BACKGROUND:
The prevalence of mental health conditions in South Africa is high, and often negatively affects engagement in healthcare for conditions, such as HIV [1,2]. Community healthcare workers (CHWs) often provide home-based support for those patients initiating and re-initiating HIV treatment and experiencing mental health challenges, with little to no training [3]. However, the mental health needs and available support for these CHWs have not been widely explored.

METHODS:
Our team conducted qualitative, semi-structured individual interviews with 21 CHWs providing home-based care, 25 patients who receive home-based care, and 10 additional stakeholders who work in economically disadvantaged communities around Cape Town. As part of these interviews, participants were asked about delivering mental health services and potential challenges that they may face due to the nature of their work. Interviews were facilitated by two South African team members experienced in qualitative research. Thematic analysis with a hybrid deductive-inductive approach was used for coding, guided by the Consolidated Framework for Implementation Research (CFIR), with 3 RAs from the US team developing an initial codebook and two South African team members who conducted rapid coding.

RESULTS:
Key themes that emerged were (1) CHWs’ experience of stress and negative emotions due to funding uncertainty to organisations that provide healthcare due to geopolitical circumstances; (2) self-disclosure of their own mental health conditions, including common mental health conditions and experiences of trauma; (3) challenges in managing emotions when providing home-based care to vulnerable patients within violent communities that they also live in; (4) limited coping mechanisms to manage feelings while conducting their work (prayer, limited time outdoors) (5) the need to develop skills for their own self-care and support from management teams and healthcare facilities in general.