Saving Souls-Mental Health Integration Project
Project Description
The Association of People Living with HIV Pakistan is a key leader in community led and community driven response in the country. APLHIV has recently conducted national level Stigma Index Study 2.0 with a component on point prevalence of depression among PLHIV. The survey highlights that though we have come a long way forward in the last decade with dedicated work of all partners, we are still behind the goal of achieving less than 10% stigma across KPs and PLHIV by 2026. The report highlights that there is a significant burden of depression and there is local l data which supports many other mental health problems such as anxiety. Spectrum disorders are more prevalent among PLHIV than general populations. In addition, there are specific mental health needs of people who use drugs which is not limited to people who inject drugs but has expanded to chemsex among other key populations. It is known through research that the reduction in new HIV infections could be at least 10% faster (SDG target 3.3.1), because of integrating mental health into HIV programs and could be as much as 16.5% faster. For each dollar invested in integrating HIV care there is 7 dollars return. In fact, mental health integration is now among priority areas in Global Fund 2023-2028 strategy.
Unfortunately, mental health and HIV both are neglected diseases in medical education, as a result physicians treating HIV, professionals’ mental health problems their clients face, and mental health professional do not understand HIV and how it can impact mental health or treatment. There are many cultural sensitivities of HIV communities which if communicated can increase trust between physicians and their clients.
Leveraging on the data and available resources that the public sector is extending for their people, APLHIV piloted a project. In this project, APLHIV aimed to develop cultural competence of ART physicians working in government hospitals and early career psychiatrists from 10 HIV treatment centers. These centers were chosen based on the burden of HIV and the existence of psychiatry services in the same hospital. HIV physicians were familiarized with integrated mental healthcare and supporting early diagnosis and facilitating treatment among PLHIV. Early career psychiatrists were equipped with HIV treatment basics, integrating mental healthcare, and establishing liaisons with ART physicians. Lastly, counsellors at HIV treatment centers chosen above and Social Mobilizers hired by APLHIV from within HIV Community were trained for screening for common mental disorders and supporting a person-centered care response.
The sites chosen for the project include, Lady reading Hospital (LRH) Peshawar, Pakistan Institute Of Medical Sciences (PIMS) Islamabad, Mayo Hospital Lahore, Services Hospital Lahore, Jinnah Hospital Lahore, Allied Hospital Faisalabad, Nishtar Hospital Multan, Sheikh Zayed Hospital Rahim Yar Khan, Jinnag Postgraduate Medical Complex Karachi and Bolan Medical Complex Quetta.
The sites chosen for the project were based on two criteria:
- High burden of PLHIV at treatment centers
- The hospital where HIV treatment center is located is also accredited for postgraduate training in psychiatry
In addition, those diagnosed with mental health conditions were supported by social mobilizers as well as psychosocial support officer based at APLHIV office, Islamabad. During the project a total 6500 PLHIV were screened from across Pakistan in ten (10) ART centers.
The project aimed to screen 5287 PLHIV whereas 6524 PLHIV were screened during project time making 123% of the committed targets. Around 42.91% of the PLHIVs in the project were screened from Punjab, 18.39% from Sind, 6.28% from Khyber-Pakhtunkhwa (KPK) and 2.51% from Federal region or Islamabad. These figures are reflective of HIV burden, which is highest in Punjab followed by Sind and KPK. Overall, 20.92% of the PLHIV screened were men who have sex with men, 4.16% were sex workers and 2.39% were people who use drugs. (PWUD) It should be noted that since PWUD seek antiretroviral (ARV) refill from differentiated service delivery sites, they are underrepresented in this screening program. 36.49% had no depressive symptoms, while 11.41% had moderately severe and 2.63% had severe depressive symptoms. Of the PLHIVs screened 42.61% had no anxiety symptoms, while 23.17% had moderate and 9.74% had severe anxiety symptoms. The presence of suicidal ideation among PLHIV was asked using ASQ, 20.66% stated that they had suicidal ideation in last few weeks.
