Impact of Depression and Anxiety on Initiation of Antiretroviral Therapy Among Men Who Have Sex with Men with Newly Diagnosed HIV Infections in China

Family Functioning and Depressive Symptoms Among HIV-Positive Men Who Have Sex with Men: Mediating Roles of Stigma and Resilience

Background

Depressive symptoms are common among HIV-positive men who have sex with men (MSM). This study aims to explore (1) the relationship between family functioning and depressive symptoms and (2) the mediating roles of stigma and resilience in the relationship among HIV-positive MSM.

Methods

We used data from a cross-sectional study of a convenience sample in Hunan Province, China, conducted in 2019. The data analysis included 191 HIV-positive MSM with an average age of 26.98 years. All participants completed self-report questionnaires on demographic variables, family functioning, stigma, resilience, and depressive symptoms.

Results

Better family functioning was significantly associated with lower depressive symptoms. Both stigma (Indirect effect = -0.04, 95% CI, -0.10 ~ -0.001) and resilience (Indirect effect = -0.06, 95% CI, -0.12 ~ -0.01) were significant partial mediators in the relationship between family functioning and depressive symptoms. A parallel and chain mediating role of stigma and resilience in the relationship between family functioning and depressive symptoms was also supported (Indirect effect = -0.03, 95% CI, -0.08 ~ -0.01).

Conclusion

Improving family functioning is crucial for alleviating depressive symptoms among HIV-positive MSM in China. Depression assessment and reduction should be an integral part of prevention and treatment programs targeting stigma and resilience.

HIV Prevention and Treatment Interventions for Black Men Who Have Sex With Men in Canada: Scoping Systematic Review

BACKGROUND

Black men who have sex with men (MSM) experience disproportionately high HIV incidence globally. A comprehensive, intersectional approach (race, gender, and sexuality or sexual behavior) in understanding the experiences of Black MSM in Canada along the HIV prevention and care continuums has yet to be explored.

OBJECTIVE

This scoping review aims to examine the available evidence on the access, quality, gaps, facilitators, and barriers of engagement and identify interventions relevant to the HIV prevention and care continuum for Black MSM in Canada.

METHODS

We conducted a systematic database search, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, of the available studies on HIV health experience and epidemiology concerning Black MSM living with or without HIV in Canada and were published after 1983 in either English or French. Searched databases include MEDLINE, Excerpta, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, PsycInfo, PubMed, Scopus, and Web of Science. From the 3095 articles identified, 19 met the inclusion criteria and were analyzed.

RESULTS

Black MSM in Canada consistently report multiple forms of stigma and lack of community support contributing to an increased HIV burden. They experience discrimination based on their intersectional identities while accessing HIV preventative and treatment interventions. Available data demonstrate that Black MSM have higher HIV incidences than Black men who have sex with women (MSW) and White MSM, and low preexposure prophylaxis knowledge and HIV literacy. Black MSM experience significant disparities in HIV prevention and care knowledge, access, and use. Structural barriers, including anti-Black racism, homophobia, and xenophobia, are responsible for gaps in HIV prevention and care continuums, poor quality of care and linkage to HIV services, as well as a higher incidence of HIV.

CONCLUSIONS

Considering the lack of targeted interventions, there is a clear need for interventions that reduce HIV diagnoses among Black MSM, increase access and reduce structural barriers that significantly affect the ability of Black MSM to engage with HIV prevention and care, and address provider's capacity for care and the structural barriers. These findings can inform future interventions, programming, and tools that may alleviate this HIV inequity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-043055.

Perceptions toward antiretroviral therapy and delayed ART initiation among people living with HIV in Changsha, China: mediating effects of treatment willingness

Introduction

Delayed antiretroviral therapy (ART) initiation is associated with poor HIV outcomes and a higher likelihood of HIV transmission.

Methods

This cross-sectional study assessed the proportion of delayed ART initiation which was defined as initiating ART after 30 days of HIV diagnosis, and evaluated the pathways influencing ART initiation among adult PLWH in Changsha, China who were diagnosed between 2014 and 2022.

Results

Of 518 participants, 37.8% delayed in initiating ART. Based on the theory of reasoned action (TRA), delayed initiation was indirectly associated with perceptions toward ART through the mediating pathway of patients' treatment willingness, with treatment willingness significantly being the full mediator.

Discussion

The findings may guide the development of interventions to improve timely uptake of ART in people who are newly diagnosed with HIV.

Biopsychosocial approach to understanding predictors of depressive symptoms among men who have sex with men living with HIV in Selangor, Malaysia: A mixed methods study protocol

BACKGROUND

Depression is the most common psychiatric disorder reported among patients living with Human Immunodeficiency Virus (HIV), resulting from the intricate combination of biological, psychological, and social factors. Biopsychosocial factors can significantly impact the psychological well-being of men who have sex with men (MSM) living with HIV through social stigma, access and compliance to care, economic insecurity, relationship difficulties, and risky behavior. Compared to MSM without HIV, MSM living with HIV were more likely to be depressed. Despite specific vulnerabilities and health needs, MSM living with HIV remain understudied and underserved in Malaysia owing to legal, ethical, and social challenges.

OBJECTIVE

This is merely a published protocol, not the findings of a future study. This study aims to determine and explain the predictors of depressive symptoms among MSM living with HIV. Specifically, this study wants to determine the association between depressive symptoms among MSM living with HIV and biological, psychosocial, and social factors. Finally, the mixed methods will answer to what extent the qualitative results confirm the quantitative results of the predictors of depressive symptoms among MSM living with HIV.

METHODS

The study has ethical approval from the Medical Research Ethics Committee (MREC) of the Ministry of Health (MOH) NMRR ID-21-02210-MIT. This study will apply an explanatory sequential mixed methods study design. It comprised two distinct phases: quantitative and qualitative study design for answering the research questions and hypothesis. This study will randomly recruit 941 MSM living with HIV in the quantitative phase, and at least 20 MSM living with HIV purposively will be selected in the qualitative phase. The study will be conducted in ten public Primary Care Clinics in Selangor, Malaysia. A self-administered questionnaire will gather the MSM's background and social, psychological, and biological factors that could be associated with depressive symptoms. For the quantitative study, descriptive analysis and simple logistic regression will be used for data analysis. Then, variables with a P value < 0.25 will be included in multiple logistic regression to measure the predictors of depressive symptoms. In the qualitative data collection, in-depth interviews will be conducted among those with moderate to severe depressive symptoms from the quantitative phase. The thematic analysis will be used for data analysis in the qualitative phase. Integration occurs at study design, method level, and later during interpretation and report writing.

