Table 2.

Evidence for sustained impact: contrasting excerpts from interviews with trained v. not-trained providers

	Trained provider	Not-trained provider
Attitudes toward incorporating mental health in HIV care	I feel that we have to work on mental health problems aggressively. Continuous updates (trainings, guidelines, brochures) on the area will give us more confidence so as to opt to manage such cases rather than ignore them. With sufficient training and support I will be more than happy to work on mental health problems. – 207	I always put myself in the shoes of others: I really feel and share the challenge and pain of my clients. If I had adequate knowledge in the area with good training I would have been supporting many clients with this problem. – 503
Attitudes toward detecting mental health problems	The training has helped me to be more conscious of mental health problems, which I used to overlook before. Prior to the training, I had no understanding as to how to approach patients with such problems because I didn't have sufficient knowledge on the area. Moreover, I used to ignore such cases because I felt it was not a serious problem at all. – 206	Unfortunately due to our facility high client load I don't have much time to deal with patients with mental health problems. Only very few things I try to discuss and provide them (with help). I usually send them to the psychiatric clinic even though I know that the service might be substandard there due to lack of adequate trained manpower. – 501
Types of problems noted	Before the training, I was not that conscious about the need for mental health assessments. My approach was very ordinary like ‘How are you? Why do you be stressed? Be courageous …’ and was not professional. After the training, however, I do not see (take) anxiety for granted. – 212	Both of them [patients with mental health problems] were presenting with almost similar behaviors – they were disturbing others, aggressive, and unstable. They were not willing to listen to others. – 502 I observed some clients with the symptoms of irritability, getting easily anger, unwilling/not happy to continue with their treatment. Overall, the symptoms indicated that these clients were not mentally stable. – 500
Decisions to refer	We see many stressful clients – some of such cases may be rehabilitated by intensive counseling and some not. Based on the level of severity of the problems we either handle them here providing allowable treatments (like amitriptyline) or we refer to the psychiatry unit. – 304	We are extremely busy and can't spend time with emotionally disturbed clients. No single organization can address all their needs. We should be aware of their problems, not ignore them but it is a joint effort (with psychiatry). – 305 He used to visit our clinic with no scheduled appointment… Finally I referred him to psychiatry clinic and the psychiatry clinic again referred him to [the psychiatric hospital]. But still he is with the same problem after 6 months. – 500