BACKGROUND: Mental health has been neglected in Sub-Saharan Africa, especially among Key Populations (KPs). KPs include female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) and are at high risk for HIV acquisition. KPs experience significant stigma and discrimination, including in health facilities. This puts them at greater risk of undiagnosed common mental disorders and high risk of exclusion from the HIV prevention, treatment and care continuum. A community-based peer-led Problem-Solving Therapy (PST) was implemented among KPs in Harare.
DESCRIPTION: Between January and September 2022, 30 Community Facilitators (CFs) including FSWs, MSM and TG peer lay cadres were trained to screen for common mental disorders (CMDs) and provide counselling to fellow KPs using the Friendship Bench model. Trained CFs used the Shona Symptom Questionnaire (SSQ-14) to screen KPs for CMDs during HIV prevention literacy sessions in communities across 9 learning sites. Those who scored SSQ =9 were offered PST and referred if there was need. Those who answered yes to either the question on hallucinations or on suicide (red flags) were immediately referred to nurses at facilities. Data were captured in a database and feedback from supervision meetings informed and strengthened continued implementation.
LESSONS LEARNED: 295 KPs were screened for CMDs using the SSQ-14. 180 KPs were offered PST and 73 returned for session 2, 27 returned for session 3, 12 returned for session 4 and 3 returned for session 5. 28 KPs were red flags, however only 10 were successfully referred to nurses at respective facilities. CFs embraced PST despite time demands that accompany integration of mental health into HIV prevention and treatment. KPs with red flags were not comfortable being referred outside their KP community, fearing stigma. The number of KPs returning after the first session dropped. CFs as the ‘counsellors’ require mental health support as they get overwhelmed.
CONCLUSIONS: Strengthened KP friendly referral structures could increase the effectiveness of referrals. Integrating mental health care in HIV prevention, care and treatment interventions for KPs could help deliver effective and affordable solutions to bridge the mental health treatment gap, leading to improved health outcomes.