RESULT

The quantitative phase was conducted between March 2022 to February 2023, while qualitative data collection is from March 2023 to April 2023, with baseline results anticipated in June 2023.

CONCLUSION

In combination, qualitative and quantitative research provides a better understanding of depressive symptoms among MSM living with HIV. The result could guide us to provide a comprehensive mental healthcare program toward Ending the AIDS epidemic by 2030.

Physical activity, anxiety, depression, and adherence to antiretroviral therapy in people with HIV

BACKGROUND

Physical activity (PA) levels, as well as symptoms of anxiety and depression, can affect adherence to antiretroviral therapy (ART) impacting people's health. This study aimed to evaluate the association between PA levels, clinical symptoms of anxiety and depression, and adherence to ART in people living with HIV (PLHIV).

METHOD

A cross-sectional study including 125 PLHIV was conducted. Adherence to ART was assessed using the Simplified Medication Adherence Questionnaire (SMAQ). For anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) was applied. The level of PA was assessed using the short version of the International Physical Activity Questionnaire (IPAQ). SPSS version 22.0 was used for statistical analysis.

RESULT

The prevalence of clinical levels of anxiety and depression symptoms was 53.6% and 37.6 %, respectively. Fifty-three percent presented clinical levels of depression and anxiety symptoms. Sixty-one people (48.8%) had vigorous physical activity levels, 36 people (28.8%) had moderate PA levels and 28 people (22.4%) had low PA levels. According to the SMAQ, 34.5% of the patients were adherent to ART.

CONCLUSION

People who performed low PA levels had more risk to develop clinical levels of depression symptoms. Clinical level of anxiety, depression, and psychological distress (PD) symptoms was found to increase the risk of non-adherence to ART.

NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations

Purpose

Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH.

Patients and Methods

Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH.

Results

PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence.

Conclusion

The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.

Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study

Background

While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness.

Methods

A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects.

Results

Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem.

Conclusion

Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.

Game-based health education to improve ART adherence of newly diagnosed young people with HIV: protocol for a stepped-wedge design randomized controlled trial

BACKGROUND

Antiretroviral therapy (ART) is one of the most effective ways for HIV-infected to treat AIDS. However, it is difficult to start ART among young people those newly diagnosed HIV-infection in China, and their adherence to ART is poor. We have designed an AIDS educational game called AIDS Fighter · Health Defense, which could improve the AIDS-related knowledge and has the potential to improve AIDS prevention ability of young students. In this study, AIDS Fighter · Health Defense will be used with newly diagnosed young people with HIV to evaluate the education effect of the game in improving ART adherence.

DESIGN

A stepped-wedge design randomized controlled trial will be conducted to confirm the education effect of AIDS Fighter · Health Defense on improving ART adherence of newly diagnosed young people with HIV, and to verify when to start game-based health education could be more effective for newly diagnosed young people with HIV.

METHODS

Participants will receive AIDS education from health workers and start ART when diagnosed with HIV and assigned into four groups randomly. The first step group to the fourth step group will receive AIDS Fighter · Health Defense in turn at the star of ART, one week, one month and three months after the start of ART. The primary outcomes are medication adherence, CD4( +) T cell count, and HIV viral load. The secondary outcomes are ART-related knowledge, ART-related skills, psychological resilience, and self-discrimination. Assessments will be completed before the intervention and one week, first month, and third month of the intervention, and then a one-year follow-up evaluation will be conducted after the intervention.

DISCUSSION

AIDS Fighter · Health Defense may be an effective approach to help newly diagnosed young people with HIV to improve ART adherence. A stepped-wedge design randomized controlled trial of this study may find the optimal time of AIDS education to improve ART adherence of newly diagnosed young people with HIV.

REGISTRATION NUMBER

Chinese Clinical Trial Registry: ChiCTR2200059766, registered 11 May 2022. http://www.chictr.org.cn/showproj.aspx?proj=169420.

What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis

BACKGROUND

Depression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM).

OBJECTIVES

This study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis.

METHODS

This study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16.

RESULTS

The results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%-39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate.

CONCLUSION

The pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.

Estimating Changes in Population Size and Behavioral Characteristics in Men Who Have Sex With Men Between 2014 and 2019: Longitudinal Study

Background

Men who have sex with men (MSM) are at high risk for HIV infection. Accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM is of great importance to develop targeted HIV prevention and interventions.

Objective

The goal of the research was accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM.

Methods

Street interception investigation methods were conducted among males aged 16 years and older in selected sites in Shenzhen in 2014 and 2019. A population survey was used to estimate the population size of MSM. Logistic regression analysis was applied to evaluate the difference in behavioral characteristics in MSM from 2014 to 2019.

Results

In this study, we surveyed 10,170 participants in 2014, of whom 448 (4.41%, 95% CI 4.01%-4.80%) participants were men who have ever had sex with another man (MSMe) and 229 (2.25%, 95% CI 1.96%-2.54%) were men who had sex with another man in the previous 6 months (MSMa). A total of 10,226 participants were surveyed in 2019, of which 500 (4.90%, 95% CI 4.47%-5.31%) and 208 (2.03%, 95% CI 1.76%-2.31%) participants were MSMe and MSMa, respectively. The results showed that the population size of MSM who are active (MSMa) in Shenzhen was 155,469 (2.29%, 95% CI 2.28%-2.30%) in 2014 and 167,337 (2.05%, 95% CI 2.04%-2.06%) in 2019. It was estimated that there were about 12,005,445 (2.04%, 95% CI 2.04%-2.04%) MSMa in China in 2019. Compared with 2014, the MSMa in 2019 were more likely to seek sex partners through mobile phone apps and less likely to have male and female sex partners in addition to having inconsistent condom use and more than 6 sex partners in the previous 6 months.

Conclusions

In Shenzhen, the proportion of MSMa among the general male population was lower in 2019 than in 2014, and the prevalence of HIV risk behavior was reduced in 2019. Although the preferred platform to find male sex partners among MSM has changed, intervention with high–HIV risk MSM could still help to reduce HIV risk behaviors among the whole MSM group. Because MSM prefer to seek sex partners through mobile phone apps, further study is needed to strengthen internet interventions with high–HIV risk MSM to curb the spread of HIV.

