Title : Geospatial access to mental health service packages for adolescents and young people living with HIV in urban and rural Zambia: A facility mapping and burden-weighted proximity analysis
Abstract:
Background: Adolescents and young people living with human immunodeficiency virus (HIV) require mental health support, but access to medication-inclusive care may be constrained by distance.
Methods: We mapped mental health services in Lusaka (urban) and Shibuyunji (rural), Zambia (February 2025). We linked 46 antiretroviral therapy (ART) sites to treatment current (TX_CURR; ages 15-24) and calculated distance from each ART site to the nearest facility providing on-site psychotropic medication and a composite package (weekend opening + on-site counseling + on-site medication).
Results: Among geocoded facilities (n=84), on-site counseling was common (97.6%) whereas on-site medication was less frequent (36.9%). Only 37.0% of linked ART sites offered the composite package on-site. Overall, 68.3% of TX_CURR was at sites with on-site medication and 99.1% was within 5 km; in Shibuyunji, 28.1% was >5 km away.
Conclusions: Rural ART sites face substantial barriers to medication-inclusive mental health care. Supporting targeted service strengthening, referral navigation, and consideration of mobile/digital modalities would help strengthen service access.
Keywords: Adolescents; Young People; Human Immunodeficiency Virus; Mental Health Services; Geospatial Access
