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[...]depression is a heterogeneous entity experienced with various combinations of signs and symptoms, severity levels, and longitudinal trajectories. [...]core features of the condition have been described over thousands of years, long before the advent of contemporary classifications, and in diverse communities and cultures. More efficient prevention of depression is likely to have powerful impacts on the Sustainable Development Goals for a country and the health of individuals and families. 5 The experiences of depression and recovery are unique for each individual Depression is the result of a set of factors, typically the interaction of proximal adversities with genetic, social, environmental, and developmental risk and resilience factors. Empowering individuals, families, and communities to work with professionals who can learn from their experiences and help demand the implementation of known preventive and therapeutic strategies and to hold health-care systems and decision makers accountable is vital. 7 A formulation is needed to personalise care Detection and diagnosis of depression on the basis of symptoms, function, and duration should be accompanied by a clinical review or formulation for each person, which takes into account individual values and preferences, life stories, and circumstances.

Adolescents and young people globally are highly vulnerable to poor mental health especially depression, and they account for 36% of new HIV infections in Eastern and Southern Africa. HIV services remain inadequate for this population and their adherence to ART is low. The Friendship Bench (FB), an evidence-based model developed in Zimbabwe to bridge the mental health gap, is a brief psychological intervention delivered on benches in primary care facilities by lay health workers (\"grandmothers\") trained in problem-solving therapy. This study explored the experience of young people living with HIV attending FB, and their perception of how problem-solving therapy impacted their adherence to ART. Semi-structured interviews were conducted in July 2019 with 10 young people living with HIV aged 18-24 years, who had recently completed FB counselling in Harare. Participants were purposively sampled and recruited from three primary care facilities. Interviews were conducted in Shona, audio-recorded, transcribed verbatim and translated into English. Transcripts were analysed in NVivo12 using inductive thematic analysis. Study findings revealed a clear emotional denial towards HIV, particularly for young people infected perinatally, and a resulting low adherence to ART. The study also unpacked the issues of internal stigma and how young people living with perinatally acquired HIV are informed of their HIV status. Participants reported that FB had a critical role in helping them accept their HIV status. Grandmothers' empathic attitude was key during counselling on adherence to ART, to demystify the disease and treatment, normalize the reality of living with HIV, encourage young people to socialize with peers and free them of guilt. Interviewees unanimously reported improved ART adherence following FB counselling, and many described enhanced health and wellbeing. Participants saw FB as a strong contributor to their general well-being, evident in decreased symptoms of depression and improved adherence to ART. FB problem-solving therapy should be rolled out to further support young people after post-test counselling or HIV serostatus disclosure for perinatally acquired HIV, for acceptance of HIV status and adherence to ART.

Background There is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middle-income countries in sub-Saharan Africa. We validated the Shona version of the PTSD Checklist for DSM-5 (PCL-5) in a primary health care clinic in Harare, Zimbabwe. Method Adults aged 18 and above attending the clinic were enrolled over a two-week period in June 2016. After obtaining written consent, trained research assistants administered the tool to eligible participants. Study participants were then interviewed independently using the Clinician Administered PTSD Scale (CAPS-5) as the gold standard by one of five doctors with training in mental health. Result A total of 204 participants were assessed. Of these, 91 (44.6%) were HIV positive, 100 (49%) were HIV negative, while 13 (6.4%) did not know their HIV status. PTSD was diagnosed in 40 (19.6%) participants using the gold standard procedure. Using the PCL-5 cut-off of ≥33, sensitivity and specificity were 74.5% (95%CI: 60.4–85.7); 70.6% (95%CI: 62.7–77.7), respectively. The area under the ROC curve was 0.78 (95%CI: 0.72–0.83). The Shona version of the PCL-5 demonstrated good internal consistency (Cronbach’s alpha = 0.92). Conclusion The PCL-5 performed well in this population with a high prevalence of HIV. There is need to explore ways of integrating screening tools for PTSD in interventions delivered by lay health workers in low and middle-income countries (LMIC).

In early development programmes in Latin America, anthropologist Paul analysed unsuccessful health programmes and attributed their failure to inadequate understanding of cultural context.3 In 1984, renowned medical anthropologist, Foster, evoked the urgent need for research on ethnomedical studies to inform community health interventions.4 Echoing Foster’s concerns, Airhihenbuwa proposes the centrality of culture in health programmes while critiquing the Eurocentrism of these programmes in the Global South. [...]most research and interventions on newborn care in the Global South focus only on mothers of young children, thereby ignoring the structure of non-western families where caregiving is collective and intergenerational.9 A second example, related to child marriage, concerns the gap between the culturally determined role of elders in perpetuating this practice and the fact that most programmes do not actively involve them while primarily targeting girls and sometimes their biological parents.10 In both cases, programmes blatantly overlook the structure and strategies of family systems to promote the well-being of newborns and adolescents by acknowledging and building on the culturally designated roles of influential family and community members. According to her, social norms are products of those culturally constructed social contexts. According to Henrich et al,14 more collectivist cultures make up approximately 88% of the world’s population, that is, the Majority World.

Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18-24) from across 10 intervention districts and audio recorded 200 of the peer supporters' monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.

Given this context, this Special Issue of the Journal of the International AIDS Society focuses on mental health and HIV, predominantly in LMIC settings with a high HIV burden, and among key populations at greatest risk of HIV, to highlight: (1) the linkage between mental health problems, and other psychosocial factors, which increase HIV risk; (2) the interventions and strategies to prevent HIV among people with mental health problems; (3) factors associated with common mental disorders among young people and adults living with HIV and (4) interventions to improve mental health among persons with HIV (PWH). [...]we endorse WHO advice to integrate screening and treatment of depression into the HIV care cascade in prevention and healthcare settings, including community-based practices [ 18]. [...]prevention must target social determinants across the life course, particularly in adolescence where risk factors can be similar to those in adults, but even more pronounced in terms of their negative consequences. [...]we need to emphasize social justice and equity to reduce disparities and inequities, for example as experienced by sexual, gender, racial and ethnic minorities.

Adolescents living with HIV have poor virological suppression and high prevalence of common mental disorders (CMDs). In Zimbabwe, the Zvandiri adolescent peer support programme is effective at improving virological suppression. We assessed the effect of training Zvandiri peer counsellors known as Community Adolescent Treatment Supporters (CATS) in problem-solving therapy (PST) on virological suppression and mental health outcomes. Sixty clinics were randomised 1:1 to either normal Zvandiri peer counselling or a peer counsellor trained in PST. In January to March 2019, 842 adolescents aged 10 to 19 years and living with HIV who screened positive for CMDs were enrolled (375 (44.5%) male and 418 (49.6%) orphaned of at least one parent). The primary outcome was virological nonsuppression (viral load ≥1,000 copies/mL). Secondary outcomes were symptoms of CMDs measured with the Shona Symptom Questionnaire (SSQ ≥8) and depression measured with the Patient Health Questionnaire (PHQ-9 ≥10) and health utility score using the EQ-5D. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for clinic-level clustering. Case reviews and focus group discussions were used to determine feasibility of intervention delivery. At baseline, 35.1% of participants had virological nonsuppression and 70.3% had SSQ≥8. After 48 weeks, follow-up was 89.5% for viral load data and 90.9% for other outcomes. Virological nonsuppression decreased in both arms, but there was no evidence of an intervention effect (prevalence of nonsuppression 14.7% in the Zvandiri-PST arm versus 11.9% in the Zvandiri arm; AOR = 1.29; 95% CI 0.68, 2.48; p = 0.44). There was strong evidence of an apparent effect on common mental health outcomes (SSQ ≥8: 2.4% versus 10.3% [AOR = 0.19; 95% CI 0.08, 0.46; p < 0.001]; PHQ-9 ≥10: 2.9% versus 8.8% [AOR = 0.32; 95% CI 0.14, 0.78; p = 0.01]). Prevalence of EQ-5D index score <1 was 27.6% versus 38.9% (AOR = 0.56; 95% CI 0.31, 1.03; p = 0.06). Qualitative analyses found that CATS-observed participants had limited autonomy or ability to solve problems. In response, the CATS adapted the intervention to focus on empathic problem discussion to fit adolescents' age, capacity, and circumstances, which was beneficial. Limitations include that cost data were not available and that the mental health tools were validated in adult populations, not adolescents. PST training for CATS did not add to the benefit of peer support in reducing virological nonsuppression but led to improved symptoms of CMD and depression compared to standard Zvandiri care among adolescents living with HIV in Zimbabwe. Active involvement of caregivers and strengthened referral structures could increase feasibility and effectiveness. Pan African Clinical Trials Registry PACTR201810756862405.

Background In 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART). The incidence of non-communicable diseases has increased markedly in PLWH as mortality is reduced due to use of HAART. Common mental disorders (CMD) are highly prevalent in PLWH. We aimed to determine factors associated with probable CMD and depression, assessed by 2 locally validated screening tools in a population with high prevalence of HIV in Harare, Zimbabwe. Methods We carried out a cross-sectional survey of a systematic random sample of patients utilizing the largest primary health care facility in Harare. Adults aged ≥18 years attending over a 2-week period were eligible, excluding those who were critically ill or unable to give written informed consent. Two locally validated screening tools the Shona symptom questionnaire (SSQ-14) and the Patient Health Questionnaire (PHQ-9) were administered by trained research assistants to identify probable CMD and depression. Results Of the 264 participants, 165 (62.5 %) were PLWH, and 92 % of these were on HAART. The prevalence of probable CMD (SSQ14 > = 9) and depression (PHQ9 > = 11) were higher among people living with HIV than among those without HIV (67.9 and 68.5 % vs 51.4 and 47.2 % respectively). Multivariable analysis showed female gender and recent negative life events to be associated with probable CMD and depression among PLWH (gender: OR = 2.32 95 % CI:1.07–5.05; negative life events: OR = 4.14; 95 % CI 1.17–14.49) and with depression (gender: OR = 1.84 95 % CI:0.85–4.02; negative life events: OR = 4.93.; 95 % CI 1.31–18.50) Conclusion Elevated scores on self-report measures for CMD and depression are highly prevalent in this high HIV prevalence population. There is need to integrate packages of care for CMD and depression in existing primary health care programs for HIV/AIDS.