Characterizing Racial Differences of Mental Health Burdens, Psychosocial Determinants, and Impacts on HIV Prevention Outcomes Among Young Men Who have Sex With Men: a Community-based Study in Two U.S. Cities

Few studies examine racial differences (e.g., Black vs. White) regarding the psychosocial pathways linking mental health burdens and various HIV-related outcomes among young men who have sex with men (MSM) in the U.S. We conducted a community-based study to examine the racial differences of mental health burdens (e.g., depression, anxiety, stress), the psychosocial determinants (e.g., HIV stigma, homonegativity, resilience, social support, loneliness, housing/food security) and impact on HIV-related outcomes (e.g., event-level alcohol/drug use before sex, condomless insertive/receptive anal sex, recent HIV testing, and PrEP awareness/willingness/use) among young Black MSM (YBMSM; n = 209) and young White MSM (YWMSM; n = 109) from two cities (Nashville, TN and Buffalo, NY) in the United States. Overall, we found YBMSM were more likely (p < 0.05) to experience anxiety and depression compared to YWMSM. Among YBMSM, we found structural inequities (housing instability, food insecurity, internalized homonegativity) were positively associated with anxiety/depression/stress (p < 0.001); we also found anxiety/depression was associated with increased alcohol/drug use before sex, and stress was associated with reduced recent HIV testing and pre-exposure prophylaxis awareness/willingness/use. Among YWMSM, we found psychological buffers (perceived social support, resilience) were associated with reduced anxiety/depression/stress (p < 0.001); anxiety was associated with increased condomless insertive/receptive anal sex and recent HIV testing among this subgroup. YBMSM and YWMSM differed in psychosocial determinants and HIV-related consequences regarding their mental health. Our findings provide important implications for developing culturally and contextually tailored interventions to address mental health burdens and HIV prevention outcomes among young MSM at highest risk for HIV acquisition.

Biopsychosocial approach to understanding determinants of depression among men who have sex with men living with HIV: A systematic review

INTRODUCTION

Men who have sex with men (MSM) living with HIV are more likely to be depressed than MSM without HIV. The AIDS epidemic will not end if the needs of people living with HIV and the determinants of health are not being addressed. Compared to HIV individuals without depression, depressed HIV individuals have worse clinical outcomes and higher mortality risk. Depression is caused by a complex combination of social, psychological, and biological variables. This systematic review, thereby motivated by the need to address this gap in the literature, aims to articulate determinants of depression among MSM living with HIV according to the biopsychosocial approach.

METHODOLOGY

We systematically searched four databases from 2011 to 2021. We searched for observational studies on determinants of depression among MSM living with HIV. The outcome is depression based on the categorical or numerical outcome. Two reviewers independently extracted data and assessed study risks of bias. Any disagreements are consulted with the third reviewer.

RESULTS

We identified 533 articles, of which only eight studies are included. A total of 3,172 MSMs are included in the studies. We found the determinants of depression and categorized them according to biological, psychological, and social approaches.

CONCLUSION

The determinants of depression with the strongest evidence across studies were enacted HIV-related stigma, unemployment, sleep disturbance, current smoker, black ethnicity, born overseas, ART initiation, and access to mental health care. Despite weaker evidence, the other relevant determinants to be included were older age, internalized stigma, self-efficacy, and social support. Efforts to improve or prevent depression among MSM living with HIV could benefit from addressing the determinants of depression based on the biopsychosocial approach immediately after HIV diagnosis. Integrating mental health screening and care into HIV treatment settings would strengthen HIV prevention and care outcomes and improve access to mental healthcare.

Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National 'Treat All' Policy

Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.

Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national "treat all" policy: a cross-sectional analysis

Introduction

Rapid antiretroviral treatment (ART) initiation reduces time from HIV infection to viral suppression, decreasing HIV transmission risk. Mental health symptoms may influence timing of ART initiation. This study estimated the prevalence of ART initiation at enrolment into HIV care and the relationship between mental health and ART initiation at enrolment into HIV care.

Methods

We conducted interviews with 426 individuals initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the association between mental health and timing of ART initiation. Depression (Patient Health Questionnaire‐9; cut‐point 10), anxiety (Generalized Anxiety Disorder‐7; cut‐point 10), post‐traumatic stress disorder (PTSD) (PTSD Checklist for DSM‐5; cut‐point 31) and harmful alcohol use (Alcohol Use Disorders Identification Test; cut‐point 16) were dichotomized to represent those with and without each exposure at first HIV care appointment. Date of ART initiation (date ART prescribed) was ascertained from medical records. Separate multivariable log‐binomial regression models were used to estimate the association between mental health exposures and ART initiation at enrolment into care.

Results and discussion

Overall, 87% initiated ART at enrolment into HIV care. Approximately 20% reported depressive symptoms, 15% reported PTSD symptoms, 12% reported anxiety symptoms and 13% reported harmful alcohol use. In multivariable analyses, individuals with moderate to severe depressive symptoms had 1.7 (95% confidence interval [CI] 1.1, 2.7) times the prevalence of not initiating ART at enrolment into HIV care compared to those with no or mild depressive symptoms. Those with symptoms of PTSD, compared to those without, had 1.9 (95% CI 1.2, 2.9) times the prevalence of not initiating ART at enrolment into HIV care. Symptoms of anxiety or harmful drinking were not associated with ART initiation at enrolment into HIV care in multivariable models.

Conclusions

Symptoms of depression and PTSD were associated with lower prevalence of ART initiation at enrolment into HIV care among this sample of individuals initiating HIV care in Cameroon under a “treat all” policy. Research should examine barriers to timely ART initiation, whether incorporating mental health services into HIV care improves timely ART initiation, and whether untreated symptoms of depression and PTSD drive suboptimal HIV care outcomes.

Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder

BACKGROUND

Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation.

METHODS

CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression.

RESULTS

Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001).

CONCLUSIONS

Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China

Background

We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy.

Methods

A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy).

Results

Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05).

Conclusions

The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.

Associations between antiretroviral therapy-related experiences and mental health status among people living with HIV in China: a prospective observational cohort study

BACKGROUND

Mental health problems (e.g., depression and anxiety) are among the most commonly reported comorbidities of HIV. Antiretroviral therapy (ART) coverage has increased sharply. The purposes of this prospective cohort study were to investigate the ART-related experiences and whether they were associated with mental health problems among a sample of people living with HIV undergoing ART in China.

