Date of Award

1-1-2023

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ashley K. Hagaman

Abstract

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory approaches to explore this research question. Our findings reveal that in lieu of formalized integrated mental health services, HIV care providers navigate a complicated implementation climate and experience tension with both the clinic they work for and the patients they serve. They overcome these complications with a range of adaptive processes. Specifically, mental health complications among patients impede on providers’ ability to achieve professional goals like viral suppression targets, and personal motivations like ensuring patients are holistically catered for. They operate within this context by becoming the resources they need to achieve these goals. Additionally, providers identified that antiretroviral therapy (ART) adherence counseling is insufficient in addressing complex mental distress. They overcome this barrier by optimizing adherence counseling with inventive problem solving techniques. Engaging in these adaptive processes places unrealistic expectations on both the providers and their patients and takes a mental toll on the providers as well. These findings highlight the hidden mechanisms HIV care providers engage in to cater to patients mental health needs and sheds light onto sustainable, context specific recommendations to successfully adopt and integrate mental health protocols into HIV practice.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2025

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