Health system barriers to accessing depression care among HIV/AIDS patients in Juja Sub-County, Kiambu county, Kenya.

Abstract

Depression is a common comorbidity among HIV/AIDS patients, adversely affecting adherence to medication and health outcomes. However, barriers to accessing depression care in resource-limited settings remain poorly understood. This study aimed to identify health system barriers to providing depression care for HIV/AIDS patients in Juja Sub-County, Kenya, based on clinicians' perspectives. A cross-sectional qualitative study was conducted in Juja Sub-County, focusing on the six comprehensive care centers (CCC) in the region. Key informant interviews (KII) were carried out with six clinicians, purposively selected for their direct involvement in HIV/AIDS care. Data were collected using a semi-structured interview guide and analyzed thematically, guided by the World Health Organization's six building blocks of the health system. Thematic analysis revealed barriers across all the building blocks of a health system. Primarily, there is limited capacity to provide depression services at all facilities as only screening and referral services are available. There is also an acute shortage of mental health professionals [1]with only one psychiatric nurse in the Sub-County. Also, there is lack of monitoring and evaluation of the quality of depression care provided. Another access barrier was a lack of medication for the treatment of depression. Clinicians reported that their capacity is limited to screening and referral. Also, our study found that funding for mental health was inadequate; similarly, there was a lack of any dedicated financial resources for the care of mental health within HIV/AIDS programs. Health system barriers to accessing depression care for HIV/AIDS patients in Juja Sub-County are multifaceted, affecting all six building blocks. Strengthening these areas through integrated service delivery, capacity building, enhanced resource allocation, and policy reforms is essential to improving access to depression care and health outcomes for HIV/AIDS patients.