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Musanje K, Kasujja R, Camlin CS, Hooper N, Hope-Bell J, Sinclair DL, Kibanja GM, Mpirirwe R, Kalyango JN, Kamya MR. Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial. PLoS One 2024; 19:e0301988. [PMID: 38722926 PMCID: PMC11081388 DOI: 10.1371/journal.pone.0301988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/20/2024] [Indexed: 05/13/2024] Open
Abstract
Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- School of Psychology, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- School of Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, United States of America
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, United Kingdom
| | - Josh Hope-Bell
- School of Medicine, Cardiff University, Wales, United Kingdom
| | | | | | - Ruth Mpirirwe
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Joan N. Kalyango
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala, Uganda
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Dao TT, Gaynes BN, Pence BW, Mphonda SM, Kulisewa K, Udedi M, Stockton MA, Kramer J, Faidas M, Mortensen H, Bhushan NL. Friendship Bench Intervention to Address Depression and Improve HIV Care Engagement Among Adolescents Living with HIV in Malawi: Study Protocol for a Pilot Randomized Controlled Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.11.24305686. [PMID: 38645199 PMCID: PMC11030483 DOI: 10.1101/2024.04.11.24305686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present a pilot trial designed to investigate feasibility, fidelity, and acceptability of an a dapted and an e nhanced F riendship B ench intervention (henceforth: AFB and EFB) in reducing depression and improving engagement in HIV care among ALWH in Malawi. Methods Design: Participants will be randomized to one of three conditions: the Friendship Bench intervention adapted for ALWH (AFB, n=35), the Friendship Bench intervention enhanced with peer support (EFB, n=35), or standard of care (SOC, n=35). Recruitment is planned for early 2024 in four clinics in Malawi.Participants: Eligibility criteria (1) aged 13-19; (2) diagnosed with HIV (vertically or horizontally); (3) scored ≥ 13 on the self-reported Beck's Depression Inventory (BDI-II); (4) living in the clinic's catchment area with intention to remain for at least 1 year; and (5) willing to provide informed consent.Interventions: AFB includes 6 counseling sessions facilitated by young, trained non-professional counselors. EFB consists of AFB plus integration of peer support group sessions to facilitate engagement in HIV care. SOC for mental health in public facilities in Malawi includes options for basic supportive counseling, medication, referral to mental health clinics or psychiatric units at tertiary care hospitals for more severe cases.Outcomes: The primary outcomes are feasibility, acceptability, and fidelity of the AFB and EFB assessed at 6 months and 12 months and compared across 3 arms. The secondary outcome is to assess preliminary effectiveness of the interventions in reducing depressive symptoms and improving HIV viral suppression at 6 months and 12 months. Discussion This pilot study will provide insights into youth-friendly adaptations of the Friendship Bench model for ALWH in Malawi and the value of adding group peer support for HIV care engagement. The information gathered in this study will lead to a R01 application to test our adapted intervention in a large-scale cluster randomized controlled trial to improve depression and engagement in HIV care among ALWH. Trial registration ClinicalTrials.gov Identifier NCT06173544.
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Gebru T, Ejara D, Yalew A, Deyessa N. Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. Sci Rep 2024; 14:1642. [PMID: 38238489 PMCID: PMC10796940 DOI: 10.1038/s41598-024-52142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024] Open
Abstract
Depression is the most frequently detected and preventable mental illness among people with human immunodeficiency syndrome, with rates two to four times higher than in the general population. Currently, depression is estimated to affect 350 million people worldwide. To assess the prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. An institutional-based cross-sectional study was conducted from April 01 to September 30, 2021, at Adama Hospital Medical College, Adama, Ethiopia. A total of 420 individuals were selected using a systematic random sampling technique. After informed consent was obtained from each study participant, data were collected through face-to-face interviews, observations, and document reviews. Subsequently, the data were entered into EPI-Info Version 7 and analyzed by Statistical Package for the Social Sciences version 21. Variables with p-values less than 0.25 in the univariable logistic regression analysis were subsequently included in the multivariable logistic regression analysis to account for potential confounding factors. The association was measured using adjusted odds ratio (AOR) with a 95% confidence interval (CI), and variables with p-values less than 0.05 were considered statistically significant. The prevalence of depression was 52.4% (95% CI 47.6-57.1). Factors significantly associated with depression among HIV-positive patients on antiretroviral therapy included employment status [AOR = 0.22(95% CI 0.13-0.36)], the patient's most CD4 count [AOR = 6.99 (95% CI 2.81-17.38)], duration of months on antiretroviral therapy [AOR = 5.05 (95% CI 2.38-10.74)] and presence of chronic non-communicable diseases [AOR = 7.90 (95% CI 4.21-14.85)]. The highest proportion of HIV-positive patients taking antiretroviral drugs exhibited depression. Employment was identified as a preventive factor, whereas having a low CD4 count, recently initiating antiretroviral therapy, and having chronic non-communicable diseases were associated with increased odds of depression among HIV-positive patients on antiretroviral therapy. There need to strengthen mental health screening and treat depression among HIV-positive patients, particularly by targeting identified factors.
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Affiliation(s)
- Tessema Gebru
- HIV Directorate, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Daba Ejara
- Department of Nursing, Shashamene Campus, Madda Walabu University, Shashamene, Ethiopia.
| | - Aster Yalew
- Department of Nursing, Shashamene Campus, Madda Walabu University, Shashamene, Ethiopia
| | - Negussie Deyessa
- School of Public Health, College Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Chen B, Wang W, Yang S. The relationship between academic stress and depression among college students during the COVID-19 pandemic: a cross-sectional study from China. BMC Psychiatry 2024; 24:46. [PMID: 38216950 PMCID: PMC10785333 DOI: 10.1186/s12888-024-05506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic is a global public health crisis. During the COVID-19 pandemic, mental health has attracted great attention. However, there is a lack of research on the relationship between academic stress and depression in Chinese college students and its mechanisms. Therefore, this study investigated the mechanisms of coping style, sleep quality, and interpersonal relationship in academic stress and depression among college students. METHODS The cross-sectional study was conducted from May to June 2022 through face-to-face questionnaires with college students in Anhui Province, China. The questionnaires included sociodemographic information, the Simplified Coping Style Questionnaire, and the Self-Rating Depression Scale. Ordered logistic regression model was used to study the relationship between academic stress and depression of college students during the COVID-19 pandemic through the mechanism analysis of coping style, sleep quality and interpersonal relationship. RESULTS Two thousand thirty-three Chinese college students participated in the study, including 1,285 female and 748 male college students, with an average age 19.81 years old (SD = 1.22 years old). The results showed that (1) Academic stress had a significant impact on depression in college students under the background of COVID-19 (p < 0.01); (2) The influence of academic stress on depression had a difference in work experience as student cadres, which showed that college students who had served as student cadres were less affected by academic stress (p < 0.10), college students who had not served as student cadres were greatly affected by the academic stress (p < 0.05); (3) College students' attitudes toward COVID-19 significantly affected depression (p < 0.01); (4) Counselors' concern had a significant impact on college students' depression (p < 0.01); (5) Positive coping style, high quality sleep and good interpersonal relationship were the important mechanisms of the impact of academic stress on college students' depression. CONCLUSIONS This study provides new findings for in-depth understanding of the relationship between academic stress and depression among college students in China during the COVID-19 pandemic, which is conducive to the provision of targeted intervention measures for the mental health of college students.
