A modified Delphi study of expert consensus on mental health service access and digital strategies for adolescents and young people living with HIV in Zambia.

Background: Adolescents and young people living with human immunodeficiency virus (HIV), hereafter AYPLHIV, experience depression, anxiety, behavioural difficulties, and psychosocial distress that may undermine antiretroviral therapy (ART) adherence and long-term HIV outcomes. In Zambia, mental health services remain fragmented, centralised, and weakly integrated with HIV care. This modified Delphi study sought expert consensus on contextually relevant system, service, and digital strategies that may strengthen mental health access for AYPLHIV. Methods: We conducted a modified two-round Delphi study with 10 Zambia-based experts in psychiatry, psychology, nursing, HIV programme management, and digital health. Twelve experts were approached; 2 did not respond and 10 completed both rounds. Round 1 collected open-ended responses on barriers, facilitators, and digital strategies. Responses were coded by the lead author, reviewed by all co-authors, documented in an audit trail, and synthesised into 29 statements. An anonymised Round 1 summary was shared before Round 2. In Round 2, experts rated each statement using a five-point Likert scale. The prespecified consensus criterion was at least 70% agreement (ratings of 4 or 5 divided by all 10 respondents) and interquartile range (IQR) of 1 or less. Results: Of 29 statements, 24 met the prespecified consensus criterion, 4 showed high agreement with moderate dispersion, and 1 did not reach consensus. Participating experts rated stigma, poverty and transport costs, low mental health literacy, limited decentralisation, weak HIV-mental health integration, and workforce shortages as important constraints. Round 1 responses additionally raised harmful gender norms and referral-navigation challenges as implementation themes. Consensus-prioritised strategies included decentralising services, strengthening youth-friendly and confidential counselling, awareness campaigns, peer advocates, and complementary digital tools with data protection, low-data or offline functionality, multilingual and audio-visual content, and cultural adaptation. Conclusions: This study identified expert-derived consensus among participating Zambia-based experts on barriers, facilitators, and potential complementary digital strategies for improving mental health access for AYPLHIV. Because AYPLHIV, caregivers, frontline ART providers, peer supporters, and community actors were not Delphi panellists, findings should be interpreted as expert consensus rather than service-user consensus. These findings may inform future co-design with young people and frontline providers, implementation research, and policy discussions. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12982-026-03060-0.