Acceptability of an Integrated Model of Mental Health and PrEP Service Delivery for South African Adolescent Girls: Qualitative Results from a Pilot Hybrid Effectiveness-Implementation Randomized Trial

Adolescent girls and young women (AGYW) at elevated HIV risk often experience common mental disorders (CMD), which are linked to lower PrEP adherence. We piloted a CMD intervention, the Youth Friendship Bench SA (YFB), and delivered alongside PrEP to improve CMD symptoms and PrEP adherence among South African AGYW. From April 2023-February 2024, 116 AGYW (18-25 years) with CMD symptoms were randomized to YFB plus standard of care (SOC) or SOC alone and followed for 12 weeks. In-depth interviews were conducted with 30 AGYW and 13 study staff and key informants. CMD screening alone was seen as beneficial, but referral uptake was low due to perceived severity thresholds, staff attitudes, and logistical barriers. YFB was highly acceptable to AGYW, who valued the intervention for being confidential, informal, and empowering. Integrated CMD and PrEP services were acceptable, and lay counsellor delivery shows promise for addressing the mental health care gap.