Mental health and workplace wellbeing among Frontline healthcare providers who provide HIV care to children, adolescents and their families: a mixed-methods study from twelve African countries

Frontline healthcare providers (HCPs) are critical to the paediatric-adolescent HIV response in Africa, yet their mental health and workplace wellbeing remain underexplored. We conducted a mixed-methods study with 617 frontline HCP who provide HIV services to children and adolescents in 12 high-prevalence African countries. Participants completed a cross-sectional survey assessing depression, work-related quality of life, empowerment, job satisfaction, and role overload. We examined differences in depression scores by age, gender and occupation. Twenty-one focus groups explored workplace experiences, challenges and their relationship to mental health and well-being. Thirty-nine per cent (<i>n</i> = 242) of participants reported at least mild depressive symptomatology. Prevalence was highest among younger HCPs: 55% among 18-29-year-olds, 39% among 30-45-year-olds and 27% among 45 + year-olds. Depression was more common in psychosocial support roles: 64% among peer supporters, 50% among community health workers and 44% among counsellors. Biomedical providers (nurses, doctors, and pharmacists) reported significantly lower depression scores than psychosocial support positions (<i>p</i> = 0.018). Work-related quality of life was significantly inversely associated with depression (<i>p</i> < 0.001). Participants described feeling overburdened and burnt out, linking mental health challenges to workplace conditions and calling for urgent improvements in work environments and well-being support for frontline HCP who provide HIV services to children and adolescents in Africa.