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Affiliation(s)
- Baoling Chen
- School of Management, Hefei University of Technology, 193 Tunxi Rd, Hefei, Anhui, 230009, People's Republic of China.
- School of Finance and Public Administration, Anhui University of Finance & Economics, #962 Caoshan Road, Bengbu City, Anhui, China.
| | - Weiwei Wang
- Internal Medicine Department, The Third People's Hospital of Bengbu, No. 38, Shengli Middle Road, Bengbu City, Anhui, People's Republic of China
| | - Shanlin Yang
- School of Management, Hefei University of Technology, 193 Tunxi Rd, Hefei, Anhui, 230009, People's Republic of China
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Ahmed CV, Doyle R, Gallagher D, Imoohi O, Ofoegbu U, Wright R, Yore MA, Brooks MJ, Flores DD, Lowenthal ED, Rice BM, Buttenheim AM. A Systematic Review of Peer Support Interventions for Adolescents Living with HIV in Sub-Saharan Africa. AIDS Patient Care STDS 2023; 37:535-559. [PMID: 37956242 DOI: 10.1089/apc.2023.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Despite widespread availability of life-saving antiretroviral therapy (ART) in sub-Saharan Africa, AIDS remains one of the leading causes of death among adolescents living with HIV (ALHIV) in sub-Saharan Africa. The purpose of this article was to review the state of the science regarding interventions to improve ART adherence and/or HIV care retention among ALHIV throughout sub-Saharan Africa. The primary aim of this review was to describe the impact of peer support interventions in improving treatment outcomes (i.e., ART adherence and retention in HIV care) among ALHIV in sub-Saharan Africa. The secondary aim of this review was to determine whether these interventions may be efficacious at improving mental health outcomes. We identified 27 articles that met the eligibility criteria for our review, and categorized each article based on the type of peer support provided to ALHIV-individualized peer support, group-based support, and individualized plus group-based support. Results regarding the efficacy of these interventions are mixed and most of the studies included were deemed moderate in methodological quality. Although studies evaluating group-based peer support interventions were the most common, most of these studies were not associated with retention, adherence, or mental health outcomes. More robust, fully powered studies are needed to strengthen our knowledge base regarding peer support for ALHIV.
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Affiliation(s)
- Charisse V Ahmed
- National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Rebecca Doyle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Darby Gallagher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olore Imoohi
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Ugochi Ofoegbu
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Robyn Wright
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Mackensie A Yore
- VA Los Angeles and UCLA National Clinician Scholars Program, VA Greater Los Angeles Healthcare System HSR&D Center of Innovation, Los Angeles, California, USA
| | - Merrian J Brooks
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Botswana UPENN Partnership, Gaborone, Botswana
| | | | - Elizabeth D Lowenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Alison M Buttenheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ro L, Akinsulore A, Oa O, Oo A, Sk M, As A. Depression and its association with psychological factors among adolescents living with HIV in Southwestern Nigeria. BMC Psychiatry 2023; 23:531. [PMID: 37488523 PMCID: PMC10367253 DOI: 10.1186/s12888-023-04912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/29/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE The aim was to determine the prevalence of depressive disorder and associated psychological factors among adolescents living with HIV/AIDS. METHODS One hundred and five adolescents with HIV were assessed for self-esteem, internalized HIV stigma and diagnosed of depressive disorder. Chi square and t tests were used to test associations and hierarchical logistic regression used to identify independent risk factors for depression. RESULTS The mean age of participants was 16.5 (± 1.97) years and 55.2% were males. Mean stigma scores were significantly higher in those with depressive disorder (16.53 ± 3.85) when compared with those without (13.42 ± 3.464) and this difference was statistically significant (t = 3.17, p = 0.01). The mean self-esteem scores were significantly lower in participants with depressive disorder (17.53 ± 4.69) compared to those without depressive disorder (19.71 ± 3.86), though not significant (t = 1.96, p = 0.053). Depressive disorder was further significantly associated with female sex, being in romantic relationship, decline in work output due to HIV and HIV stigma. Independent risk factors were sex and HIV stigma. CONCLUSION Depressive disorder is common among adolescents living with HIV infection in Nigeria. The association between HIV stigma and depression, thus suggests the need for prevention strategies targeting the impacts of HIV infection among adolescents.
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Affiliation(s)
- Lawal Ro
- Federal Medical Centre, Abeokuta, Ogun State, Nigeria
| | | | - Oginni Oa
- Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Aloba Oo
- Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Mosaku Sk
- Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Akanmu As
- University of Lagos, Lagos, Lagos State, Nigeria
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Liu Z, Chen X, Li J, Xie Z, Huang Y, Luo D. HIV-related stress predicts depression over five years among people living with HIV. Front Public Health 2023; 11:1163604. [PMID: 37377546 PMCID: PMC10291293 DOI: 10.3389/fpubh.2023.1163604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Extant literature has demonstrated significant associations between HIV-related stress, social support, and depression among PLWH. However, little research has been conducted on the changes in such associations over time. Our study aims to explore the longitudinal relationship between HIV-related stress, social support, and depression among PLWH over five years. Methods 320 PLWH were recruited from Changsha Center for Disease Control and Prevention (CDC), Hunan Province, China. They were assessed for depressive symptoms, HIV-related stress, and social support within 1 month of HIV diagnosis, 1 year after diagnosis, and five years after diagnosis, respectively. Relationships between these variables were examined using a fixed effect model. Result The prevalence of depressive symptoms within the first month, first year, and fifth years of HIV diagnosis was 35, 12.2, and 14.7%, respectively. Emotional stress (β: 0.730, 95% CI: 0.648, 0.811), social stress (β: 0.066, 95% CI: 0.010, 0.123), instrumental stress (β: 0.133, 95% CI:0.046, 0.221) positively predicted depression, while social support utilization (β: -0.176, 95% CI: -0.303, -0.049) negatively predicted depression. Conclusion Our study suggests that HIV-related stress and social support predict depressive symptoms over time among PLWH and that reducing HIV-related stress and improving social support in the early stages of diagnosis is extremely important in preventing depressive symptoms among PLWH.
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Affiliation(s)
- Zongyan Liu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Xi Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Jie Li
- Furong District Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Zhi Xie
- Changsha Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Yunxiang Huang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Dan Luo
- Xiangya School of Public Health, Central South University, Changsha, China
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Brooks M, Burmen B, Olashore A, Gezmu AM, Molebatsi K, Tshume O, Phoi O, Morales K, Matshaba M, Benton T, Lowenthal ED. Symptoms of depression, anxiety, and thoughts of suicide/self-injury in adolescents and young adults living with HIV in Botswana. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:54-62. [PMID: 37116112 PMCID: PMC10787227 DOI: 10.2989/16085906.2023.2186252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/30/2023]
Abstract
Globally, mental health problems have been reported to be more common in youth living with HIV (YLWH) than in the general population, but routine mental health screening is rarely done in high-volume HIV clinics. In 2019, YLWH in a large HIV clinic in Botswana were screened using the Generalized Anxiety Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in a pilot standard-of-care screening programme. Two-way ANOVA was used to describe the effects of age group (12-<16, 16-<20 and 20-25 years old) and sex on GAD-7 and PHQ-9 scores. Chi-square statistics were used to compare characteristics of YLWH with and without potential suicidality/self-harm symptoms based on question 9 in the PHQ-9. Among 1 469 YLWH, 33.1%, 44.3% and 15.0% had anxiety, depression and potential suicidality/self-harm symptoms respectively. YLWH of 20-25 years old and 16-<20 years old had higher GAD-7 scores compared to 12-<16-year-olds (p = 0.014 and p = <0.001 respectively). Female YLWH of 20-25 years old had higher PHQ-9 scores compared to 12-<16-year-olds (p = 0.002). There were no other sex-age dynamics that were statistically significant. Female YLWH endorsed more thoughts of suicidality/self-harm than males (17% versus 13%, p = 0.03 respectively). Given the proportion of YLWH with mental health symptoms, Botswana should enhance investments in mental health services for YLWH, especially for young female adults who bear a disproportionate burden.
