From Research to Practice: A Qualitative Study Examining the Integration of Telehealth-Based Suicide Prevention in HIV Care into Tanzania’s Healthcare System

Abstract

BackgroundDespite the life-saving potential of mental health interventions, their scalability and integration within healthcare systems present significant challenges, particularly in low-resource global settings. In this study, we investigated the potential to scale and integrate IDEAS for Hope, a brief telehealth counseling intervention designed to reduce suicide risk and improve HIV care engagement among people living with HIV (PLWH) in Kilimanjaro, Tanzania. By examining the complex interplay of barriers and facilitators, our objective was to conduct qualitative interviews focused on identifying actionable strategies for successful national implementation.MethodsThis qualitative study used semi-structured in-depth interviews with 20 key stakeholders, including Ministry of Health officials, healthcare administrators, telecommunications providers, community organizations, and insurance providers. Using purposive sampling, interviews were conducted in-person (n=17) and via Zoom (n=3). Interviews were audio-recorded, transcribed, and analyzed in NVivo 14 using thematic analysis. The CFIR-ERIC mapping tool was applied to align identified barriers and participant-recommended strategies with evidence-based implementation strategies, and a stakeholder analysis was conducted to assess key actors’ roles in intervention scale-up. ResultsFindings showed a mix of facilitators and barriers to implementation. Strong institutional support and emerging policy directives promote mental health integration within HIV care, yet barriers persist, including shortage of trained mental health professionals, inadequate digital infrastructure in rural areas, the criminalization of suicide, and stigma. Stakeholders proposed policy reforms, workforce capacity building, digital infrastructure expansion, and the integration of telehealth services within national insurance schemes. Additionally, task-shifting strategies, such as training community health workers (CHWs) to deliver mental health support, were identified as promising solutions for intervention scale-up.Conclusion This study shows that IDEAS for Hope is a feasible and effective intervention for addressing suicide risk among PLWH in Tanzania. However, successful implementation requires addressing systemic, legal, cultural, and infrastructural barriers. By identifying key challenges and solutions, this research informs future scale-up efforts, offering a strategic framework for integrating telehealth mental health services within national healthcare systems.