Project Description
The Association of People Living with HIV Pakistan is a key leader in community led and community driven response in the country. APLHIV has recently conducted national level Stigma Index Study 2.0 with a component on point prevalence of depression among PLHIV. The survey highlights that though we have come a long way forward in the last decade with dedicated work of all partners, we are still behind the goal of achieving less than 10% stigma across KPs and PLHIV by 2026. The report highlights that there is a significant burden of depression and there is local l data which supports many other mental health problems such as anxiety. Spectrum disorders are more prevalent among PLHIV than general populations. In addition, there are specific mental health needs of people who use drugs which is not limited to people who inject drugs but has expanded to chemsex among other key populations. It is known through research that the reduction in new HIV infections could be at least 10% faster (SDG target 3.3.1), because of integrating mental health into HIV programs and could be as much as 16.5% faster. For each dollar invested in integrating HIV care there is 7 dollars return. In fact, mental health integration is now among priority areas in Global Fund 2023-2028 strategy.
Unfortunately, mental health and HIV both are neglected diseases in medical education, as a result physicians treating HIV, professionals’ mental health problems their clients face, and mental health professional do not understand HIV and how it can impact mental health or treatment. There are many cultural sensitivities of HIV communities which if communicated can increase trust between physicians and their clients.
Leveraging on the data and available resources that the public sector is extending for their people, APLHIV piloted a project. In this project, APLHIV aimed to develop cultural competence of ART physicians working in government hospitals and early career psychiatrists from 10 HIV treatment centers. These centers were chosen based on the burden of HIV and the existence of psychiatry services in the same hospital. HIV physicians were familiarized with integrated mental healthcare and supporting early diagnosis and facilitating treatment among PLHIV. Early career psychiatrists were equipped with HIV treatment basics, integrating mental healthcare, and establishing liaisons with ART physicians. Lastly, counsellors at HIV treatment centers chosen above and Social Mobilizers hired by APLHIV from within HIV Community were trained for screening for common mental disorders and supporting a person-centered care response.
The sites chosen for the project include, Lady reading Hospital (LRH) Peshawar, Pakistan Institute Of Medical Sciences (PIMS) Islamabad, Mayo Hospital Lahore, Services Hospital Lahore, Jinnah Hospital Lahore, Allied Hospital Faisalabad, Nishtar Hospital Multan, Sheikh Zayed Hospital Rahim Yar Khan, Jinnag Postgraduate Medical Complex Karachi and Bolan Medical Complex Quetta.
The sites chosen for the project were based on two criteria:
- High burden of PLHIV at treatment centers
- The hospital where HIV treatment center is located is also accredited for postgraduate training in psychiatry
In addition, those diagnosed with mental health conditions were supported by social mobilizers as well as psychosocial support officer based at APLHIV office, Islamabad. During the project a total 6500 PLHIV were screened from across Pakistan in ten (10) ART centers.
The project aimed to screen 5287 PLHIV whereas 6524 PLHIV were screened during project time making 123% of the committed targets. Around 42.91% of the PLHIVs in the project were screened from Punjab, 18.39% from Sind, 6.28% from Khyber-Pakhtunkhwa (KPK) and 2.51% from Federal region or Islamabad. These figures are reflective of HIV burden, which is highest in Punjab followed by Sind and KPK. Overall, 20.92% of the PLHIV screened were men who have sex with men, 4.16% were sex workers and 2.39% were people who use drugs. (PWUD) It should be noted that since PWUD seek antiretroviral (ARV) refill from differentiated service delivery sites, they are underrepresented in this screening program. 36.49% had no depressive symptoms, while 11.41% had moderately severe and 2.63% had severe depressive symptoms. Of the PLHIVs screened 42.61% had no anxiety symptoms, while 23.17% had moderate and 9.74% had severe anxiety symptoms. The presence of suicidal ideation among PLHIV was asked using ASQ, 20.66% stated that they had suicidal ideation in last few weeks.