METHODS

The participants were 400 people living with HIV who had started ART for the first time in Guangzhou city. They were followed-up 1-year after ART initiation. Probable depression and moderate/severe anxiety were measured at baseline and Month 12, while experiences related to ART (e.g., side effects and regained self-confidence) were measured at Month 6. Univariate and multivariate logistic regressions were used to explore the associations between baseline characteristics, ART-related experiences and mental health status.

RESULTS

Among the 300 participants (75.0%) who completed all three surveys, a significant decline in prevalence of probable depression (23.0% at baseline vs. 14.0% at Month 12, P = 0.002) and moderate/severe anxiety (14.7% at baseline vs. 8.7% at Month 12, P = 0.023) was observed during the follow-up period. After adjustment for mental health status and potential confounders at baseline, a number of ART-related experiences at Month 6 were associated with probable depression and/or moderate/severe anxiety measured at Month 12. Improved physical health, relationships with sexual partners, and self-confidence were associated with decreased mental health issues, while the side effects of ART, AIDS-related symptoms, and inconvenience in daily life due to ART use were associated with increased mental health issues.

CONCLUSIONS

ART-related experiences were associated with mental health problems, tailored mental health promotion interventions targeting these experiences are needed.

HIV incidence and sexual behavioral correlates among 4578 men who have sex with men (MSM) in Chengdu, China: a retrospective cohort study

Background

The prevalence of HIV among men who have sex with men (MSM) in southwest China is still increasing. This study aimed to investigate the trend in HIV incidence and its associated risk factors among MSM in Chengdu, China.

Method

Incidence data were collected from the largest local non-governmental organization (NGO) serving MSM in Chengdu between 2012 and 2018, while information on sexual behaviors was collected from 2014. All MSM who received voluntary counseling and testing services (VCT) in the collaborating NGO at least twice during the study period were included. We calculated the HIV incidence density among MSM every 2 years and the overall incidence rate. A Cox proportional hazards regression model was employed to identify risk factors for HIV infection.

Result

A total of 4578 HIV-negative participants were included in the cohort. The total incidence density was 5.95 (95% CI: 5.37–6.56)/100 person-years (PYs) between 2012 and 2018. The segmented incidence density was 9.02 (95% CI: 7.46–10.78), 5.85 (95% CI: 4.86–6.97), 5.43 (95% CI: 4.53–6.46), and 3.09 (95% CI: 2.07–4.41)/100 PYs in 2012–2013, 2014–2015, 2016–2017, and 2018, respectively. After adjusting for sociodemographic characteristics, compared to participants without sexual partners within 6 months, MSM with one fixed partner (Adjusted Hazard Ratio, AHR = 1.18, 95% CI: 0.44–3.19) and more than five partners (AHR = 2.24, 95% CI: 0.81–6.20) had increased risk of HIV infection. MSM who used condom inconsistently had a higher risk of HIV infection (AHR = 1.87, 95% CI: 1.46–2.38) compared to consistent condom users.

Conclusion

The decreased HIV incidence density among MSM was potentially related to the successful comprehensive HIV prevention strategies in Chengdu. Multiple male sexual partnerships and inconsistent condom use during anal intercourse were risk factors associated with HIV occurrence.

Depressive symptoms and use of HIV care and medication-assisted treatment among people with HIV who inject drugs

OBJECTIVE

Vietnam, Indonesia, and Ukraine have major burdens of IDU and HIV. We estimated the prevalence of depressive symptoms at baseline among people living with HIV who inject drugs, evaluated associations between depression at baseline and 12-month HIV care outcomes and medication-assisted treatment (MAT), and evaluated the study intervention effect by baseline depression subgroups.

DESIGN

HPTN 074 was a randomized study. The study intervention included psychosocial counseling, systems navigation, and antiretroviral treatment (ART) at any CD4+ cell count.

METHODS

Moderate-to-severe depression was defined as a Patient Health Questionnaire-9 score of 10 or above. ART and MAT were self-reported. Eligibility criteria were: 18-60 years of age, active IDU, and viral load of at least 1000 copies/ml. Adjusted probability differences (aPD) were estimated using inverse-probability weighting.

RESULTS

A total of 502 participants enrolled from April 2015 to June 2016. Median age was 35 years; 85% identified as men. Prevalence of baseline moderate-to-severe depression was 14% in Vietnam, 14% in Indonesia, and 56% in Ukraine. No evident associations were detected between baseline depression and ART, viral suppression, or MAT at 12-month follow-up. The study intervention improved the proportions of people who inject drugs achieving 12-month viral suppression in both the depressed [intervention 44%; standard of care 24%; estimated aPD = 25% (95% confidence interval: 4.0%, 45%)] and nondepressed subgroups [intervention 38%; standard of care 24%; aPD = 13% (95% confidence interval: 2.0%, 25%)].

CONCLUSION

High levels of depressive symptoms were common among people living with HIV who inject drugs in Ukraine but were less common in Vietnam and Indonesia. The study intervention was effective among participants with or without baseline depression symptoms.

Neuropsychiatric Adverse Events During 12 Months of Treatment With Efavirenz in Treatment-Naïve HIV-Infected Patients in China: A Prospective Cohort Study

Background: Efavirenz (EFV) is widely used in antiretroviral therapy (ART), but the incidence and risk factors of neuropsychiatric adverse events (NPAEs) after EFV treatment have rarely been studied in Chinese ART naïve patients. Methods: This prospective cohort study assessed HIV-infected patients initiating antiretroviral treatment with EFV to determine prevalence of and factors associated with NPAEs over a 12-month follow-up period using the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Results: A total of 546 patients were enrolled. Prevalence of anxiety, depression, and sleep disturbances at baseline were 30.4, 22.7, and 68.1%, respectively. Six patients discontinued treatment due to drug related NPAEs. Treatment was associated with improvements in HADS-A, HADS-D, and PSQI scores over the 12-month follow-up, and the frequencies of patients with anxiety, depression, and sleep disturbances significantly decreased after 12 months. Abnormal baseline HADS-A, HADS-D, and PSQI scores and other factors, including high school education or lower income, unemployment, divorce, and WHO III/IV stages, were associated with severe neuropsychiatric disorders over the 12 months. Conclusions: These findings suggested EFV discontinuation due to NAPEs was low, and the HADS-A, HADS-D, and PSQI scores after 12 months of EFV treatment were associated with several risk factors. The clinicians should keep in mind and routinely screen for the risk factors associated with neuropsychiatric disorders in HIV-infected patients.

