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Abstract：
BACKGROUND: Adolescents living with Human Immunodeficiency Virus (HIV) have an increased risk of depression, negatively affecting their adherence to antiretroviral therapy (ART) and treatment outcomes. Integrating mental health care in HIV care and treatment settings improves comprehensive care. However, integration remains challenging in Tanzania, like in other high-burden and low-resource settings. The overall objective of this work is to inform the development of a psychological intervention for depression in adolescents living with HIV (ALWHIV). We describe perceived barriers and opportunities for implementing an integrated, evidence-based psychological intervention to manage adolescent depression in HIV care and treatment centers (HIV-CTC) from the perspectives of adolescents, caregivers, and healthcare providers (HCPs) in Dar es Salaam, Tanzania.
METHODS: To inform intervention development and implementation, this study utilized a qualitative design through a phenomenological approach informed by the Consolidated Framework for Implementation Research (CFIR) to explore implementation barriers and facilitators in ALWHIV, HCPs, and caregivers. Forty-five in-depth interviews were conducted in three HIV-CTCs in Kinondoni Dar es Salaam. Audio records were transcribed verbatim and analyzed deductively through NVIVO software.
RESULTS: Barriers to implementing an integrated psychological intervention to address depression in ALWHIV included (A) poor mental health awareness among caregivers, adolescents, HCPs, and policy-makers, (B) high level of stigma against mental health care, (C) poor communication between adolescents and HCPs concerning mental health care, (D) lack of contextualized intervention of proven effectiveness and guidelines of mental health care, and (E) inadequate mental health care supportive supervision and mentorship. Facilitators for implementation included supportive infrastructure, positive pressure from HIV implementing partners, tension for change, and participant\'s perception of the advantage of a psychological intervention as compared to just usual HIV care and treatment counseling.
CONCLUSIONS: Despite several modifiable barriers to implementing a psychological intervention in HIV CTC, there were encouraging facilitators and opportunities for implementing an integrated, evidence-based psychological intervention to address depression in ALWHIV in Kinondoni Dar es Salaam, Tanzania.
METHODS: To inform intervention development and implementation, this study utilized a qualitative design through a phenomenological approach informed by the Consolidated Framework for Implementation Research (CFIR) to explore implementation barriers and facilitators in ALWHIV, HCPs, and caregivers. Forty-five in-depth interviews were conducted in three HIV-CTCs in Kinondoni Dar es Salaam. Audio records were transcribed verbatim and analyzed deductively through NVIVO software.
RESULTS: Barriers to implementing an integrated psychological intervention to address depression in ALWHIV included (A) poor mental health awareness among caregivers, adolescents, HCPs, and policy-makers, (B) high level of stigma against mental health care, (C) poor communication between adolescents and HCPs concerning mental health care, (D) lack of contextualized intervention of proven effectiveness and guidelines of mental health care, and (E) inadequate mental health care supportive supervision and mentorship. Facilitators for implementation included supportive infrastructure, positive pressure from HIV implementing partners, tension for change, and participant\'s perception of the advantage of a psychological intervention as compared to just usual HIV care and treatment counseling.
CONCLUSIONS: Despite several modifiable barriers to implementing a psychological intervention in HIV CTC, there were encouraging facilitators and opportunities for implementing an integrated, evidence-based psychological intervention to address depression in ALWHIV in Kinondoni Dar es Salaam, Tanzania.
摘要：
背景：患有人类免疫缺陷病毒（HIV）的青少年患抑郁症的风险增加，对他们坚持抗逆转录病毒治疗（ART）和治疗结果产生负面影响。将精神保健纳入艾滋病毒护理和治疗环境可改善全面护理。然而,一体化在坦桑尼亚仍然具有挑战性，就像在其他高负担和低资源环境中一样。这项工作的总体目标是为艾滋病毒感染者（ALWHIV）青少年抑郁症的心理干预措施的发展提供信息。我们描述了实施一体化的感知障碍和机会，基于证据的心理干预，从青少年的角度管理艾滋病毒护理和治疗中心（HIV-CTC）的青少年抑郁症，看护者,和达累斯萨拉姆的医疗保健提供者(HCP)，坦桑尼亚。
方法：为干预制定和实施提供信息，本研究通过由实施研究综合框架（CFIR）提供的现象学方法进行了定性设计，以探索ALWHIV中的实施障碍和促进者，HCP,和照顾者。在Kinondoni达累斯萨拉姆的三个HIV-CTC中进行了45次深入访谈。音频记录逐字转录，并通过NVIVO软件进行演绎分析。
结果：实施综合心理干预以解决ALWHIV患者抑郁症的障碍包括（A）护理人员的心理健康意识差，青少年,HCP,和政策制定者，(B)对精神卫生保健的严重污名，（C）青少年与HCPs之间在精神保健方面的沟通不畅，(D)缺乏对精神卫生保健的经证实的有效性和指导方针的情境干预，(E)精神卫生保健支持性监督和指导不足。实施的促进者包括支持性基础设施，来自艾滋病毒执行伙伴的积极压力，改变的张力，以及参与者对心理干预与普通艾滋病毒护理和治疗咨询相比具有优势的看法。
结论：尽管在HIVCTC中实施心理干预存在一些可改变的障碍，有令人鼓舞的促进者和实施综合方案的机会，基于证据的心理干预，以解决Kinondoni达累斯萨拉姆的ALWHIV抑郁症，坦桑尼亚。
方法：为干预制定和实施提供信息，本研究通过由实施研究综合框架（CFIR）提供的现象学方法进行了定性设计，以探索ALWHIV中的实施障碍和促进者，HCP,和照顾者。在Kinondoni达累斯萨拉姆的三个HIV-CTC中进行了45次深入访谈。音频记录逐字转录，并通过NVIVO软件进行演绎分析。
结果：实施综合心理干预以解决ALWHIV患者抑郁症的障碍包括（A）护理人员的心理健康意识差，青少年,HCP,和政策制定者，(B)对精神卫生保健的严重污名，（C）青少年与HCPs之间在精神保健方面的沟通不畅，(D)缺乏对精神卫生保健的经证实的有效性和指导方针的情境干预，(E)精神卫生保健支持性监督和指导不足。实施的促进者包括支持性基础设施，来自艾滋病毒执行伙伴的积极压力，改变的张力，以及参与者对心理干预与普通艾滋病毒护理和治疗咨询相比具有优势的看法。
结论：尽管在HIVCTC中实施心理干预存在一些可改变的障碍，有令人鼓舞的促进者和实施综合方案的机会，基于证据的心理干预，以解决Kinondoni达累斯萨拉姆的ALWHIV抑郁症，坦桑尼亚。
