In paediatric HIV and tuberculosis clinics, the adult beside a child may be supervising months or years of daily treatment while carrying serious pressures of their own. Yet care often focuses on the child’s physical health. In a PLOS Medicine article, Adwoa Kumiwa Asare Afrane and MN Ahun argue that care should also address caregivers’ mental health and treat the family as a unit.
The article is an argument for changing policy and practice, not a trial of a new caregiver treatment. Its authors point to how illness, stigma and social conditions can affect an entire household. Caregivers may themselves be living with HIV, and may also face bereavement, poverty or food insecurity. Their wellbeing matters in its own right, the authors say, and may be connected to how children fare.
Evidence from Ghana’s SANKOFA paediatric HIV disclosure trial illustrates that connection. The article reports that depressive symptoms were common among caregivers, children’s depression scores were correlated with caregivers’ scores, and caregiver psychosocial factors changed alongside the disclosure process. But outside the research protocol, caregivers’ mental health was not routinely assessed or supported as part of paediatric HIV care, according to the authors.
The relationship between caregiver mental health and children’s treatment outcomes is not settled. Depression and other mental health conditions are recognised barriers to antiretroviral adherence among adults living with HIV, and some caregivers manage their own treatment as well as a child’s. But findings about children’s adherence are less consistent. In one South African cohort described in the article, caregiver alcohol use and whether the caregiver was the child’s biological mother predicted adherence more strongly than caregiver depression. Research on caregiver mental health in paediatric TB is described as sparse.
The article also points to possible effects beyond treatment adherence. Maternal depression has been associated with disrupted attachment, poorer feeding practices and developmental delays in young children. In a study of more than 4,700 children and caregivers in Northern Ghana, caregiver psychological distress was negatively associated with children’s academic achievement and socioemotional outcomes. Among families where caregivers had no formal education, reduced caregiver engagement in education partly explained the association with children’s literacy. These findings describe associations; they do not show that a particular clinic intervention would improve children’s outcomes.
SANKOFA offers another important qualification. Its intervention helped caregivers prepare for and carry out disclosure of a child’s HIV status. The article reports improved immunological outcomes for children at 48 weeks, with no worsening of depression scores in children or caregivers. However, the trial was not designed to test a caregiver mental health intervention. Whether identifying and treating caregiver depression improves children’s virological or TB treatment outcomes remains an open question. The authors also caution that screening alone has an inconsistent evidence base, especially when it is not connected to treatment and follow-up.
Afrane and Ahun see a policy opening in Ghana. In July 2026, Ghana hosted an African Union health session that produced the Accra Declaration, which commits member states to integrate HIV, TB and mental health services into primary healthcare and universal health coverage packages. Ghana’s first Maternal Mental Health Policy, launched in April 2026, already embeds screening and support in routine antenatal and postnatal care. The authors argue that its approach should extend to caregivers in paediatric HIV and TB clinics, including those beyond the perinatal period.
The article describes existing foundations, including primary care mental health capacity-building and insurance coverage for several mental health conditions. It also points to programmes in Uganda and Zimbabwe that used trained lay health workers to provide psychological support to adults, with reported benefits in trials. Those programmes were mostly designed for adults seeking their own care, however, and few have been adapted for caregivers bringing children to HIV or TB clinics.
The authors propose building on existing services: include caregiver needs in paediatric guidelines, train clinic staff to provide support and referrals, connect families with social support, and evaluate effects on caregivers as well as children. Whether those steps are feasible and improve health outcomes will need to be tested. Their central case is that caregivers deserve care themselves, while family wellbeing is part of the setting in which children manage long-term illness.