Barriers and facilitators to accessing mental health services among young people living with HIV and healthcare professionals in Mozambique: a content and sentiment analysis using the capability, opportunity, motivation and behaviour (COM-B) framework

Background: Ensuring timely and effective access to mental health (MH) services is crucial in Mozambique, where the suicide rate is 13.7/100.000, twice that of sub-Saharan Africa. This is particularly significant for a MH at-risk group, such as young adults (YA) living with HIV. This study aimed to assess barriers/facilitators to access MH services for YAs, comparing by HIV status, in Beira, Mozambique. Methods: A cross-sectional study using focus groups and key-informant interviews was conducted between July and August 2023, involving YAs (18-24 years) with (YALHIV) and without HIV (YAHIV-) and MH staff of five health centres (HCs). A deductive approach was adopted using the COM-B framework to classify themes referring to barriers/facilitators to access MH services. Two researchers carried out the content analysis independently, assessing the inter-rater agreement through Cohen's K. Results: A total of 48 YAs (half with HIV), and 15 MH providers were involved. Of the 650 themes identified, 347 (53.4%) were labelled as barriers. Opportunities were the most frequent barrier (57.7%): social ones were related to community stigma, while physical ones to staff shortage, lack of community services, and distance from HCs. Physical opportunities were a more frequent barrier in YAHIV- (p < 0.001) and females (p = 0.013). Automatic motivation was related to self-stigma and preconceived distrust. It was more common as a barrier among YAHIV- (65.6% vs. 35.5%, p = 0.032). Reflective motivation was the most frequent facilitator (33.1%): YALHIV reported good knowledge of their MH risk factors, and YAHIV- had previous positive experiences with MH services for people close to them. Psychological capability was a barrier for both YAs and MH staff, related to a lack of knowledge of health services and MH in general. Conclusions: Addressing community and self-stigma and scaling up community MH services, increasing MH staff, are the two main action points that emerged to improve access to MH services. More attention should be paid to YAHIV-, which showed significant access barriers.