Title : Integrating community mental health approaches to enhance treatment adherence among adolescents living with HIV in Namibia

Background: Sub-Saharan Africa carries 67-70% of the global HIV burden, and children and adolescents living with HIV (C/ALHIV) face compounded risks related to stigma, violence, violence, poverty and economic instability. and economic instability. Depression affects an estimated 24% of people with HIV in the region, compared with fewer than 3% of the general population, while suicide mortality is higher among people living with HIV. Yet mental health and psychosocial support (MHPSS) remains largely absent from HIV programming, and intersecting stigma surrounding HIV and mental health discourages adolescents from seeking care.

Project HOPE is integrating community-based MHPSS into adolescent HIV programming in Namibia, by equipping Community Case Workers (CCWs) to provide first line mental health support. The intervention embeds screening, psychoeducation, and basic psychosocial support into routine HIV case management to improve treatment adherence and overall well-being.

Methods: CCWs were trained to administer the Patient Health Questionnaire 9 for Adolescents (PHQA), translated into local languages, to screen for depressive symptoms and provide first-line support. Adolescents with elevated PHQ-A scores, poor antiretroviral therapy (ART) adherence, or high viral load received age-appropriate, story-based psychoeducation using culturally adapted characters to normalize emotional distress, explain the relationship between emotional states and ART adherence, and promote practical coping skills. Caregivers received structured problem-solving and stress management support to strengthen household resilience and improve treatment support. CCWs were additionally trained to assess suicide risk, provide basic psychosocial support and refer adolescents to specialized psychological support when needed. CCWs also participated in self-care training, focused on stress management, nervous system regulation.

Results: Among 6,114 adolescents enrolled in the program, 13% (850) screened positive for symptoms of depression using the PHQ 9-A. Building the capacity of CCWs to identify adolescents experiencing psychological distress and provide timely, community-based psychosocial support increased access to mental health services within routine HIV care. Adolescents receiving the intervention demonstrated improved ART adherence, while caregivers reported greater problem-solving skills and confidence in managing their stress reactions. The integration of routine mental health screening and psychoeducation into community HIV services was feasible, acceptable, and strengthened early identification and management of common mental health conditions.

Conclusions: Integrating community mental health and psychosocial support into HIV care represents a feasible and cost-effective strategy to enhance treatment adherence among adolescents living with HIV. Training CCWs to identify psychological distress, deliver culturally appropriate psychoeducation and provide first-line mental health support strengthened the continuity of HIV care while facilitating early intervention for depression and suicide risk. Embedding age-appropriate mental health interventions within routine HIV programming has the potential to improve adherence, enhance psychosocial well-being, and prevent common mental health conditions among adolescents living with HIV. 

To be updated shortly..