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Affiliation(s)
- Merrian Brooks
- Department of Pediatrics, Craig Dalsimer Division of Adolescent Medicine, Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Anthony Olashore
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
| | | | | | - Ontibile Tshume
- Botswana Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Onkemetse Phoi
- Botswana Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Knashawn Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Mogomotsi Matshaba
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
- Division of Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Tami Benton
- Department of Psychiatry and Behavioral Services, University of Pennsylvania Perelman School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, USA
| | - Elizabeth D Lowenthal
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, USA
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Musanje K, Camlin CS, Kamya MR, Vanderplasschen W, Louise Sinclair D, Getahun M, Kirabo H, Nangendo J, Kiweewa J, White RG, Kasujja R. Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001605. [PMID: 36963093 PMCID: PMC10021405 DOI: 10.1371/journal.pgph.0001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The dual burden of living with HIV and negotiating life stage changes has been identified as a contributing factor to lapsed adherence among adolescents with HIV in sub-Saharan Africa. While psychosocial support can promote medication adherence, most interventions in use with adolescents were originally developed for the general population creating a gap in appropriate support. Life-stage-appropriate, evidence-based psychosocial support interventions have been used with young people in high-income contexts, prompting interest in their use in low-income contexts. However, many interventions are less effective when implemented outside of their original settings, hence the need for modifications before implementation. We aimed to culturally adapt an evidence-based psychosocial support intervention designed to improve the mental health of young people for use among adolescents with HIV in a sub-Saharan African context and to explore the acceptability of the adapted intervention among adolescents. We engaged thirty stakeholders (n = 30) in Kampala, Uganda including psychologists, psychiatrists, social workers, HIV counselors, religious leaders and adolescent peers from December 2021 to April 2022 to modify an evidence-based intervention for adolescents. Key adaptations included simplifying the language, adding local practices, integrating locally relevant slang and stories into therapy, introducing racially-congruent visuals and cards representing emotions, and adjusting therapy materials for use in resource-constrained settings. We then tested the acceptability of the intervention in a small sample of service users using a qualitative approach. We recruited nine adolescents with HIV from a participating clinic in Kampala, delivered six 90-minute sessions of the adapted intervention across three weeks and conducted in-depth interviews to assess the acceptability of the intervention. We used thematic analysis to analyze the qualitative data. The adapted intervention was perceived as acceptable among adolescents with HIV, with many stating that it helped them overcome fears, increased their self-acceptance, and gave them the confidence to make careful health-enhancing decisions.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | | | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Hope Kirabo
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - John Kiweewa
- Fairfield University, Fairfield, Connecticut, United States of America
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
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Musindo O, Jafry S, Nyamiobo J, Becker KD, Gellatly R, Maloy C, Lozano-Ruiz A, Romero-Gonzalez B, Kola L, Merali Z, Chorpita BF, Kumar M. Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review. EClinicalMedicine 2023; 57:101835. [PMID: 36874395 PMCID: PMC9981905 DOI: 10.1016/j.eclinm.2023.101835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023] Open
Abstract
Background Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.
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Affiliation(s)
- Otsetswe Musindo
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University, Amsterdam, Netherlands
| | - Sheharbano Jafry
- Department of Global Health, University of Washington Seattle, USA
| | - Joseph Nyamiobo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Kimberly D. Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Caitlin Maloy
- Health Sciences Library, University of Washington Seattle, USA
| | - Alvaro Lozano-Ruiz
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Borja Romero-Gonzalez
- Department of Psychology, Faculty of Education, University of Valladolid, Valladolid, Spain
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Zul Merali
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Mental Health Problems Across the HIV Care Continuum for Adolescents Living with HIV in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2023:10.1007/s10461-023-03981-w. [PMID: 36650389 PMCID: PMC10350473 DOI: 10.1007/s10461-023-03981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Mental health problems (e.g., anxiety, depression) are frequently experienced by adolescents living with HIV (ALWH) and can worsen HIV-related outcomes. This scoping review synthesizes the existing research on ALWHs' mental health problems at multiple steps along the HIV care continuum in sub-Saharan Africa. Searching PubMed, CINAHL, EMBASE, and PsycINFO identified 34 peer-reviewed studies that met inclusion criteria. Most studies assessed ALWHs' mental health problems at the "Engaged or Retained in Care" continuum step, are cross-sectional, focus on depression and anxiety, and used measures developed in high-income countries. Studies identify mental health problems among ALWH as prevalent and barriers to care. Significant gaps remain in understanding how mental health problems and their relationships with HIV-related health outcomes shift across the continuum. Additional attention is needed, especially at the HIV testing and viral suppression steps, to generate a more comprehensive understanding of mental health needs and priority timepoints for intervention for ALWH.
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12
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Shanaube K, Gachie T, Hoddinott G, Schaap A, Floyd S, Mainga T, Bond V, Hayes R, Fidler S, Ayles H. Depressive symptoms and HIV risk behaviours among adolescents enrolled in the HPTN071 (PopART) trial in Zambia and South Africa. PLoS One 2022; 17:e0278291. [PMID: 36454874 PMCID: PMC9714741 DOI: 10.1371/journal.pone.0278291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mental health is a critical and neglected public health problem for adolescents in sub-Saharan Africa. In this paper we aim to determine the prevalence of depressive symptoms and the association with HIV risk behaviours in adolescents aged 15-19 years in Zambia and SA. METHODS We conducted a cross-sectional survey from August-November 2017 in seven control communities of HPTN 071 (PopART) trial (a community-randomised trial of universal HIV testing and treatment), enrolling approximately 1400 eligible adolescents. HIV-status was self-reported. Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ), with a positive screen if adolescents scored ≥12. We fitted a logistic regression model to identify correlates of depressive symptoms with subgroup analyses among those who self-reported ever having had sex, by gender and country. RESULTS Out of 6997 households approached, 6057 (86.6%) were enumerated. 2546 adolescents were enumerated of whom 2120 (83.3%) consented to participate and were administered the SMFQ. The prevalence of depressive symptoms was 584/2120 (27.6%) [95%CI: 25.7%-29.5%]. Adolescents in SA were less likely to experience depressive symptoms (Adjusted Odds Ratio [AOR] = 0.63 (95% CI: 0.50, 0.79), p-value<0.0001). Female adolescents (AOR = 1.46 (95% CI: 1.19, 1.81), p-value<0.0001); those who reported ever having sex and being forced into sex (AOR = 1.80 (95% CI: 1.45, 2.23), p-value<0.001) and AOR = 1.67 (95% CI: 0.99, 2.84); p-value = 0.057 respectively) were more likely to experience depressive symptoms. Among 850 (40.1%) adolescents who self-reported to ever having had sex; those who used alcohol/drugs during their last sexual encounter were more likely to experience depressive symptoms (AOR = 2.18 (95% CI: 1.37, 3.47); p-value = 0.001), whereas those who reported using a condom were less likely to experience depressive symptoms (AOR = 0.74 (95% CI: 0.55, 1.00); p-value = 0.053). CONCLUSION The prevalence of depressive symptoms among adolescents ranged from 25-30% and was associated with increased HIV-risk behaviour.
