Using RE-AIM to Assess the Implementation of Depression Screening in HIV Clinics in Kenya

HIV remains a major public health challenge in Kenya, with untreated depression complicating HIV care and impacting treatment adherence and viral suppression. Despite Kenya's success in meeting international HIV control targets to date, diagnosis and treatment of depression among people living with HIV (PLH) remains insufficiently addressed. Given the well-established adverse impacts of depression on HIV care outcomes, improving depression care is critically important to maintaining Kenya’s laudable progress in addressing their HIV epidemic. The 2022 Kenyan HIV Prevention and Treatment guidelines recommend at least annual use of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in HIV care settings, but only 52% of PLH in care had been screened in the last year according to national administrative data. Our long-term goal is to improve rates of equitable screening, referral, and treatment for depression among PLH in Kenya, thereby improving HIV care outcomes. The objective of this R36 application is to leverage implementation science approaches to evaluate the current utilization of PHQ-9 screening in HIV clinics in Kenya. This project aims to evaluate the utilization of PHQ-9 screening in Kenyan HIV clinics using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. This study will pursue three specific aims: (1) Estimate the prevalence of depression among PLH in Kenya and assess variations across key populations, clinic types, and geographic regions to inform targeted interventions. (2) Analyze the reach, effectiveness, and maintenance of PHQ-9 screening in government-funded HIV centers using electronic health record data, including evaluation of equity in screening based on demographic characteristics. (3) Conduct a qualitative evaluation of PHQ-9 implementation in three purposively selected HIV clinics in Kisumu, Kenya, exploring barriers and facilitators through in-depth interviews with purposively selected care providers. For aims 1 and 2, we will conduct quantitative analyses of nationally representative HIV program data. For aim 3, we will conduct qualitative, in-depth interviews with healthcare providers and staff at three selected HIV clinics in Kisumu, Kenya. This proposed research is highly significant because it aims to improve mental health integration into HIV care, enhance screening practices, and guide policy and program improvements, thereby advancing both mental health and HIV care outcomes in Kenya and potentially other African settings. Project Number: 1R36MH140596-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Tigest Mekonnen | Institution: EMORY UNIVERSITY, ATLANTA, GA | Award Amount: $46,682 | Activity Code: R36 | Study Section: Special Emphasis Panel[ZRG1 F17B-M (20)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11186926