Missed opportunities to address common mental disorders and risky alcohol use among people living with HIV in Zomba, Malawi:A cross sectional clinic survey

Common mental disorders (CMDs) and risky alcohol use are highly prevalent among peopleliving with HIV, yet many do not receive treatment for these mental health problems. InMalawi, despite a mental health policy aiming to include mental healthcare into primaryhealth care, many clients with HIV go unscreened and untreated for mental illnesses, indicatingmissed opportunities to offer mental health care to people living with HIV. The aim ofthis study was to determine the numbers and types of missed opportunities for screeningand treatment of CMDs and risky alcohol use amongst a sample of people living with HIVattending anti-retroviral (ART) clinics in Zomba Malawi. A descriptive cross-sectional clinicsurvey was used, at three ART clinics in the Zomba district. Random sampling was conductedfor all clients attending their ART clinics on specific days. The study surveyed 382participants living with HIV. Of these participants, the majority were women (N = 247,64.7%), and 87 (22.8%) screened positive for CMDs and/or alcohol misuse using the selfreportingquestionnaire 20 (SRQ-20) and alcohol use disorder identification test (AUDIT). Ofthese, only 47 (54%) had been screened by health workers for CMDs or risky alcohol use inthe past 12 months, and 66 (76%) wanted to receive treatment. Of the total sample of 382participants, only 92 (24%) and 89 (23%) had been screened for CMDs or risky alcohol useby health workers. Failures by clinical officers and nurses to screen or treat CMDs and riskyalcohol use in ART clinics represent missed opportunities to address the mental health ofpeople living with HIV. Providing psychoeducation for staff, guidelines for screening andmanaging CMDs and alcohol use, increasing human resources, and accelerating implementationof the mental health policy in Malawi may be a few ways of improving mental healthservice provision at ART clinics in Malawi