Face-to-face, confidential and health worker-led: Understanding the preferences for behavioral health services among people with HIV in Lesotho

Behavioral treatments can help people with human immunodeficiency virus (HIV) improve their quality of life and treatment adherence. In Lesotho, where a fifth of adults live with HIV and depression and harmful alcohol use is prevalent among this group, little is known about the local suitability of established behavioral treatment strategies. We explored preferences regarding two strategies evaluated in other settings: involving phones and trusted individuals in treatment. We thematically analyzed 28 semi-structured interviews with potential service users receiving routine HIV care in the Butha-Buthe and Mokhotlong districts. Key concerns included the feasibility of phone-based treatment in rural areas and issues of limited literacy, electricity and network coverage. Others highlighted potential benefits for younger and working individuals for phone-based treatment, preferring calls over texts. Involving trusted individuals in treatment was favored, as this could foster support and accountability. Behavioral issues related to depression and alcohol use were viewed as complex, requiring face-to-face attention from trusted professionals, such as nurses and counselors, who were seen as knowledgeable and capable of maintaining confidentiality. Peer providers were not favored due to privacy concerns. These findings emphasize the need for face-to-face, confidential and health worker-led approaches for integrating behavioral treatment into HIV care in Lesotho.