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Affiliation(s)
| | - Thomas Gachie
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Albertus Schaap
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Virginia Bond
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of infectious disease, Imperial College, London, Imperial College NIHR BRC, United Kingdom
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Mhungu A, Sixsmith J, Burnett E. Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:1365-1379. [PMID: 36318422 PMCID: PMC10129999 DOI: 10.1007/s10461-022-03872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 04/28/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.
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Affiliation(s)
- Alington Mhungu
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| | - Emma Burnett
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
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14
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Kip EC, Udedi M, Kulisewa K, Go VF, Gaynes BN. Stigma and mental health challenges among adolescents living with HIV in selected adolescent-specific antiretroviral therapy clinics in Zomba District, Malawi. BMC Pediatr 2022; 22:253. [PMID: 35524228 PMCID: PMC9077887 DOI: 10.1186/s12887-022-03292-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Of the 1.8 million adolescents between the ages of 10 and 19 living with HIV globally in 2020; approximately 1.5 million of these live in sub-Saharan Africa. These adolescents living with HIV (ALHIV) are at higher risk of experiencing mental health problems than those without; in Malawi, 18.9% have a depressive disorder. ALHIV can face numerous psychosocial challenges, but little is known about how ALHIV in Malawi perceive these stressors. Understanding psychosocial challenges of ALHIV is a key step in ensuring good mental health care. The aim of this study was to assess the psychosocial challenges faced by ALHIV attending adolescent-specific ART program in Zomba, Malawi. METHODS Between April and May 2019, we engaged a purposive sample of ALHIV ages 12-18 (n = 80) in a series of eight focus groups drawing from four Teen Clubs linked to an adolescent-specific ART program. Data were analyzed inductively and deductively to identify themes related to ALHIV psychosocial experiences. RESULTS Two themes that emerged from the study include: 1) stigma and discrimination within communities and families; 2) non-adherence to medications. HIV-related stigma was associated with increased psychological distress; physical and emotional/verbal abuse; low social support, isolation, and a feeling of rejection; and risky health behaviors such as medication hiding and non-adherence to ART. Discriminatory actions were manifested in a form of being given separate utensils for their meals and mistreatment at school. Furthermore, some parents did not allow their children to play with the participants out of fear that HIV transmission. CONCLUSIONS Stigma and discrimination are overlooked potential barriers to HIV treatment and care. If HIV services are to effectively meet ALHIVs' needs, mental health interventions are needed to prevent and manage depression and improve adherence to ART. These findings highlight the crucial need to develop culturally relevant mental interventions aimed at helping ALHIV to cope with these diverse challenges.
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Affiliation(s)
- Esther C Kip
- Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Michael Udedi
- Malawi Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Kazione Kulisewa
- Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Vivian F Go
- University of North Carolina, Chapel Hill, USA
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van Staden Q, Laurenzi CA, Toska E. Two years after lockdown: reviewing the effects of COVID-19 on health services and support for adolescents living with HIV in South Africa. J Int AIDS Soc 2022; 25:e25904. [PMID: 35475319 PMCID: PMC9042673 DOI: 10.1002/jia2.25904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION South Africa's progress towards the 95-95-95 goals has been significantly slower among adolescents living with HIV (ALHIV), among whom antiretroviral therapy (ART) adherence, retention in care and viral suppression remain a concern. After 2 years of living with COVID-19, it is important to examine the direct and indirect effects of the pandemic on healthcare resources, access to HIV services and availability of support structures, to assess their impact on HIV care for ALHIV. DISCUSSION The COVID-19 response in South Africa has shifted healthcare resources towards combatting COVID-19, affecting the quality and availability of HIV services-especially for vulnerable populations, such as ALHIV. The healthcare system's response to COVID-19 has threatened to diminish fragile gains in engaging ALHIV with HIV services, especially as this group relies on overburdened public health facilities for their HIV care. Reallocation of limited health resources utilized by ALHIV disrupted healthcare workers' capacity to form and maintain therapeutic relationships with ALHIV and monitor ALHIV for ART-related side effects, treatment difficulties and mental health conditions, affecting their ability to retain ALHIV in HIV care. Prevailing declines in HIV surveillance meant missed opportunities to identify and manage opportunistic infections and HIV disease progression in adolescents. "Lockdown" restrictions have limited access to healthcare facilities and healthcare workers for ALHIV by reducing clinic appointments and limiting individual movement. ALHIV have had restricted access to social, psychological and educational support structures, including national feeding schemes. This limited access, coupled with reduced opportunities for routine maternal and sexual and reproductive health services, may place adolescent girls at greater risk of transactional sex, child marriages, unintended pregnancy and mother-to-child HIV transmission. CONCLUSIONS Adolescent HIV care in South Africa is often overlooked; however, ART adherence among ALHIV in South Africa is particularly susceptible to the consequences of a world transformed by COVID-19. The current structures in place to support HIV testing, ART initiation and adherence have been reshaped by disruptions to health structures, new barriers to access health services and the limited available education and psychosocial support systems. Reflecting on these limitations can drive considerations for minimizing these barriers and retaining ALHIV in HIV care.
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Affiliation(s)
- Quintin van Staden
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Universitas HospitalBloemfonteinSouth Africa
| | - Christina A. Laurenzi
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Elona Toska
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
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Nyongesa MK, Nasambu C, Mapenzi R, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Psychosocial and mental health challenges faced by emerging adults living with HIV and support systems aiding their positive coping: a qualitative study from the Kenyan coast. BMC Public Health 2022; 22:76. [PMID: 35022012 PMCID: PMC8756635 DOI: 10.1186/s12889-021-12440-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV transitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults. METHODS In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18-24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software. RESULTS Young adults living with HIV from this setting face various challenges at different levels of the social ecosystem. At the individual level, key challenges they reported included acceptance of HIV positive status, antiretroviral adherence, economic burden associated with access to healthcare, building an intimate relationship, mental health problems, and HIV status disclosure. At the family level, death of parents, poverty, and being unaccepted were the commonly mentioned challenges. At the community level, socialization difficulties and long waiting time at the HIV clinic were highlighted. HIV stigma and discrimination were frequently reported across the different levels. Economic independence, social support (from families, friends, organizations, healthcare providers and peer meetings), and reliance on spirituality aided positive coping among these young adults amidst the challenges of living with HIV. CONCLUSIONS In this rural setting, emerging adults living with HIV face various challenges at the individual, family, and community level, some of which are cross-cutting. Our findings underscore the need for designing multi-level youth-friendly interventions that can address modifiable challenges encountered by emerging adults living with HIV in this and similar settings. Such interventions should incorporate appropriate context-specific support structures that may help these young people smoothly transit into adult life.
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Affiliation(s)
- Moses K Nyongesa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya.