Female sex workers (FSWs) are at an elevated risk of HIV infection with an eight-fold risk of HIV infection. In countries like Zimbabwe, FSWs have an HIV incidence of around 10.2%. With this elevated risk, the World Health Organization has prioritized Female sex workers (FSWS) for PrEP - an HIV prevention option taken as a daily pill during periods of risk but, FSWs continue to experience challenges with daily PrEP adherence due to daily dosing, related side effects, ARV stigma and low risk perception. This article presents the FSWs' lived experiences with PrEP adherence in Zimbabwe. We purposively identified twenty FSWs and conducted individual interviews to understand FSW lived experiences with PrEP adherence. We applied Colaizzi's seven steps of phenomenological analysis to develop the themes. Three main themes emerged, namely positive experiences with PrEP adherence, negative experiences with PrEP adherence and the meaning attached to PrEP adherence. The positive experiences theme had four sub-themes as, overcoming PrEP-related forgetfulness, overcoming mobility-related PrEP disruptions, overcoming COVID-19 pandemic-related PrEP experiences and overcoming PrEP-related side effects. The negative experiences theme had two sub-themes including, enduring GBV and stigma associated with PrEP use and, COVID-19-related disruptions to PrEP adherence. The third emerging them was on the meaning attached to PrEP adherence. This theme had one sub-theme on PrEP adherence as a survival strategy. Whilst FSWs reported both positive and negative experiences with PrEP adherence, it is important that FSWs used the meaning they attached to these experiences to take control of their lives and be more determined to use PrEP adherence for survival and protection from HIV. Based on these findings, we recommend close monitoring and support to promote adherence, minimize PrEP discontinuity and promote positive lived experiences with PrEP adherence.

IntroductionDepressed mood is a psychological state characterised by sadness or loss of interest in activities, is a common symptom that accompanies most major mental disorders. It is therefore reasonable to consider it as a transdiagnostic target, which when addressed, may improve the functioning and quality of life of persons with lived experience of mental disorders. However, there is limited understanding of the depressed mood as a transdiagnostic target across major mental disorders. Therefore, this scoping review aims to synthesise knowledge on depressed mood, its measurement and interventions among persons with anxiety and/or psychosis.Methods and analysisThis scoping review followed Arksey and O'Malley’s framework. Peer-reviewed articles and grey literature published from January 1988 to April 2024 were searched in the following databases: Medline/PubMed, Scopus, Web of Science, Africa-Wide Information, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, SocINDEX, Humanities International Complete, Sabinet, Open Grey and Google Scholar. Articles were screened at title, abstract and full article levels. Data extracted were analysed using thematic analysis and reported following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. We also consulted stakeholders such as lived experience experts, clinicians and researchers to contextualise our findings.ResultsWe screened 245 full articles out of the 4039 hits and included 28 articles in this review. Although depressed mood is conceptually different from clinical depression, the terms are used interchangeably in the literature. The prevalence of depressed mood in psychosis was 7.3–33.3%, with no prevalence studies specific to anxiety disorders. Commonly used outcome measures included Beck’s Depression Inventory (n=6) and Patient Health Questionnaire-9 (n=5). Psychosocial conservative interventions such as cognitive–behavioural therapy were the most common interventions. Other interventions, including yoga, pharmacotherapy and Ecology Momentary Interventions, were also reported. All interventions were reported to improve depressed mood, and most were implemented in high-income settings. Stakeholders, including lived experience experts, concurred on the importance of using depressed mood as a transdiagnostic target, viewing it as a ‘window’ for early identification and management of many common mental disorders.DiscussionThere is a need to clarify the definition and diagnostic cut-off points on common outcome measures of depressed mood. There is also a need for increased research on depressed mood as a viable transdiagnostic target in anxiety and/or psychosis with a special focus on low-to-middle income countries.ConclusionDepressed mood is an important and prevalent transdiagnostic target with great promise for early management in anxiety and/or psychosis. Valid diagnostic and measurement tools are developing, and so are the targeted interventions in the context of anxiety and/or psychosis.