and traditional medicine practitioners to improve linkages between HIV and mental health.
• Recognise existing opportunities, such as HIV testing and counselling sites, as potential opportunities to provide basic mental health care and referral.
• Implement education and sensitisation campaigns about the intersection of HIV, mental health, and harmful substance use, particularly in rural areas, to improve awareness and understanding of mental health issues and that these are often prevalent among PLHIV.
• Incorporate screening and referral for substance use into mental health and HIV services, and strengthen programmes.