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Carophine Nasambu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Rachael Mapenzi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Wakida EK, Atuhaire CD, Karungi CK, Maling S, Obua C. Mbarara University Research Training Initiative: Experiences and Accomplishments of the MEPI Junior D43 TW010128 Award in Uganda. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1397-1410. [PMID: 34887692 PMCID: PMC8650769 DOI: 10.2147/amep.s339752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In 2015, Mbarara University of Science and Technology was awarded the Mbarara University Research Training Initiative (MURTI) under grant number D43 TW010128 to build capacity of junior faculty to become the next generation of researchers in Africa. In this paper, we document the experiences and achievements of the research capacity building efforts at MUST. METHODS We conducted a descriptive evaluation study which involved document review and in-depth interviews. We used "Reach" and 'Effectiveness' from the RE-AIM framework to guide the document review, and the organizational theory of implementation effectiveness to guide the in-depth interviews. RESULTS In the MURTI program, we conducted 17 short courses between August 2015 and July 2021, a total of 6597 attendances were recorded. The most attended courses were responsible conduct of research (n = 826), qualitative research methods (n = 744), and data management (n = 613). Thirty-three fellows were recruited and funded to conduct mentored research leading to 48 publications and 14 extramural grant applications were yielded. From the in-depth interviews, the participants appreciated the research training program, the enhanced research skills attained, and the institutional capacity built. They attributed the success of the program to the training approach of using short courses, readiness of the junior faculty to change, and the supportive environment by the mentors and trainers in the program. CONCLUSION The D43 TW010128 research training grant-built capacity for the junior faculty at MUST, enhanced their research skills, promoted research capacity institutionally and provided career development for the junior faculty. This was possible due to the positive attitude of the junior faculty (organizational readiness) to change and the supportive environment (mentors and trainers) during implementation of the grant. These two factors provided a favorable institutional climate that guaranteed success of the funding goals.
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Affiliation(s)
- Edith K Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clara D Atuhaire
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine K Karungi
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Brathwaite R, Ssewamala FM, Neilands TB, Nabunya P, Byansi W, Damulira C. Development and external validation of a risk calculator to predict internalising symptoms among Ugandan youths affected by HIV. Psychiatry Res 2021; 302:114028. [PMID: 34129997 PMCID: PMC8277696 DOI: 10.1016/j.psychres.2021.114028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/24/2021] [Indexed: 12/20/2022]
Abstract
The aim of the study was to develop and externally validate a model to predict individualized risk of internalizing symptoms among AIDS-affected youths in low-resource settings in sub-Saharan Africa. Longitudinal data from 558 Ugandan adolescents orphaned by AIDS was used to develop our predictive model. Least Absolute Shrinkage and Selection Operator logistic regression was used to select the best subset of predictors using 10-fold cross-validation. External validation of the final model was conducted in a sample of 372 adolescents living with HIV in Uganda. Best predictors for internalizing symptoms were gender, family cohesion, social support, asset ownership, recent sexually transmitted infection (STI) diagnosis, physical health self-rating, and previous poor mental health; area under the curve (AUC) = 72.2; 95% CI = 67.9-76.5. For adolescents without history of internalizing symptoms, the AUC = 69.0, 95% CI = 63.4-74.6, and was best predicted by gender, drug use, social support, asset ownership, recent STI diagnosis, and physical health self-rating. Both models were well calibrated. External validation in adolescents living with HIV sample was similar, AUC = 69.7; 95% CI = 64.1-75.2. The model predicted internalizing symptoms among African AIDS-affected youth reasonably well and showed good generalizability. The model offers opportunities for the design of public health interventions addressing poor mental health among youth affected by HIV/AIDS.
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Affiliation(s)
- Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A..
| | - Fred M. Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - Torsten B. Neilands
- Division of Prevention Science, University of California, San Francisco, California, 94143, U.S.A
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
| | - William Byansi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, U.S.A
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Nakasujja N, Vecchio AC, Saylor D, Lofgren S, Nakigozi G, Boulware DR, Kisakye A, Batte J, Mayanja R, Anok A, Reynolds SJ, Quinn TC, Pardo CA, Kumar A, Gray RH, Wawer MJ, Sacktor N, Rubin LH. Improvement in depressive symptoms after antiretroviral therapy initiation in people with HIV in Rakai, Uganda. J Neurovirol 2021; 27:519-530. [PMID: 34333739 PMCID: PMC8524346 DOI: 10.1007/s13365-020-00920-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 10/20/2022]
Abstract
Depression is common following HIV infection and often improves after ART initiation. We aimed to identify distinct dimensions of depression that change following ART initiation in persons with HIV (PWH) with minimal comorbidities (e.g., illicit substance use) and no psychiatric medication use. We expected that dimensional changes in improvements in depression would differ across PWH. In an observational cohort in Rakai, Uganda, 312 PWH (51% male; mean age = 35.6 years) completed the Center for Epidemiologic Studies-Depression (CES-D) scale before and up to 2 years after ART initiation. Twenty-two percent were depressed (CES-D scores ≥ 16) pre-ART that decreased to 8% after ART. All CES-D items were used in a latent class analysis to identify subgroups with similar change phenotypes. Two improvement phenotypes were identified: affective-symptom improvement (n = 58, 19%) and mixed-symptom improvement (effort, appetite, irritability; n = 41, 13%). The affect-improvement subgroup improved on the greatest proportion of symptoms (76%). A third subgroup was classified as no-symptom changes (n = 213, 68%) as they showed no difference is symptom manifestation from baseline (93% did not meet depression criteria) to post-ART. Factors associated with subgroup membership in the adjusted regression analysis included pre-ART self-reported functional capacity, CD4 count, underweight BMI, hypertension, female sex(P's < 0.05). In a subset of PWH with CSF, subgroup differences were seen on Aβ-42, IL-13, and IL-12. Findings support that depression generally improves following ART initiation; however, when improvement is seen the patterns of symptom improvement differ across PWH. Further exploration of this heterogeneity and its biological underpinning is needed to evaluate potential therapeutic implications of these differences.
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Affiliation(s)
| | - Alyssa C Vecchio
- Institute of Global Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, USA
| | - Sarah Lofgren
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
- Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
- Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, USA
| | | | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA.
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Olashore AA, Paruk S, Akanni OO, Tomita A, Chiliza B. Psychiatric Disorders in Adolescents Living with HIV and Association with Antiretroviral Therapy Adherence in Sub-Saharan Africa: A Systematic Review and Meta-analysis. AIDS Behav 2021; 25:1711-1728. [PMID: 33216245 DOI: 10.1007/s10461-020-03100-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
In sub-Saharan Africa (SSA), a systematic approach to exploring the prevalence of psychiatric disorders (PDs) and adherence to antiretroviral treatment (ART) in adolescents living with HIV (ALWHIV) is lacking. This study aimed to systematically review the studies conducted in SSA on the prevalence of PDs among ALWHIV and their association with ART adherence. A systematic search of all English studies assessing PDs among ALWHIV using the Web of Science, PubMed, and EBSCO databases was conducted between March 1 and September 30, 2019. Forty-two studies published between 2009 to 2019 met the inclusion criteria, of which 15 were included in the meta-analysis. The most common PDs were depression (0.24, 95% CI 0.14-0.36) and anxiety disorder (0.26, 95% CI 2-0.44). The available evidence could not conclude on the definitive association between PDs and ART adherence; therefore, further research is required. However, the need for mental health integration in the care for ALWHIV is evident.
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Affiliation(s)
- Anthony A Olashore
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
| | - Saeeda Paruk
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Oluyemi O Akanni
- Clinical Services, Federal Neuropsychiatric Hospital, Benin City, Edo State, Nigeria
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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21
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Too EK, Abubakar A, Nasambu C, Koot HM, Cuijpers P, Newton CRJC, Nyongesa MK. Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2021; 24 Suppl 2:e25705. [PMID: 34164931 PMCID: PMC8222842 DOI: 10.1002/jia2.25705] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub-Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA. METHODS We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: "Depression OR Anxiety", "Young people", "HIV infections" and "sub-Saharan Africa". RESULTS AND DISCUSSION Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV-negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV-related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV-positive status, bullying, sexual abuse, HIV-related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms. CONCLUSIONS The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV-negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV-clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth-friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.