Reported prevalence of depression or depressive symptoms among men who have sex with men in China, 2004-2018: A systematic review and meta-analysis

BACKGROUND

Depression is a major mental disorder that imposes a considerable burden on health. Men who have sex with men (MSM) are at high risk for depression. Numerous studies have reported the prevalence of depression or depressive symptoms among MSM in China. However, the estimates have varied substantially between studies. This meta-analysis aimed to establish the pooled prevalence of depression or depressive symptoms among Chinese MSM to attract public attention.

METHOD

A systematic search of several electronic databases and a subsequent manual search was performed to identify relevant studies. A random effects model was adopted to calculate the pooled prevalence of depression or depressive symptoms. Heterogeneity between studies and publication bias was also assessed.

RESULTS

A total of 54 articles with a sample size of 21,950 MSM were analysed. The pooled prevalence of depression or depressive symptoms among MSM was 40.0% (95% CI: 37.9%-45.0%). Substantial heterogeneity was observed across individual studies. The pooled summary estimate stratified by screening instruments and cutoff scores ranged from 19.0% to 60.2%. Subgroup analysis indicated that survey dates, sampling method, HIV infection status and occupation can partially contribute to the between-study heterogeneity.

LIMITATIONS

The findings should be interpreted with caution because of several limitations related to the heterogeneity across studies, sampling method and quality assessment.

CONCLUSIONS

Overall, the reported prevalence of depression or depressive symptoms among Chinese MSM was fairly high. The study suggested that more attention and effective intervention programmes are urgently provided to prevent and improve mental health issues among Chinese MSM.

HIV Treatment Knowledge in the Context of "Treatment as Prevention" (TasP)

According to 2012 universal ART guidelines, as part of "treatment as prevention" (TasP), all people living with HIV (PLWH) should immediately initiate antiretroviral therapy post-diagnosis to facilitate viral suppression. PLWH who are virally suppressed have no risk of sexually transmitting HIV. This study used descriptive analysis of quantitative data (N = 99) and thematic analysis of qualitative interviews (n = 36) to compare participants recruited from a hospital-based detoxification (detox) unit, largely diagnosed with HIV pre-2012 (n = 63) vs. those recruited from public, urban sexual health clinics (SHCs), mainly diagnosed in 2012 or later (n = 36). Detox participants were significantly more knowledgeable than SHC participants about HIV treatment, except regarding TasP. SHC participants' desire for rapid linkage to care and ART initiation was in line with 2012 universal ART guidelines and TasP messaging regarding viral suppression. More targeted messaging to PLWH pre-2012 could ensure that all PLWH benefit from scientific advances in HIV treatment.

Prevalence of depression, anxiety and suicide among men who have sex with men in China: a systematic review and meta-analysis

AIMS

Chinese men who have sex with men (MSM) are at high risk for depression, anxiety and suicide. The estimated prevalence of these problems is essential to guide public health policy, but published results vary. This meta-analysis aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and suicide among Chinese MSM.

METHODS

Systematic searches of EMBASE, MEDLINE, PsycINFO, PubMed, CNKI and Wanfang databases with languages restricted to Chinese and English for studies published before 10 September 2019 on the prevalence of depressive symptoms, anxiety symptoms, suicidal ideation, suicide plans and suicide attempts among Chinese MSM. Studies that were published in the peer-reviewed journals and used validated instruments to assess depression and anxiety were included. The characteristics of studies and the prevalence of depression and anxiety symptoms, suicidal ideation, suicide plans and suicide attempts were independently extracted by authors. Random-effects modelling was used to estimate the pooled rates. Subgroup analysis and univariate meta-regression were conducted to explore potential sources of heterogeneity. This study followed the PRISMA and MOOSE.

RESULTS

Sixty-seven studies were included. Fifty-two studies reported the prevalence of depressive symptoms, with a combined sample of 37 376 people, of whom 12 887 [43.2%; 95% confidence interval (CI), 38.9-47.5] reported depressive symptoms. Twenty-seven studies reported the prevalence of anxiety symptoms, with a combined sample of 10 531 people, of whom 3187 (32.2%; 95% CI, 28.3-36.6) reported anxiety symptoms. Twenty-three studies reported the prevalence of suicidal ideation, with a combined sample of 15 034 people, of whom 3416 (21.2%; 95% CI, 18.3-24.5) had suicidal ideation. Nine studies reported the prevalence of suicide plans, with a combined sample of 5271 people, of whom 401 (6.2%; 95% CI, 3.9-8.6) had suicide plans. Finally, 19 studies reported the prevalence of suicide attempts, with a combined sample of 27 936 people, of whom 1829 (7.3%; 95% CI, 5.6-9.0) had attempted suicide.

CONCLUSIONS

The mental health of Chinese MSM is poor compared with the general population. Efforts are warranted to develop interventions to prevent and alleviate mental health problems among this vulnerable population.

The Disparities in Mental Health between Gay and Bisexual Men Following Positive HIV Diagnosis in China: A One-Year Follow-Up Study

This study aimed to determine the change in mental health (depression and anxiety) among HIV-positive gay and bisexual men (GBM) one year after diagnosis and the disparities in trajectories of mental health between them. The potential factors contributing to the disparities were also investigated. This was a one-year follow-up study focusing on the mental health of newly diagnosed HIV-positive individuals. Participants rated their depression, anxiety, stress, and social support levels at baseline and one year later. Information on the utilization of mental healthcare and the initiation of antiretroviral therapy (ART) after diagnosis was collected at one-year follow-up. A total of 171 and 87 HIV-positive gay and bisexual men, respectively, completed two-time points surveys in this study. The depressive and anxiety symptoms experienced by HIV-positive GBM improvement one year after diagnosis. These improvements tended to be smaller in gay participants. Other factors including mental health care utilization and ART status during the one-year follow-up period, changes in social stress scores and objective social support scores were also associated with the changes in depression and anxiety, and all these factors, except for change in objective support, were found to be statistically different between HIV-positive GBM. Special attention should be given to the mental health of HIV-positive gay men. Promoting HIV-positive gay men to assess to mental health services and ART may be important for these populations to improve mental health. Enhancing social support and reducing stress levels may also be necessary for the vulnerable HIV-positive sexual minority groups.

