From research to practice: a qualitative study examining the integration of telehealth-based suicide prevention in HIV care in Tanzania.

Despite the life-saving potential of mental health interventions, their scalability and integration within healthcare systems present significant challenges, particularly in low-resource global settings. This study investigated scaling IDEAS for Hope, a telehealth counseling intervention designed to reduce suicide risk and improve HIV care engagement among people living with HIV in Kilimanjaro, Tanzania, and identified actionable implementation strategies for successful scale-up. We conducted 20 semi-structured interviews, between May and July of 2024, with purposively sampled stakeholders from the Ministry of Health, healthcare administrations, telecommunications, insurance providers, and community organizations. We analyzed the data thematically in NVivo 14 and used CFIR-ERIC mapping to align identified barriers and participant-recommended strategies with evidence-based implementation strategies. Findings showed institutional support and emerging policy directives promoting mental health integration within HIV care, but also persistent barriers, including shortages of trained mental health professionals, inadequate rural digital infrastructure, criminalization of suicide and stigma. Stakeholders recommended policy reform, workforce capacity strengthening, digital infrastructure expansion, integration of telehealth into insurance schemes, and task-shifting strategies. Implementation of IDEAS for Hope appears feasible but requires addressing systemic, legal, and infrastructural barriers. These findings inform future scale-up and provide a framework for integrating telehealth mental health services within national healthcare systems.