Table 1.
Characteristics of the HIV-mental health integration intervention related to sustainability
| Influences on sustainabilitya | Promoted sustainability | Hindered sustainability |
|---|---|---|
| Intervention characteristics | ||
| Flexibility/fit | Content fit will with patient needs and built on prior training in HIV counseling | Inability to address social determinants of mental health problems could be frustrating to staff |
| Effectiveness or benefit | Trained staff felt material was effective, benefited patients | |
| Ability to maintain fidelity | Promotion of inter-professional collaboration built knowledge; charts and ‘pocket guides’ useful | Lack of booster sessions to support and create new collaborations and maintain attention to program |
| Context | ||
| System/policy change | Government interest in integrated care as vehicle for expanded access to mental health services | Though endorsed by leadership no long-term champions emerged at local level |
| Setting characteristics (structure, policies) | High volume patient care, lack of privacy; policies requiring nurses to rotate services; fixed national medical record not allowing mental health care to be documented | |
| Capacity | ||
| Workforce | Elevated status of mental health nurses and/or returned them to mental health roles | Continued turnover in HIV staff; mental health not part of on-boarding of new HIV staff |
| Processes | ||
| Building relationships | Increased informal bi-directional consulting between HIV and mental health staff | Lack of formal joint activities such as rounds or team meetings |
| Mechanisms for evaluation and feedback | Absence of screening and documentation requirements that could have facilitated evaluation |