HIV care continuum characteristics among people with opioid use disorder and HIV in Vietnam: baseline results from the BRAVO study

BACKGROUND

Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. The primary objective of this analysis was to evaluate associations between participant characteristics and the critical steps in the HIV care continuum of ART initiation and HIV viral suppression among people with opioid use disorder and HIV in Vietnam.

METHODS

We assessed baseline participant characteristics, ART status, and HIV viral suppression (HIV RNA PCR < 200 copies/mL) enrolled in a clinical trial of HIV clinic-based buprenorphine versus referral for methadone among people with opioid use disorder in Vietnam. We developed logistic regression models to identify characteristics associated with ART status and HIV viral suppression.

RESULTS

Among 283 study participants, 191 (67.5%) were prescribed ART at baseline, and 168 of those on ART (90%) were virally suppressed. Years since HIV diagnosis (aOR = 1.12, 95% CI 1.06, 1.19) and being married (aOR = 2.83, 95% CI 1.51, 5.34) were associated with an increased likelihood of current prescription for ART at baseline. Greater depression symptoms were negatively associated with receipt of ART (aOR = 0.97, 95% CI = (0.94, 0.9963)). In the HIV suppression model, once adjusting for all included covariates, only receipt of ART was associated with viral suppression (aOR = 25.9, 95% CI = (12.5, 53.8). In bivariate analyses, methamphetamine was negatively correlated with ART prescription (p = 0.07) and viral suppression (p = 0.08).

CONCLUSION

While fewer than 90% of participants had received ART, 90% of those on ART had achieved HIV viral suppression at baseline, suggesting that interventions to improve uptake of ART in Vietnam are essential for achieving UNAIDS 90-90-90 goals in people who use heroin in Vietnam. Social determinants of health associated with ART and HIV viral suppression suggest that social support may be a key to facilitating both of these steps in the HIV care continuum.

HIV Epidemiology and Prevention in Southwestern China: Trends from 1996-2017

The aim of this review is to describe long-term HIV epidemiology and prevention trends in Guangxi, a provincial-level region located along a major drug trafficking corridor in southwestern China. Between 1996 and 2006, HIV transmission in Guangxi was primarily fueled by Injection Drug Use (IDU). Since 2006, heterosexual sex has become the dominant mode of HIV transmission, followed by drug injection. Moreover, older, heterosexual adults appear to be at increased risk for HIV. The vast majority of new HIV cases are attributed to local HIV subtypes already circulating within Guangxi (93%), though imported subtypes are associated with younger age groups. Since 2011, HIV incidence in Guangxi has stabilized, due in part to HIV prevention efforts that include expanded HIV testing, antiretroviral treatment, and other intervention measures. Between 1996 and 2017, Guangxi, China experienced dramatic changes in the primary HIV transmission mode and at-risk age group. Due in part to local and National AIDS control and prevention campaigns, HIV incidence trends in Guangxi no longer appear to be increasing.

Addressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China

PURPOSE OF REVIEW

Men who have sex with men (MSM) in China experience elevated risks of mental health issues in comparison to the general population in China, which contribute to vulnerability to HIV/STI risks and can comprise the effectiveness of HIV prevention efforts. A conceptual framework for understanding this mental health disparity is minority stress theory, which posits that experiences of external prejudice events (i.e., distal stressors) and internal stress processes such as internalized homophobia and concealment (i.e., proximal stressors) contribute to sexual minorities' elevated risk of psychological distress. To deepen the understanding of mental health among Chinese MSM and explore the potential utility of minority stress theory in this population, this paper synthesizes research evidence regarding prevalent mental health issues as well as how minority stress may be linked to psychological health in Chinese MSM.

RECENT FINDINGS

Results indicate that Chinese MSM experience a high prevalence of several mental health issues including depression, anxiety, suicidal behaviors, and alcohol dependence. This review further reveals minority stress to be an important determinant of psychological distress among Chinese MSM, though evidence is mixed regarding the relationship between proximal minority stress and psychological health. Nonetheless, there is a lack of mental health services and interventions focusing on MSM in China. Culturally relevant, competent, and LGBT-affirmative mental health interventions are needed for Chinese MSM. To guide future intervention research, we provide considerations for reducing minority stress and promoting psychological health among Chinese MSM.

Coverage and adherence of antiretroviral therapy among Chinese HIV-positive men who have sex with men with high CD4 counts in the era of 'Treat all'

OBJECTIVES

HIV-positive men who have sex with men (MSM) with CD4 cell counts> 350 cells/mm³ in China recently became eligible for free antiretroviral therapy (ART) due to updated national guidelines. This study aimed to investigate ART coverage and adherence among a large sample of HIV-positive MSM in China.

METHODS

A cross-sectional survey was conducted in Chengdu and Hangzhou, China, from February to November 2016. Participants were 277 MSM who had received a confirmatory HIV diagnosis and had CD4 levels of> 350 cells/mm³ . Trained staff of collaborating non-governmental organizations contacted all HIV-positive MSM listed in their service records and invited them to join the study. The ART initiation, ART adherence and interactions between healthcare professionals and the patients were assessed.

RESULTS

ART coverage was 60.3%. Among those who were on ART (n = 167), no participants reported missing any doses in the last four days, but 25.7% reported non-compliance to either ART dosing schedule or dosage instructions. After adjusting for background variables and perceived eligibility for ART, two variables were significant factors of higher ART coverage: (i) receiving a recommendation from healthcare professionals for immediate ART initiation and (ii) perceiving having received an adequate explanation of potential harms of ART. Being prescribed> 3 pills per dose and not having a temporary resident permit were associated with non-compliance.

CONCLUSIONS

Significant efforts are needed to increase ART coverage among HIV-positive MSM with high CD4 counts in China. Although prevalence of missing doses was low, non-compliance to dosing schedule/instructions should not be neglected. Interactions between healthcare professionals and MSMs play an important role in facilitating ART initiation.

Role of psychosocial status in predicting health-related quality of life at 1-year follow-up among newly diagnosed people living with HIV

Background

Psychosocial problems are common among people living with HIV (PLWH) and have been cross-sectionally associated with health-related quality of life (HRQoL). We evaluated the longitudinal relationship between psychosocial status and HRQoL among PLWH during the first year after diagnosis.