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Affiliation(s)
- Ezra K Too
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
| | - Amina Abubakar
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordUK
- Institute for Human DevelopmentAga Khan UniversityNairobiKenya
| | - Carophine Nasambu
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
| | - Hans M Koot
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pim Cuijpers
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Charles RJC Newton
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Moses K Nyongesa
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Cavazos-Rehg P, Byansi W, Doroshenko C, Neilands TB, Anako N, Sensoy Bahar O, Kasson E, Nabunya P, Mellins CA, Ssewamala FM. Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda. Soc Sci Med 2021; 280:113946. [PMID: 34020312 DOI: 10.1016/j.socscimed.2021.113946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Many adolescents living with HIV in sub-Saharan Africa (SSA) experience poverty and have access to limited resources, which can impact HIV and mental health outcomes. Few studies have analyzed the impact of economic empowerment interventions on the psychosocial wellbeing of adolescents living with HIV in low resource communities, and this study aims to examine the mediating mechanism(s) that may explain the relationship between a family economic empowerment intervention (Suubi + Adherence) and mental health outcomes for adolescents (ages 10-16 at enrollment) living with HIV in Uganda. METHOD We utilized data from Suubi + Adherence, a large-scale six-year (2012-2018) longitudinal randomized controlled trial (N = 702). Generalized structural equation models (GSEMs) were conducted to examine 6 potential mediators (HIV viral suppression, food security, family assets, and employment, HIV stigma, HIV status disclosure comfort level, and family cohesion) to determine those that may have driven the effects of the Suubi + Adherence intervention on adolescents' mental health. RESULTS Family assets and employment were the only statistically significant mediators during follow-up (β from -0.03 to -0.06), indicating that the intervention improved family assets and employment which, in turn, was associated with improved mental health. The proportion of the total effect mediated by family assets and employment was from 42.26% to 71.94%. CONCLUSIONS Given that mental health services provision is inadequate in SSA, effective interventions incorporating components related to family assets, employment, and financial stability are crucial to supporting the mental health needs of adolescents living with HIV in under-resourced countries like Uganda. Future research should work to develop the sustainability of such interventions to improve long-term mental health outcomes among this at-risk group.
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Affiliation(s)
- Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA.
| | - William Byansi
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Christine Doroshenko
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Torsten B Neilands
- University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Nnenna Anako
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA; Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO, 63110, USA
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Claude A Mellins
- Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
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23
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Ayano G, Demelash S, Abraha M, Tsegay L. The prevalence of depression among adolescent with HIV/AIDS: a systematic review and meta-analysis. AIDS Res Ther 2021; 18:23. [PMID: 33906698 PMCID: PMC8077927 DOI: 10.1186/s12981-021-00351-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/19/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression is particularly common among adolescents with HIV/AIDS and has been associated with disruption of the important developmental process, subsequently leading to a wide range of negative mental, physical and psychosocial consequences, as well as poor quality of life in those population groups. Nevertheless, to the best of our knowledge, there are no prior systematic reviews and meta-analytic studies that determined the prevalence of depression among adolescents with HIV/AIDS. METHOD We systematically searched PubMed, Scopus and Web of Science for relevant literature until May 2020. A random-effect meta-analysis was used to pool prevalence rates from individual studies. Sensitivity and subgroup analyses were performed to identify the source of heterogeneities and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's quality assessment checklist was used to evaluate the quality of the included studies. Cochran's Q and the I2 tests were used to assess heterogeneity between the studies. RESULTS A total of ten studies were included for the final analysis, with 2642 adolescents living with HIV/AIDS. Our final meta-analysis showed that more than a quarter of adolescents with HIV had depression [26.07% (95% CI 18.92-34.78)]. The prevalence was highest amongst female adolescents (32.15%) than males (25.07%) as well as amongst the older adolescents aged 15-19 years (37.09%) than younger adolescents aged 10-14 years (29.82%). CONCLUSION Our study shows that a significant proportion of adolescents with HIV had depression, indicating the imperativeness of intervention strategies to alleviate the suffering and possibly reduce the probable negative ramifications.
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24
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Okumu M, Nyoni T, Byansi W. Alleviating psychological distress and promoting mental wellbeing among adolescents living with HIV in sub-Saharan Africa, during and after COVID-19. Glob Public Health 2021; 16:964-973. [PMID: 33843460 DOI: 10.1080/17441692.2021.1912137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
COVID-19 social control measures (e.g. physical distancing and lockdowns) can have both immediate (social isolation, loneliness, anxiety, stress) and long-term effects (depression, post-traumatic stress disorder) on individuals' mental health. This may be particularly true of adolescents living with HIV (ALHIV) and their caregivers - populations already overburdened by intersecting stressors (e.g. psychosocial, biomedical, familial, economic, social, or environmental). Addressing the adverse mental health sequelae of COVID-19 among ALHIV requires a multi-dimensional approach that at once (a) economically empowers ALHIV and their households and (b) trains, mentors, and supervises community members as lay mental health services providers. Mental health literacy programming can also be implemented to increase mental health knowledge, reduce stigma, and improve service use among ALHIV. Schools and HIV care clinics offer ideal environments for increasing mental health literacy and improving access to mental health services.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Thabani Nyoni
- Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - William Byansi
- Brown School of Social Work, Washington University, St. Louis, MO, USA
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25
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Nyongesa MK, Mwangi P, Kinuthia M, Hassan AS, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Prevalence, risk and protective indicators of common mental disorders among young people living with HIV compared to their uninfected peers from the Kenyan coast: a cross-sectional study. BMC Psychiatry 2021; 21:90. [PMID: 33568115 PMCID: PMC7877112 DOI: 10.1186/s12888-021-03079-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/31/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, common mental disorders (CMDs) like depression and anxiety are under-investigated amongst young people living with HIV (YLWH). To address the gap, in Kenya we: a) determined the prevalence of CMDs among YLWH compared to their uninfected peers; b) investigated HIV status as an independent predictor of CMDs in young people; c) investigated CMDs risk and protective indicators with more focus on YLWH. METHODS Between November 2018 and September 2019, 819 young people aged 18-24 years (407 HIV-infected) were recruited from two Counties on the Kenyan coast. Locally adapted pre-existing mental health measures, Patient Health Questionnaire (9-item) and Generalized Anxiety Disorder scale (7-item), were administered among other questionnaires via audio computer-assisted self-interview. Logistic regression was used to determine the correlates of CMDs. RESULTS Prevalence of CMDs was significantly elevated among YLWH compared to their uninfected peers i.e. 29% vs. 12%; p < 0.001 for depressive symptoms, 19% vs. 8%; p < 0.001 for anxiety symptoms, and 16% vs. 5%; p < 0.001 for comorbid depressive and anxiety symptoms. HIV status independently predicted depressive symptoms and its co-occurrence with anxiety symptoms. Among YLWH, negative life events, higher perceived HIV-related stigma and low adherence to antiretroviral therapy were the risk indicators for elevated CMDs. Among HIV-uninfected youths, death of both parents was a risk indicator for elevated depressive symptoms. Protective indicators against CMDs among youths with and without HIV included higher social support and health-related quality of life. CONCLUSION At the Kenyan coast, YLWH have significantly higher burden of CMDs compared to their uninfected peers. Being HIV-positive as a youth in this setting is predictive of more depressive symptoms and its comorbidity with anxiety symptoms. YLWH at high risk of CMDs in coastal Kenya can benefit from early detection, referral and treatment if routine screening for CMDs is integrated in their care package. The mental wellbeing of bereaving HIV-unaffected youths could be improved through continued support to help them come to terms with their loss. At the community level, programmes strengthening the social capital or improving the overall quality of life of youths with or without HIV may be beneficial to their mental health.
