Rapid Qualitative Analysis to Inform Preimplementation of a Stepped-Care Model for Depression Care Among Older People Living With HIV in Ibadan, Nigeria.

Abstract

Background: Depression is common among older adults living with HIV (OLHIV) and is associated with poor antiretroviral adherence and higher viral load. Despite the importance of addressing psychological health issues in older people living with HIV, there is a paucity of tailored depression interventions for low-resource settings. Although the stepped-care task-sharing (SCT) intervention model is effective for depression in low-resource settings, it has not been applied to this population. This study examined preimplementation requirements for piloting a SCT model for depression among OLHIV in a government-funded clinic in Southwest Nigeria.

Methods: We conducted a qualitative preimplementation study, guided by the Consolidated Framework for Implementation Research (CFIR), to assess the contextual fit and feasibility of integrating a SCT intervention for depression into routine HIV services. In-depth interviews were conducted with healthcare providers and older adults with HIV at the Infectious Disease Institute, Ibadan, Nigeria. Data were analyzed using rapid qualitative methods to identify CFIR-informed barriers, facilitators, and adaptation needs to guide intervention refinement prior to pilot testing.

Results: Twenty-two interviews were conducted with healthcare providers (n = 11) and OLHIV (n = 11), each lasting 30-45 min. Findings indicated that the SCT intervention was perceived as feasible, supported by staff willingness and existing clinic structures that could be leveraged during pilot testing. Key barriers to implementation included high workload, limited provider training, stigma, discontinuity of care, and financial constraints. Facilitators included organizational readiness and high acceptability among service users.

Conclusion: The SCT model is perceived as acceptable and potentially feasible for integrating depression care into HIV services for OLHIV. However, it requires adaptation into existing workflows, provider capacity, and patient follow-up routines. Findings provide insights to refine the intervention processes in preparation for pilot testing and integration of psychological healthcare into HIV services.