Method

A consecutive sample of newly diagnosed PLWH was recruited from Changsha Center for Disease Control and Prevention in Hunan Province, China. Assessments were conducted at baseline and 1 year later. The measures used in this study included the Medical Outcomes Study HIV Survey (MOS-HIV), the 9-item Patient Health Questionnaire (PHQ-9), the HIV/AIDS Stress Scale (SS-HIV) and the Social Support Rating Scale (SSRS). The trajectories of depression from baseline to 1-year follow-up were categorized into four groups: never (PHQ-9 < 10 at two time points), new-onset (PHQ-9 < 10 at baseline & PHQ-9 ≥ 10 at follow-up), recovered (PHQ-9 ≥ 10 at baseline & PHQ-9 < 10 at follow-up) and persistent depression (PHQ-9 ≥ 10 at two time points). In addition, the trajectories of stress and social support were classified by calculating the proportions of participants whose stress and social support scores changed between baseline and 1-year follow-up by more than 0.5 effect size in either direction. Generalized linear models were used to examine the potential role of baseline and changes in psychosocial status in predicting the HRQoL at 1 year, after adjusting for socio-demographic and clinical characteristics.

Results

A total of 410 participants completed both the baseline and 1-year follow-up surveys. Higher stress levels at baseline predicted a lower HRQoL at 1 year, while baseline depression status and social support did not predict 1-year HRQoL scores. Compared to those who were never depressed at both baseline and follow-up, participants who experienced new-onset or persistent depression had lower HRQoL at 1 year. Additionally, the 1-year HRQoL score of participants who recovered from depression by follow-up was comparable to that of participants who were never depressed. Moreover, participants who experienced increases in stress levels by follow-up had lower HRQoL scores at 1 year than those with decreases in stress levels. Changes in social support did not predict 1-year HRQoL scores in this study.

Conclusions

Assessing psychosocial status regularly and implementing effective interventions targeted at psychosocial problems may be particularly important for PLWH to improve their HRQoL. Among PLWH, special attention should be given to those with new-onset or persistent depression and those with high stress levels at the time of diagnosis and increased stress levels 1 year after the new HIV diagnosis.

Providing competent, comprehensive and inclusive sexual health services for men who have sex with men in low- and middle-income countries: a scoping review

Although men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmissible infections, sexual health services for MSM in low- and middle-income countries (LMIC) remain under-resourced and are poorly understood. A scoping review of literature on MSM sexual health in LMIC was conducted in order to identify key clinical services and gaps in knowledge. Three databases were searched, in addition to hand-reviewing key journals and bulletins, to identify literature with a focus on MSM sexual health. Key services related to providing care to MSM in LMIC that emerged from our review are described. These services include creation of safe and confidential clinic environments, HIV testing services, behavioural interventions, HIV pre-exposure prophylaxis (PrEP), rapid antiretroviral therapy (ART) initiation and STI services. Compared with high-income settings, major differences in LMIC include lack of diagnostic technology, unfavourable legal environments and lack of funding for MSM health. Innovative approaches to healthcare delivery, such as harnessing mobile technology, self-testing and crowdsourcing interventions, can improve health services among MSM in LMIC. There are gaps in the evidence about how best to provide sexual health services for MSM in LMIC settings. Implementation research and scale-up of existing biomedical and behavioural interventions, such as HIV/STI testing services, PrEP and early antiretroviral initiation are urgently needed in LMIC.

Switch to dolutegravir is well tolerated in Thais with HIV infection

INTRODUCTION

Dolutegravir (DTG) is recommended as part of first-line antiretroviral therapy (ART) for people living with HIV(PLHIV). We sought to determine the rate of adverse events (AEs) and discontinuations among Thais treated during acute HIV infection (AHI) and switched to DTG-based regimens.

METHODS

Thai participants in the SEARCH010/RV254 cohort who initiated ART during AHI and switched to DTG for at least 48 weeks were prospectively observed and included in the analysis. Rates and characteristics of DTG-related AEs and discontinuations were described.

RESULTS

A total of 313 Thai participants were included in the analysis. The median age was 29 years, 96% were male, 64% had a Bachelor's degree or higher and 16% had a body mass index (BMI) <18.5 kg/m2 . Participants were on ART for a median of 124 weeks before switching to DTG. The median (IQR) body weight increased from 63 (56 to 70) kg before to 65 (58 to 73) kg (p < 0.0001) after 48 weeks of DTG. Forty-nine (16%) developed DTG-related AEs, corresponding to an incidence of 16.6 per 100 person-years. Neuropsychiatric symptoms were most frequently encountered (n = 25, 8%), followed by laboratory abnormalities (n = 16, 5%). Six (2%) discontinued DTG, corresponding to an incidence of 2.4 per 100 person-years. All discontinuations were due to increased liver enzymes in the presence of hepatitis C virus coinfection. In the multivariate analysis, incident hepatitis C virus infection was the only risk factor for discontinuing DTG (hazard ratio 59.4, 95% CI 8.5 to 297.9, p < 0.0001). Neither low BMI nor concurrent abacavir therapy was associated with discontinuation.

CONCLUSIONS

DTG was well tolerated with few discontinuations in this cohort of young men. Incident hepatitis C virus infection was a driver of liver-related AEs leading to discontinuations. In populations at risk, regular testing for hepatitis C virus during ART is recommended to anticipate possible AEs, guide management and improve safety.

Intention to initiate antiretroviral therapy (ART) among people living with HIV in China under the scaling-up of ART: the role of healthcare workers' recommendations

BACKGROUND

The early initiation of antiretroviral therapy (ART) for people living with HIV (PLWH) benefits both individuals and societies. However, little is known about the intention to initiate ART among PLWH in China in the context of a scaling-up of treatment or how the recommendations of healthcare workers affect this intention.

METHODS

A total of 451 ART-naïve PLWH were recruited from communities in Guangzhou, China for this study. Data were collected by trained physicians via face-to-face interviews. Logistic regression models were fitted for the data analyses.

RESULTS

Of the participants, 93.8% were male, 72.7% were infected via homosexual behaviour and 68.5% reported an intention to initiate ART. In the latter category, 77.8, 41.9 and 20.0% of respondents received strong recommendations to initiate ART from healthcare workers at the Centres for Disease Control and Prevention (CDC), community healthcare centres and non-governmental organisations (NGOs), respectively. After adjusting for potential confounders, depression, anxiety and strong recommendations from healthcare workers at the CDC and NGOs correlated significantly with ART intention. In the adjusted final hierarchical logistic regression model, the duration of infection [multivariate odds ratio (OR_m) = 0.30, p < 0.001], route of HIV infection (OR_m = 0.18, p < 0.01), infection status of the current spouse/regular sex partner (OR_m = 0.21-0.23, p < 0.01), anxiety (OR_m = 2.44-2.65, p < 0.05) and strong recommendations from CDC physicians (OR_m = 3.67, p < 0.01) or NGOs workers (OR_m = 3.67, p < 0.01) were independently associated with the ART intention, whereas a recommendation from a community healthcare centre physician was not.