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Affiliation(s)
- Moses K. Nyongesa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya ,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Mwangi
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Michael Kinuthia
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Amin S. Hassan
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R. J. C. Newton
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
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Girma D, Assegid S, Gezahegn Y. Depression and associated factors among HIV-positive youths attending antiretroviral therapy clinics in Jimma town, southwest Ethiopia. PLoS One 2021; 16:e0244879. [PMID: 33406163 PMCID: PMC7787463 DOI: 10.1371/journal.pone.0244879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression is recognized as a prominent health problem and a growing public health concern in HIV-positive youths. Despite this fact, in Ethiopia, there is a dearth of evidence on the prevalence of depression and its associated factors among HIV-positive youths. METHODS A facility-based cross-sectional study was conducted from March 16 to June 01, 2020, among 331 HIV-positive youths attending antiretroviral therapy clinics in Jimma town. A systematic random sampling technique was used to enroll study participants. Bivariable and multivariable logistic regression was done to identify factors associated with depression. Variables with a p-value ≤0.25 on the bivariable analysis were candidates for multivariable analysis. Adjusted odds ratios with the respective 95% CI were calculated and p-value <0.05 were used to set statistically significant variables in the multivariable analysis. RESULTS Out of a total of 331 sampled HIV positive youth, 325 have participated in this study with a response rate of 98.2%. The prevalence of depression was 30.2% (95%CI:25.2%-35.1%). Female sex (AOR = 4.12, 95%CI:2.28-7.47), history of hospital admission (AOR = 2.45, 95%CI:1.28-4.70), discontinued education due to HIV/AIDS illness (AOR = 2.09, 95%CI:1.12-3.90), poor treatment adherence (AOR = 2.23, 95%CI:1.04-4.78), opportunistic infections (AOR = 2.16, 95%CI:1.17-3.97), high baseline viral load (AOR = 3.35, 95%CI:1.82-6.16) and ≤6 months duration of HIV diagnosis (AOR = 3.14, 95%CI: 1.47-5.72) were factors significantly associated with depression. CONCLUSION This study demonstrated a high prevalence of depression among HIV-positive youths. Factors such as female sex, treatment non-adherence, opportunistic infections,
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Affiliation(s)
- Derara Girma
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Sahilu Assegid
- Epidemiology Department, Institute of Public Health, Health Sciences College, Jimma University, Jimma, Ethiopia
| | - Yenealem Gezahegn
- Epidemiology Department, Institute of Public Health, Health Sciences College, Jimma University, Jimma, Ethiopia
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Disclosure, Social Support, and Mental Health are Modifiable Factors Affecting Engagement in Care of Perinatally-HIV Infected Adolescents: A Qualitative Dyadic Analysis. AIDS Behav 2021; 25:237-248. [PMID: 32638220 DOI: 10.1007/s10461-020-02968-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adolescents living with perinatally acquired HIV in South Africa face significant barriers to successful transition from pediatric to adult care. We performed in-depth qualitative interviews with 41 adolescents living with HIV and 18 of their caregivers to investigate modifiable factors to improve engagement in care prior to transition to adult care. Based on dyadic, inductive content analysis, findings suggest that HIV status disclosure, social support, and mental health are targets for improvement in engagement in care. Early disclosure and a sense of belonging facilitated engagement in care, while barriers included delayed or inadequate disclosure, denial, and lack of disclosure to others. Adherence support improved by having a biological mother as a direct supervisor. Barriers to care included changing caregivers, abandonment, undiagnosed mental health problems and learning difficulties. Despite these factors, the majority of adolescents showed resilience and remained engaged in care despite difficult circumstances.
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28
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Tsegay L, Ayano G. The Prevalence of Suicidal Ideation and Attempt Among Young People with HIV/AIDS: a Systematic Review and Meta-Analysis. Psychiatr Q 2020; 91:1291-1304. [PMID: 32960412 DOI: 10.1007/s11126-020-09851-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Studies have suggested that suicidal ideation and attempt are highly prevalent among young people with HIV/AIDS and have been linked with increased risk of complete suicide. However, thus far, there are no worldwide systematic reviews and meta-analysis of the prevalence of suicidal ideation and attempt among young people with HIV/AIDS. A systematic search of PubMed, Scopus, and Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prevalence rates from individual studies were pooled by using a random-effect meta-analysis. The quality of included studies was assessed by the Joanna Briggs Institute's quality assessment checklist. We used the Cochran's Q and the I2 tests to measure heterogeneity across the studies. In total, 14 studies involving 4842 young people with HIV/AIDS were included in this meta-analysis. Our random effect meta-analysis indicated that roughly a quarter of young people with HIV/AIDS had lifetime suicidal ideations [24.38% (95% CI; 18.49-31.44)], and more than one in ten had current [10.33% (95% CI; 6.13-16.88)], and 6 month [13.03% (95% CI; 4.71-31.24)] suicidal ideations. Likewise, a significant proportion of young people with HIV/AIDS had current [3.75% (95% CI; 2.30-6.06)], 6 month [15.33% (95% CI; 10.00-22.78)], and lifetime [13.05% (95% CI; 7.55-21.61)] suicidal attempts. The pooled prevalence estimate of both suicidal ideation and attempts varied according to the sample size of the participants. This study found that a considerable proportion of young people with HIV/AIDS had suicidal ideation and attempt, suggesting the urgent needs of intervention strategies to relieve the suffering and possibly prevent death due to suicide.
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Affiliation(s)
- Light Tsegay
- Department of Psychiatry, College of Health Sciences, Axum University, Axum, Ethiopia.
| | - Getinet Ayano
- Reserach and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.,School of Public Health, Curtin University, Bentley, WA, Australia
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29
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Haas AD, Technau KG, Pahad S, Braithwaite K, Madzivhandila M, Sorour G, Sawry S, Maxwell N, von Groote P, Tlali M, Davies MA, Egger M. Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa. J Int AIDS Soc 2020; 23:e25644. [PMID: 33283916 PMCID: PMC7720277 DOI: 10.1002/jia2.25644] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Mental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders. METHODS Adolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre-screening questions followed by full screening (conditional on positive pre-screening) for depression (Patient Health Questionnaire-9 [PHQ-9]), suicide (Adolescent Innovations Project [AIP]-handbook), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), post-traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC-PTSD-5]) and substance use (CAGE Adapted to Include Drugs [CAGE-AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening. RESULTS Out of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre-screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ-9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD-7 ≥10), 38 (3.2%) for PTSD (PC-PTSD-5 ≥3), 18 (1.7%) for substance use (CAGE-AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load. CONCLUSIONS ALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.
