Table 3.

Influences on sustainability: excerpts from interviews with trained providers

	Favors sustainability	Hinders sustainability
Program factors
Perceived effectiveness	I remember my client who started to hallucinate after he took ART for 5 months. At the time I had already taken the training. I treated him and helped him recover from the problem without a need to refer him to a psychiatrist. He totally recovered after 15 days of treatment and follow up – and was back to his business. – 201	We usually observe mental health problems in mothers who are economically deprived, who divorced/betrayed by their husbands, who have several children, etc. It is common that husbands abandon such mothers when they learn of their HIV status – and that leads them to stress that again leads to mental health problems. We usually provide strong counseling for such clients but sometimes we end up fruitless. – 302.
Perceived fit	Definitely [training] helped me to be conscious of mental health problems, easily identify such cases, and link with our mental health clinic when need be… Without the training I wouldn't have managed such clients as intended. – 303	So not only health facilities but also other civil society organizations, financial institutions, the media, and other stakeholders should work together to mitigate the impact (of chronic illnesses such as HIV, TB, and leprosy). – 305
Promoting new partnerships	[The training] enhanced the level of communication and collaboration between my team and the psychiatry unit. Currently the two units have a very good understanding and (more) synergy than ever before. – 207	I consult my supervisor and colleagues when I face challenges. It is a teamwork and no one can handle all cases on its own. Previously we also had a regular professional counseling and discussion sessions with mental health specialists from OPD. It is no longer happening now after the lead mental health specialist left the facility. – 212
Contextual factors
Burdens and competing demands		I am highly interested to support such clients as far as my work environment allows, but it takes time. 301
Physical space		For the sake of privacy we sometimes abstain ourselves from asking some important questions. 302
Support from management		There are inconsistencies in service provision, which is majorly related to loose commitment of staff. If we are committed, we have the knowledge and so we can deliver. – 301
Inclusion in new staff orientation		You may get surprised. I only know very recently even about the presence of one psychiatrist at the facility. I don't know really whether there is any conditions which conducive for mental health management in the facility. – 502
Quality of partnerships	This week I faced a controversial issue regarding a patient that was referred to me from psychiatry unit. I discussed with doctors in my unit and diagnosed him for toxoplasmosis. Currently we are waiting for the result. In case he is diagnosed negative for toxoplasmosis we will send him back to the psychiatry unit for further diagnosis. 207	Not at all [ever provided MH care to ART patient] due to several reasons. One thing I am a new employee and the other is I expect I am not supposed to work in the clinic for longer duration due to the need of rotation to other units according to the facility regulation. I may rotate to emergency clinic and wards too. – 501