Abstract
Models estimate that the disability burden from mental disorders in Sub-Saharan Africa (SSA) will more than double in the next 40 years. Similar to HIV, mental disorders are stigmatized in many SSA settings and addressing them requires community engagement and long-term treatment. Yet, in contrast to HIV, the public mental healthcare cascade has not been sustained, despite robust data on scalable strategies. We draw on findings from our International AIDS Society (IAS) 2020 virtual workshop and make recommendations for next steps in the scale up of the SSA public mental healthcare continuum. Early HIV surveillance and care cascade targets are discussed as important strategies for HIV response in SSA that should be adopted for mental health. Advocacy, including engagement with civil society, and targeted economic arguments to policymakers, are reviewed in the context of HIV success in SSA. Parallel opportunities for mental disorders are identified. Learning from HIV, communication of strategies that advance mental health care needs in SSA must be prioritized for broad global audiences. The COVID-19 pandemic is setting off a colossal escalation of global mental health care needs, well-publicized across scientific, media, policymaker, and civil society domains. The pandemic highlights disparities in healthcare access and reinvigorates the push for universal coverage. Learning from HIV strategies, we must seize this historical moment to improve the public mental health care cascade in SSA and capitalize on the powerful alliances ready to be forged. As noted by Ambassador Goosby in our AIDS 2020 workshop, 'The time is now'.
Highlights
Models estimate that the disability burden from mental disorders in Sub-Saharan Africa (SSA) will more than double in the 40 years
Epidemiologic models estimate that the disability burden from mental disorders in SSA will increase by 130% over the 40 years (Charlson et al, 2014)
In stark contrast to HIV, care and treatment cascades for mental health have not expanded across the SSA public sector care continuum, despite nearly 20 years of epidemiological, efficacy and effectiveness data demonstrating that local non-specialists are capable of successful mental health care delivery for common mental health disorders in SSA (Bolton et al, 2003; Lancet Global Mental Health Group et al, 2007; van Ginneken et al, 2021)
Summary
HIV researchers, health policymakers, and funders collaborated to advance the HIV treatment cascade in SSA, reducing population-level HIV mortality and morbidity. Reflecting their success, the burden of human disease in SSA is shifting from communicable to noncommunicable disorders, with a substantial contribution from mental disorders (Gouda et al, 2019). In July of 2020, as part of the International AIDS Conference (AIDS 2020), we convened a scientific workshop entitled, ‘Why HIV and Mental Health Care Need to Work Together in Sub-Saharan Africa: Collaborative Scale-Up to Address Evolving Epidemics’, which brought together researchers, policy experts, and funders to share insights on the prevalence of mental disorders in HIV-affected populations in SSA; explore opportunities for collaborative mental health-HIV implementation; and identify research needs. We discuss the role of these stakeholders for advancing the effort, outline progress in the care continua for HIV and mental disorders, compare and contrast where lessons from HIV are valuable, and make recommendations for steps
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