Table 1 Data analysis method

Objective 1: To determine the level of psychological distress (as measured by the HSC), and determine the prevalence of MDD, GAD, PTSD, and SUD (as measured by the SCID-5) among persons who are seeking an HIV test

Descriptive statistics will be used to determine the level of psychological distress, and prevalence estimates for common mental disorders, using a confidence interval of 95%. Rates of comorbidity will also be calculated to determine the number of individuals who meet diagnostic criteria for two or more disorders

Objective 2: To determine the sensitivity, specificity, and positive and negative predictive values of the BDI, BAI, PTSD-SS, AUDIT and DUDIT in predicting MDD, GAD, PTSD, and SUD, respectively among persons seeking HIV testing

The sensitivity, specificity and positive and negative predictive values of self-report measures, will be calculated using receiver operator curve (ROC) analysis [49]. By determining the area under the curve for each of the self-report measures, we will be able to establish the optimal cut-score on the various self-report measures, using the SCID-5 as the gold standard

Objective 3: To document fluctuations in the level of psychological distress and the development of psychiatric symptoms in the 12 month period following receipt of an HIV positive diagnosis

Repeated measures of ANOVA for scores obtained on the HSC, BDI, BAI, PTSD-SS, AUDIT, and DUDIT, at times 1, 2 and 3, will be used to establish if there are significant fluctuations in levels of psychological distress and symptoms of psychiatric disorders over the 12 month period following receipt of an HIV positive diagnosis, using a confidence interval of 95%. Mixed-effects regression models will be used where appropriate to take account of both fixed effects and random effects, on the repeated measures of psychiatric symptoms over the three time points [50]

Objective 4: To determine if there are significant differences between HIV positive and HIV negative individuals, on self-report measures of common mental health problems, over the course of 1 year following HIV testing

A t-test will be used to determine whether a significant difference exists between HIV positive and negative persons on the means of their scores on the BDI, BAI, PTSD-SS, AUDIT and DUDIT. These comparisons will be made at 6 and 12 months after receiving an HIV test

Objective 5: To document the lived experience of a group of individuals from low income settings in the 12 month period following receipt of an HIV positive diagnosis, in order to learn from them about: the specific resource challenges they experience (such as food insecurity, housing, employment, and social and family support); their psychosocial concerns; their perception of the barriers to receiving appropriate care; and their access to health care services and psychosocial support

Interpretive phenomenological analysis (IPA) will be used to elicit a thick description of the participants’ lived experiences of adjusting to an HIV positive status. Themes will be identified and organized into over-arching themes which provide insight into how individuals understand, adjust to and manage their HIV positive status. Similarly, the interviews will be used to provide insight into specific resource challenges they experience, their psychosocial concerns, medical and psychosocial support needs, access to care and perceived barriers to receiving care. The themes elicited in the interviews with participants who do not meet diagnostic criteria for a common mental disorder, will be compared with the themes emerging from the interviews with patients who do meet criteria for a common mental disorder. This comparison between the lived experience of the two groups will hopefully provide insight into why some individuals develop psychiatric symptoms following receipt of an HIV positive test result, while others do not. We have chosen to use IPA to analyze the qualitative data as this is a well-established and structured approach which is well suited to exploring people’s lived worlds; this method has also been extensively used in health psychology research to document patients’ experience of illness and recovery [51]