TY - JOUR T1 - Evaluation of a Depression Intervention in People With HIV and/or TB in Eswatini Primary Care Facilities: Implications for Southern Africa JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-22-00016 VL - 11 IS - 2 SP - e2200016 AU - Nina Putnis AU - Nick Riches AU - Archibald Nyamayaro AU - Darah Boucher AU - Rebecca King AU - Ian F. Walker AU - Alett Burger AU - Paul Southworth AU - Violet Mwanjali AU - John Walley Y1 - 2023/04/28 UR - http://www.ghspjournal.org/content/11/2/e2200016.abstract N2 - Key FindingsIntegrating care for chronic diseases, including mental health conditions, is a critical yet challenging element of universal health coverage goals, especially in low- and middle-income countries. The simple intervention for depression and anxiety, based on behavioral methodologies, supports people living with HIV and/or TB with comorbid depression or anxiety.This pilot service evaluation presents real-life findings, with a focus on acceptability and feasibility, demonstrating issues around feasibility and the capacity of nonspecialist nursing staff to undertake additional mental health counseling without explicit support and resources, including time. It demonstrates acceptability among staff and patients.Key ImplicationsPolicymakers, health systems leaders, and health service staff should recognize the importance of integrated care, especially neglected mental health care, and advocate for dedicated resources, time, and capacity of health workers to take on this additional role.Meaningful consultation with the health workforce is a critical element of service development.Introduction:Depression associated with chronic illnesses is common in Southern Africa, yet there are major treatment gaps. This study assesses the feasibility and acceptability of the Healthy Activity Program intervention for depression among people with HIV and/or TB. The intervention involves training nonspecialist nurses in depression, including identification, counseling based on behavioral activation theory, and structured referral.Methods:This is a mixed methods evaluation of a pilot counseling service integrated within routine HIV and TB care from 2018 to 2019. Participants included people living with HIV and/or patients with TB in rural Eswatini.Results:A total of 324 people living with HIV and/or TB were screened for depression, with 19% (62/324) screening positive. The median number of sessions attended was 3 (interquartile range: 1–5), with 16/60 (26%) attending the minimum 5 sessions. Qualitative results indicated acceptability, but there were concerns about feasibility.Conclusions:The Healthy Activity Program is a promising option to manage the treatment gap for depression in people with HIV and/or TB. However, task-shifting to nonspecialist health care professionals without increasing staff capacity is a barrier to implementation. Realistic and pragmatic assessments of capacity and workforce are essential. ER -