Health Professionals’ Perspectives on the Provision of Mental Health Services for People with Mental Health Problems and HIV: A Qualitative Study

Background: Mental health problems are common among people living with HIV (PLWH); however, the use of mental health services remains inadequate in many low- and middle-income countries. Objectives: This study aimed to explore the perspectives of health professionals on the provision of mental health services for PLWH presenting with mental health problems in primary health care in Lesotho. Methods: A qualitative descriptive approach was adopted, involving semi-structured interviews with 50 health professionals who were purposely selected, including nurses and medical officers, each with a minimum of 2 years’ primary health care experience in the Maseru district. Data were collected between December 2022 and January 2023, audio-recorded, and transcribed verbatim. Data collection continued until thematic saturation was achieved, and analysis was conducted using a thematic framework analysis. Results: The analysis revealed two main themes: (1) limited knowledge of mental health problems, encompassing an inadequate understanding of signs and symptoms, diagnosis, and management, and (2) barriers to the management of mental health problems. Key subthemes included the shortage of qualified mental health specialists and psychiatric medications, the absence of dedicated counselling services for the prevention of mental health problems, lack of a mental health department, time constraints within clinical practice, and limitations in clinical infrastructure. Cultural beliefs, stigma, and discrimination, both among health professionals and in the broader community, were also identified as significant impediments. Participants described a substantial treatment gap, driven by insufficient training and limited resources, which undermines the effective delivery of mental health services. Conclusions: The findings revealed that health professionals working in primary health care in Lesotho experience considerable knowledge gaps and systemic constraints that hinder the provision of adequate mental health services for PLWH who have mental health problems. These challenges can be mitigated through targeted capacity building, the integration of MHS into primary care, improved resource allocation, and strategies to reduce stigma, thereby enhancing health outcomes.