This series explores the broader implications of recently proposed changes in US policy and funding for science and public health in the US and around the globe. In this story, Dr. Jeremy Schwartz discusses how cuts to USAID funding for HIV programs in Uganda could undermine efforts to integrate mental health care into HIV treatment, as well as the stability of essential health services for persons living with HIV.

Please tell us about a research, patient care, or educational program you have been involved in and its significance to global public health.

Dr. Jeremy Schwartz: One of my current federally funded projects (5R21MH134565-02), supported by the National Institute of Mental Health, seeks to identify new strategies to improve mental health care for patients in HIV clinics in Uganda. This initiative builds on nearly a decade of successful integration of hypertension care into HIV programs, an approach that has now been adopted into national guidelines.

Building on this model, the Ugandan government has now begun integrating mental health care into HIV services. This is particularly important because mental health conditions are more prevalent among people living with HIV. However, implementing mental health screening, diagnosis, and treatment in busy clinical settings remains challenging, particularly because of concerns about privacy and the stigma that surrounds mental health conditions.

To address these challenges, we are working closely with patients and clinicians to adapt an innovative digital health tool to allow patients to confidentially answer sensitive questions via their mobile phones. This project builds on a similar digital health solution previously developed for heart failure patients with funding from a grant (5R01HL166585-02) from the National Heart, Lung, and Blood Institute. Our research will determine if the digital approach can improve mental health outcomes while reducing clinician workload and streamlining mental health services.

How have new federal policies impacted this work in the short term?

USAID is the main implementing agency for PEPFAR, the President’s Emergency Fund for AIDS Relief. The halting of funds to USAID projects in Uganda has created substantial uncertainty for patients, job insecurity for healthcare workers, and disrupted the flow of medicines to treat HIV and prevent its spread. Although our mental health integration research is separately funded, conducting this research depends on our patients being able to attend HIV clinics and access life-sustaining medications.

If they continue, how will the new policies impact this work and public health over the longer term?

Integrating care for noncommunicable diseases like hypertension and mental health conditions with HIV care relies on stable, well-functioning HIV programs. Without the support of PEPFAR funds through USAID, people living with HIV may lose access to consistent care. This could jeopardize efforts to integrate care for other chronic conditions and weaken the overall health system.