Mental Health Research Unit, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
Butabika National Referral Mental Hospital, Kampala, Uganda.
PLoS One. 2021 Nov 30;16(11):e0259425. doi: 10.1371/journal.pone.0259425. eCollection 2021.
There is growing recognition of the burden of depression in people living with HIV/AIDS (PLWHA), associated with negative behavioural and clinical outcomes. Unfortunately, most HIV care providers in sub-Saharan Africa do not routinely provide mental health services to address this problem. This article describes the process of developing a model for integrating the management of depression in HIV care in Uganda. Theory of Change (ToC) methodology was used to guide the process of developing the model. Three successive ToC workshops were held with a multi-disciplinary group of 38 stakeholders within Wakiso district, in the Central region of Uganda. The first 2 workshops were for generating practical ideas for a feasible and acceptable model of integrating the management of depression in HIV care at all levels of care within the district healthcare system; while the third and final workshop was for consensus building. Following meaningful brainstorming and discussions, the stakeholders suggested improved mental wellbeing among PLWHA as the ultimate outcome of the program. This would be preceded by short-term and intermediate outcomes including reduced morbidity among persons with HIV attributable to depression, allocation of more resources towards management of depression, increased help-seeking among depressed PLWHA and more health workers detecting and managing depression. These would be achieved following several interventions undertaken at all levels of care. The participants further identified some indicators of successful implementation such as emphasis of depression management in the district healthcare plans, increased demand for anti-depressants etc; as well as various assumptions underlying the intervention. All these were graphically aligned in a causal pathway, leading to a ToC map, contextualizing and summarizing the intervention model. The ToC was a valuable methodology that brought together stakeholders to identify key strategies for development of a comprehensible contextualized intervention model for managing depression within HIV care in Uganda; allowing greater stakeholder engagement and buy-in.
人们越来越认识到艾滋病毒/艾滋病感染者（PLWHA）中抑郁的负担，这与负面的行为和临床结果有关。不幸的是，撒哈拉以南非洲的大多数艾滋病毒护理提供者并没有常规提供心理健康服务来解决这个问题。本文描述了在乌干达制定将抑郁管理纳入艾滋病毒护理模型的过程。变化理论（ToC）方法被用来指导制定模型的过程。在乌干达中部地区的瓦基索区，与 38 名多学科利益相关者举行了三次连续的 ToC 研讨会。前两次研讨会是为了在区医疗保健系统内的所有护理水平上为可行和可接受的将抑郁管理纳入艾滋病毒护理的模式生成切实可行的想法；而第三次也是最后一次研讨会是为了达成共识。在有意义的头脑风暴和讨论之后，利益相关者提出改善 PLWHA 的心理健康作为该计划的最终结果。这将以前期结果为基础，包括因抑郁而减少艾滋病毒患者的发病率、分配更多资源用于抑郁管理、增加抑郁 PLWHA 的求助意愿以及更多的卫生工作者发现和管理抑郁。所有这些都将通过在所有护理水平上采取的几项干预措施来实现。参与者还确定了一些成功实施的指标，例如在区医疗保健计划中强调抑郁管理、对抗抑郁药的需求增加等；以及干预的各种假设。所有这些都以因果关系图的形式对齐，形成一个 ToC 图，使干预模型在上下文中得到总结。ToC 是一种有价值的方法，它将利益相关者聚集在一起，确定了发展一种可理解的、针对乌干达艾滋病毒护理中抑郁管理的上下文化干预模型的关键策略；从而使更多的利益相关者参与并支持。
