HIV and mental health provider experiences of implementing brief depression and suicide screening among people living with HIV in Tanzania: A qualitative study

Depression and suicidal thoughts and behaviour are remarkably common among people living with HIV worldwide, leading to a higher burden of disease, poor HIV care engagement, and death. Suicidal behaviour is criminalized in 20 countries worldwide, including Tanzania, where culturally appropriate interventions are lacking. We describe the experiences of counsellors who screened patients as the initial procedure in a randomized controlled clinical trial aimed to reduce suicide and depression, and improve HIV care engagement in Kilimanjaro, Tanzania. The clinical trial was registered at clinicaltrials.gov (ID: NCT04696861). We conducted in-depth interviews (IDIs) with 10 HIV counsellors and four mental health workers. Interviews were held 3 months post-enrollment of participants. Data was collected from March to August 2023. We referred to a brief screener developed for the trial, combining the PHQ-2 for depression and one question on suicidal ideation. IDIs focused on the frequency of depression and suicide assessments before and after the trial; the nature of assessments and referrals; perceived significance, acceptability, and feasibility of the screening process; and opinions on the criminalization of suicide. Data was analyzed using NVivo. Themes were identified, collected, compared, combined, and tabulated. Differences were resolved by the first three and final authors. Our findings revealed an increased focus on mental health assessments and referrals since the start of the trial, perceived high necessity of integration of mental health screening, and a high acceptability and feasibility of screening. Participants consistently reported increased mental health awareness and a positive overall experience of screening. Counsellors favoured abolishment of laws against suicide due to their hindering support-seeking. In a mental health resource-limited setting, these findings highlight the need for targeted and integrated non-specialist interventions. Feedback from counsellors indicated that screening was acceptable and feasible; further research is needed to assess the sustainability of screening.