Acceptability and Feasibility of a Task-Shifted Collaborative Care Model for Depression and Anxiety in Primary HIV Clinics in the Philippines: A Qualitative Inquiry

Background Depression and anxiety can greatly impact the overall health of a person living with HIV (PLHIV). Management of mental health conditions should be an integral part of HIV care. The Collaborative Care Model (CoCM) is an evidence-based model of care that integrates mental health in primary care. This study aimed to assess the acceptability and feasibility of implementing the CoCM for depression and anxiety in HIV clinics in the Philippines using HIV counsellors as care managers. Methods We conducted a qualitative study by facilitating focus group discussions (n = 7) and key informant interviews (n = 18) with 53 HIV and mental health stakeholders, including PLHIV (n = 20), HIV counsellors (n = 11), physicians (n = 10), clinic heads (n = 4), policy makers (n = 4), and mental health providers (n = 4) from August 2021 to March 2022. Participants were recruited from 17 HIV clinics in the Philippines. We employed a thematic analysis using the Consolidated Framework for Implementation Research (CFIR) domains as themes. Results Almost all PLHIV participants were men (95%), with a mean age of 28 years old, while 58% of the other stakeholders were women, with a mean age of 44 and working in their field for an average of 8 years. Factors that influenced acceptability of the CoCM included the need for better mental health services, increasing access to mental health care and providing more holistic care. Participants expressed acceptability for HIV providers to do mental health screening and care due to the trust that had previously been built during their HIV care. Perceived barriers included inadequate numbers of psychiatrists, an overburdened and understaffed HIV workforce, low mental health knowledge among HIV providers, and implementation cost. For the CoCM to be feasible and more acceptable, mental health trainings, collaborations for improved access to psychiatrists (e.g., within and across clinics), clear care integration protocols, proper planning and pilot testing were recommended. Conclusion We found the CoCM to be acceptable among study participants as a way to integrate mental health in HIV care. Strategies including capacity-building for HIV providers and strengthening of health systems are needed for the CoCM to be more feasible in HIV clinics in the Philippines.