Driving Viral Suppression and Retention in Care through Mental Health Interventions

Driving Viral Suppression and Retention in Care through Mental Health Interventions

Mental illness is a debilitating health condition that affects individuals’ cognitive, affective, and behavioural functioning. Members of key population, particularly young ones, experience a disproportionate degree of mental illness compared to the general population. Undiagnosed mental health conditions could result in poor adherence, virology failure and poor retention. Unstable patients find it difficult to adhere to their drugs, coupled with other factors that affect their viral load and retention in care. Depending on the severity level, patients may be directly referred from the point of testing to the psychologist to support their stabilization.

20-year-old Adindu had been facing financial overburden, being the only one catering to the needs of her parents and siblings. The hardship forced her to drop out of the university at the end of her second year. She relocated to Umuahia in search of greener pastures. Adindu would use her earnings to support her sick mother and siblings back home. Amidst tears, she expressed frustration over her situation. She felt that her future was bleak.

In December 2020, Adindu was diagnosed with HIV and placed on ART in one of the FHI Global Fund supported One Stop Shop (OSS) facilities managed by the Society for Family Health (SFH) in Umuahia, Abia state. At the OSS, Adindu had an additional diagnosis which showed depression and suicidal behaviour, including persistent sadness, insomnia, weepy spells, loss of appetite, poor concentration, lack of interest in pleasurable activities, feelings of hopelessness, and suicidal thoughts. She commenced Cognitive Behavioral Therapy (CBT) and a reduction of access to lethal means counselling. After six months on treatment, she moved to Lagos to work in a brothel. While living in Lagos, she continued her treatment; she always returned to Umuahia to refill and continuously received her therapy on WhatsApp and physically during her refill at the OSS. Overall, Adindu went through four modules of CBT for the first and second episodes and was taken through emotional regulation. In addition, Adindu engaged in psychoeducation on the importance of establishing boundaries and had counselling to apply for jobs to minimize her financial burden. As a result, she commenced occupational therapy to improve her employability skill. Over time, her mood improved significantly after completing the occupational therapy. She secured a job that improved her activity and energy levels. Her adherence also improved optimally following close monitoring of her ART. Adindu is now more stable, and her retention in care continues to remain positive.

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