Table 1.

Mental health and substance use screening model

Condition	Pre‐screen			Full screen
	Question	Answers (points)	Positive screen	Tool	Positive screen
Depression	How often do you feel sad?	Every day (4) Most of the time: five to six days a week (3) Sometimes: three to four days a week (2) Not much: one to two days a week (1) Never (0)	2 or higher	Screening for depression using the Patient Health Questionnaire (PHQ‐9) [44]	10 or higher
Suicidality			2 or higher on depression pre‐screen	Screening for suicidality using the Adolescent Innovations Project (AIP) working with Adolescents living with HIV handbook [48]	Past or current thoughts of self‐harm/suicide or previous suicide attempt
Anxiety	How often do you feel worried?	Every day (4) Most of the time: five to six days a week (3) Sometimes: three to four days a week (2) Not much: one to two days a week (1) Never (0)	2 or higher	Screening for anxiety using the Generalized Anxiety Disorder 7‐item (GAD‐7) scale [45]	10 or higher
Post‐traumatic stress disorder (PTSD)	Have you ever/since your last visit had a bad experience where you were scared that you or someone you love would be seriously hurt or killed?	Yes No	Yes	Screening for PTSD using the Primary Care PTSD Screen for DSM‐5 (PC‐PTSD‐5) [46]	3 or higher
Substance use	Do you drink alcohol or use drugs?	Yes No	Yes	Screening for substance use using the CAGE Adapted to Include Drugs (CAGE‐AID) scale [47]	2 or higher

Screening tools have been validated in various settings and populations including in low‐ and middle‐income settings and adolescents and showed mostly good (area under the curve [AUC] >0.8) or acceptable (AUC>0.7) diagnostic accuracy [44, 59]. However, none of the tools has been validated in South African ALHIV.