Expert consensus on barriers, facilitators and digital strategies to improve mental health service access for adolescents and young people living with HIV in Zambia 2025: A Delphi study

BackgroundAdolescents and young people living with HIV (AYPLHIV) experience a high burden of depression, anxiety, behavioral difficulties, and psychosocial distress. These challenges undermine antiretroviral therapy (ART) adherence and long-term HIV outcomes. In Zambia, mental health services remain fragmented, centralized, and weakly integrated with HIV care. Expert consensus is needed to prioritize feasible system, service, and digital strategies to strengthen mental health access for AYPLHIV. MethodsWe conducted a two-round Delphi study with ten Zambian mental health experts (psychiatry, psychology, nursing, HIV program management, and digital health). Round One (September 1-10 2025) collected open-ended responses on barriers, facilitators, and mobile health (mHealth) strategies. Responses were thematically analyzed in Ligre 6.5.1 and synthesized into 29 candidate statements. In Round Two (September 15-20, 2025), experts rated each statement on a five-point Likert scale (1-5). Consensus was defined a priori as [≥]70% rating a statement 4-5 and an interquartile range (IQR) [≤]1. ResultsConsensus was reached for 27 of 29 statements (93%). Experts identified HIV- and mental-health-related stigma, poverty and transport costs, limited decentralization, low mental health literacy, harmful gender norms, and shortages of trained providers as key barriers to AYPLHIV accessing care. Priority facilitators included decentralizing services to primary and community levels, integrating mental health into ART clinics, strengthening youth-friendly and confidential counseling, expanding peer-support models, and improving multisector collaboration. mHealth solutions were strongly endorsed as confidential, scalable tools if they ensured robust data protection, offline or low-data functionality, multilingual and audio-visual content, and clear referral pathways to facility-based services. ConclusionsThis Delphi process generated clear expert consensus on pragmatic priorities for expanding youth mental health care within Zambias HIV program. The findings provide a framework for policymakers and implementers to integrate mental health and mHealth into HIV prevention, treatment, and care for AYPLHIV and to guide implementation and scale-up of youth-focused mental health interventions.