A recent publication exploring facilitators and barriers to implementing population-level portal-based depression and anxiety screening for people with HIV has been selected as the second TC CFAR Directors’ Choice for 2024. Published in JMIR Formative Research, the paper is led by corresponding author Neda Laiteerapong, MD, MS, associate professor of medicine at the University of Chicago. 

Depression and anxiety are common among people with HIV and are associated with inadequate viral suppression, disease progression, and increased mortality. However, depression and anxiety are underdiagnosed and undertreated in people with HIV. Conducting population-level depression and anxiety screening through the patient portal is a promising intervention that has not been studied in HIV care settings. 

“People living with HIV have a higher risk for experiencing stigma from their HIV status, sexual preferences, and gender identity. These stigmas, and the chronic condition of HIV itself, can increase the mental health burden and increase the likelihood of developing depression and anxiety,” said Laiteerapong. “In most settings, patients with HIV do not receive routine screening and are evaluated for mental health problems only when they bring up the issue to their care providers.” 

For this study, the authors conducted interviews based on the Consolidated Framework for Implementation Research with 10 clinicians at an HIV clinic. Study results found that facilitators to implementing population-level portal-based depression and anxiety screening for people with HIV included empowering patients and initiating communication about mental health, staff beliefs about the importance of mental health screening and benefits for HIV care, and more. Barriers included patient access, experience, and comfort using the portal; variations in how providers use the electronic health record and communicate with patients; and limited capacity to address mental health concerns during visits for HIV; among others. 

Proposed strategies to overcome the hurdles of implementing population-level portal-based screening for people with HIV were highlighted in the paper. The authors suggested before implementation, clinics can refine how results are displayed and communicated in the electronic health record; make screening tools available for patients to use on demand in the portal; create protocols for positive depression and anxiety screeners, including those indicating imminent risk; and more. During implementation, the authors said clinics should provide training for clinicians and staff on protocols; offer technical support for patients on how to use the portal; help clinicians manage mental health concerns; and additional strategies. 

Laiteerapong “benefitted from a TC CFAR pilot award for this study, which was instrumental,” she said. She collaborated with Jessica Ridgway, MD, MS, associate professor of medicine at the University of Chicago and director of the TC CFAR’s Clinical Sciences Core, on this project. They both recently presented the TC CFAR workshop, “Population Health and Patient Portal Mental Health Screening for People Living with HIV.”  

Read the entire publication of the Directors’ Choice selection.