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Affiliation(s)
- Andreas D Haas
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karl-Günter Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shenaaz Pahad
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Braithwaite
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mampho Madzivhandila
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gillian Sorour
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Maxwell
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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30
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Nabunya P, Damulira C, Byansi W, Muwanga J, Bahar OS, Namuwonge F, Ighofose E, Brathwaite R, Tumwesige W, Ssewamala FM. Prevalence and correlates of depressive symptoms among high school adolescent girls in southern Uganda. BMC Public Health 2020; 20:1792. [PMID: 33238965 PMCID: PMC7689972 DOI: 10.1186/s12889-020-09937-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background In sub-Saharan Africa (SSA), adolescent girls and young women are three times more likely than boys to have depressive disorders. Understanding adolescents’ unique and common vulnerabilities and protective factors is essential for the development of appropriate interventions and programming focused on child and adolescent mental health. This paper examines the prevalence and predictors of depressive symptoms among high school adolescent girls in southern Uganda. Methods Baseline data from a longitudinal cluster randomized study involving 1260 adolescent girls (14–17 years), recruited from 47 secondary schools were utilized. Depressive symptoms were estimated using the 21-item Beck’s Depression Inventory. Hierarchical linear regression modelling was utilized to estimate key predictors of depressive symptoms among adolescent girls. Results Of the total sample, 16.35% (n = 206) reported severe depressive symptoms and almost one in every three adolescent girls interviewed (29.68%, n = 374) reported moderate symptoms. These symptoms were more prevalent among older adolescents (16 years and above). In addition, family relationships, social support, as well as measures of psychological wellbeing (self-concept and self-esteem) were all associated with lower levels of depressive symptoms. Hopelessness was associated with higher levels of depressive symptoms among adolescent girls. Conclusion Findings from this study indicate a high prevalence of depressive symptoms, especially among older adolescent girls. In addition, family support factors and adolescents’ psychological wellbeing were associated with low levels of depressive symptoms –pointing to the need to strengthen family functioning and adolescent’s psychological wellbeing to mitigate risks. Taken together, findings support increasing calls for early screening and detection of depressive symptoms to facilitate timely referral to care and treatment. Findings may also inform the development and incorporation of gender-specific mental health components in programming targeting adolescent girls, in low-resource communities in SSA. Trial registration This trial was prospectively registered with ClinicalTrials.gov (registration number: NCT03307226) on 11 October 2017.
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Affiliation(s)
- Proscovia Nabunya
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Christopher Damulira
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - William Byansi
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Joelynn Muwanga
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Flavia Namuwonge
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Eloho Ighofose
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Rachel Brathwaite
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Wilberforce Tumwesige
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
| | - Fred M Ssewamala
- Washington University in St. Louis, Brown School of Social Work, International Center for Child Health and Development (ICHAD), One Brookings Drive, St. Louis, MO, 63130, USA
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Govindasamy D, Seeley J, Olaru ID, Wiyeh A, Mathews C, Ferrari G. Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review. Health Qual Life Outcomes 2020; 18:120. [PMID: 32370772 PMCID: PMC7201613 DOI: 10.1186/s12955-020-01352-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
Young people living with HIV (YPLHIV) in sub-Saharan Africa (SSA) are at high risk of having a poor quality of life. Addressing wellbeing explicitly within HIV/AIDS policies could assist mitigation efforts. However, guidance on wellbeing measures to evaluate policies for YPLHIV is scarce. The aims of this mixed-methods review were to identify: i) key dimensions of wellbeing and ii) wellbeing measures that align to these dimensions among YPLHIV (15-24 years) in SSA. We searched six social science and medical databases, including grey literature. We included studies that examined correlates and lived experiences of wellbeing, among YPLHIV in SSA, from January 2000 to May 2019. Two reviewers independently screened abstracts and full texts and assessed methodological quality of included articles. We analysed quantitative and qualitative data using descriptive and meta-ethnographic approaches, respectively. Thereafter, we integrated findings using a framework approach. We identified 6527 citations. Of these, 10 quantitative and 30 qualitative studies were included. Being male, higher educational status, less stigma and more social support were likely correlates of wellbeing. Themes that shaped experiences suggestive of wellbeing were: 1) acceptance and belonging- stigma, social support; 2) coping; 3) standard of living. Our final synthesis found that the following dimensions potentially characterise wellbeing: self-acceptance, belonging, autonomy; positive relations, environmental mastery, purpose in life. Wellbeing for YPLHIV is multi-dimensional and relational. Relevant measures include the Personal Wellbeing Index, Ryff's Psychological Wellbeing Scale and Mental Health Continuum Short Form. However, psychometric evaluations of these scales among YPLHIV in SSA are needed.
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Affiliation(s)
- Darshini Govindasamy
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa.
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ioana D Olaru
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Giulia Ferrari
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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The prevalence of mental health problems in sub-Saharan adolescents living with HIV: a systematic review. Glob Ment Health (Camb) 2020; 7:e29. [PMID: 33489245 PMCID: PMC7786273 DOI: 10.1017/gmh.2020.18] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Despite the progress made in HIV treatment and prevention, HIV remains a major cause of adolescent morbidity and mortality in sub-Saharan Africa. As perinatally infected children increasingly survive into adulthood, the quality of life and mental health of this population has increased in importance. This review provides a synthesis of the prevalence of mental health problems in this population and explores associated factors. A systematic database search (Medline, PsycINFO, Scopus) with an additional hand search was conducted. Peer-reviewed studies on adolescents (aged 10-19), published between 2008 and 2019, assessing mental health symptoms or psychiatric disorders, either by standardized questionnaires or by diagnostic interviews, were included. The search identified 1461 articles, of which 301 were eligible for full-text analysis. Fourteen of these, concerning HIV-positive adolescents, met the inclusion criteria and were critically appraised. Mental health problems were highly prevalent among this group, with around 25% scoring positive for any psychiatric disorder and 30-50% showing emotional or behavioral difficulties or significant psychological distress. Associated factors found by regression analysis were older age, not being in school, impaired family functioning, HIV-related stigma and bullying, and poverty. Social support and parental competence were protective factors. Mental health problems among HIV-positive adolescents are highly prevalent and should be addressed as part of regular HIV care.
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33
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Yousuf A, Mohd Arifin SR, Musa R, Md Isa ML. Depression and HIV Disease Progression: A Mini-Review. Clin Pract Epidemiol Ment Health 2019; 15:153-159. [PMID: 32174997 PMCID: PMC7040472 DOI: 10.2174/1745017901915010153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
Abstract
Background Depression is the most common mental disorder and a leading cause of disability, which commonly presents unexplained psychological and physical symptoms. Depression and HIV/AIDS are commonly comorbid. This review provides an insight into the effect of depression on disease progression among people living with HIV. Methods A search for relevant articles was conducted using a database like MEDLINE, Scopus, PsycINFO and CINAHL. Peer-reviewed English journals published between 2015 and 2019 were included in the review. Results A total of eight studies conducted in different settings were included in the review. This review has found that psychosocial, neurohormonal and virologic factors associated with depression affect HIV disease progression. Yet, the chronicity of depression, absence of the hormones that have a buffer effect on depression and lack of examination if depression is a predictor, or an outcome of disease progression, were some of the gaps that require further investigation. Conclusion Considerably, more research is needed to better understand the effect of mental disorder, especially depression, on HIV disease progression to AIDS and future interventions should, therefore, concentrate on the integration of mental health screening in HIV clinical setup.
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Affiliation(s)
- Abdilahi Yousuf
- College of Medicine and Health Sciences, Jijiga University , Jijiga, Ethiopia
| | | | - Ramli Musa
- Department of psychiatric, Kulliyah of medicine, IIUM, Malaysia
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