Mapping mental health and psychosocial support service availability for adolescents and young people living with HIV in Lusaka and Shibuyunji districts, Zambia: Alignment with ART program burden (September 2024)

Vollständiger Abstract

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Adolescents and young people living with HIV (AYPLHIV) experience substantial mental health and psychosocial challenges, yet information on youth-responsive service availability is often limited for routine planning. We mapped mental health and psychosocial support services in Lusaka and Shibuyunji districts of Zambia and assessed alignment with AYPLHIV antiretroviral therapy (ART) program burden using treatment current (TX-CURR) ages 15–24 data. We conducted a cross-sectional mapping survey (10–21 February 2025) of facilities providing any mental health/psychosocial service to characterize service modalities, operating days, eligibility/consent requirements, privacy infrastructure, and ownership. We linked mapped facilities to ART sites and September 2024 TX-CURR using standardized facility names and districts, and calculated burden-weighted coverage among linked sites. As of September 2024, 16,550 AYPLHIV (15–24) were on ART across 87 sites, with 97.7% of burden in Lusaka. We mapped 88 facilities (73 Lusaka; 15 Shibuyunji); 58.0% were government-owned and 40.9% privately owned. Counseling was widely available (97.7%), whereas group therapy (31.8%), medication (37.5%), and medical supervision [observed medication] (38.6%) were less common; medication was frequently referral-based. Weekend availability was reported by 60.2% and parental/guardian consent requirements by 28.4%. Routine data readiness was higher in Lusaka than Shibuyunji (93.2% vs 66.7%; OR 6.8, 95% CI 1.7–27.7; p = 0.011). Forty-seven facilities were linked to ART sites representing 11,194 AYPLHIV: burden-weighted coverage was 40.7% for weekend services, 47.2% for referral medication, and 23.0% for a composite package (weekend availability + on-site counseling + referral medication). AYPLHIV burden is concentrated in Lusaka, but key access features (weekend options, privacy) and biomedical support beyond counseling often depend on referral pathways and are not consistently aligned with high-burden sites. Strengthening youth-friendly service organization, referral functionality, and routine monitoring at high-burden sites may improve equitable access to mental health and psychosocial support.