CONCLUSIONS

In Guangzhou, the prevalence of ART intention was below the 90-90-90 targets. Further studies aimed at an in-depth understanding and encouragement of health care workers' perceptions regarding early ART are warranted as a means of scaling up new ART strategies.

Association between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive men who have sex with men (MSM) in Nanjing, China

Among Chinese HIV-positive men who have sex with men (MSM), high levels of depression are common. The association between HIV and depression is attributed to several factors, particularly HIV-related stigma. However, to date, how HIV-related stigma leads to depression among Chinese HIV-positive MSM is still unclear. As such, this study aims to examine the relationships between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive MSM in China. We conducted a cross-sectional survey study among 347 HIV-positive MSM from July to August 2016 in Nanjing, China. Measurements were sociodemographic and psychological constructs including perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms. Structural equation modeling (SEM) was used to examine the relationships among these constructs. Overall,134 (38.6%) participants had depressive symptoms. Perceived stigma was directly associated with depressive symptoms (β = .196, p < .001). Perceived stigma also indirectly affected depressive symptoms (β = .200, p < .001)through social support and self-esteem. Social support (β = -.124, p = .004) and self-esteem (β = -.536, p = .001), but not resilience, were direct predictors of depressive symptoms. Resilience was directly associated with self-esteem (β = .512, p < .001). Perceived HIV stigma could directly and indirectly impact depressive symptoms in HIV-positive MSM. Improving personal self-esteem, resilience and social support might reduce impact of perceived stigma on depressive symptoms among HIV-positive MSM in China.

Psychometric Properties and Factor Structure of the Chinese Version of the Hospital Anxiety and Depression Scale in People Living With HIV

The population of people living with HIV (PLWH) is growing in number and usually results in mental health problems that impact their quality of life. Therefore, valid instruments and screening methods for psychological disorders are of great significance. The Hospital Anxiety and Depression Scale (HADS) reveals good psychometric properties, but shows ambiguous results in factor structure. This study aims to evaluate psychometric properties in terms of the internal reliability and structure validity of the Chinese version of the HADS (C-HADS) in a large sample of PLWH in China. The C-HADS was administered to 4,102 HIV-infected adults at an HIV clinic in China. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure. Measurement invariance was assessed across gender and course of infection. Internal reliability was also assessed. A bifactor model with anomalous loadings of items 7, 8, and 10 fits the data best and holds measurement invariance across gender and course of infection. Internal reliability was good with all Cronbach's alphas > 0.70 and Spearman's ρ between 0.30 and 0.70. The C-HADS has good psychometric properties in terms of internal reliability and structure validity of a bifactor model. The C-HADS is recommended to be used as a total scale that measures general psychological distress, instead of anxiety and depression separately, when applied to PLWH. Further studies are needed to evaluate criterion validity, the cutoff score, and the effect of wording and scoring of the HADS.

Depression and Quality of Life among Patients Living with HIV/AIDS in the Era of Universal Treatment Access in Vietnam

Although antiretroviral treatment (ART) access has been universal in recent years, few studies have examined if this policy contributes to the mental health of the patients. This study assessed depression and its relations with health-related quality of life (HRQOL), which is defined as the status of general well-being, physical, emotional, and psychological, among HIV patients. A cross-sectional study was conducted in 482 patients at five outpatient clinics. Patient Health Questionnaire-9 (PHQ-9) and EuroQol-5 dimensions-5 levels (EQ-5D-5L) were used to assess the severity of depression and HRQOL. About one-fifth of patients reported symptoms of depression. According to the result of a multivariate logistic regression model, patients who had a lower number of CD4 cells at the start of ART, who received ART in the clinic without HIV counseling and testing (HCT) services, who had a physical health problem, and who experienced discrimination were more likely to have depression. Depression was associated with significantly decreased HRQOL. Depression is prevalent and significantly negatively associated with HRQOL of HIV/AIDS patients. We recommend screening for depression and intervening in the lives of depressed individuals with respect to those who start ART late, and we also recommend community-based behavioral change campaigns to reduce HIV discrimination.

Depression, Loneliness, and Sexual Risk-Taking Among HIV-Negative/Unknown Men Who Have Sex with Men in China

Research conducted among men who have sex with men (MSM) in high-income countries has demonstrated that negative mental health is one of the significant drivers of HIV infection, and few studies have examined the status of mental health among MSM in China. We sought to describe depression and loneliness and identify their correlates among Chinese MSM. A cross-sectional study was conducted among HIV-negative or unknown status MSM in 2014. Time-location sampling and online convenience sampling methods were employed. Depression was measured via a short version of CES-D (CES-D 10). Loneliness was measured from a single item in CES-D 10. Multivariable logistic regressions were conducted to identify independent correlates of depression and loneliness. A total of 507 individuals participated in the study. Of them, 26.8 and 35.5% reported moderate-to-severe symptoms of depression and feeling lonely, respectively. Depressed participants were more likely to have a sense of hopelessness for the future (AOR 3.20, 95% CI 1.90, 5.20) and report higher levels of internalized homophobia (AOR 2.32, 95% CI 1.47, 3.67). Participants who reported feeling lonely were more likely to have had condomless receptive anal intercourse in the past 6 months (AOR 1.67, 95% CI 1.08, 2.58) and feel hopeless for the future (AOR 2.40, 95% CI 1.60, 3.70). MSM in China have significant rates of depression and loneliness. HIV prevention efforts should address the mental health needs of Chinese MSM such as providing safe environments for social support and role models.

Relationships Between Illness Perception and Post-traumatic Growth Among Newly Diagnosed HIV-Positive Men Who have Sex with Men in China

Newly diagnosed HIV-positive men who have sex with men (NHMSM) are at high risk of mental health problems but may also develop post-traumatic growth (PTG). According to the Common Sense Model, illness perception (including both cognitive representation and emotional representation) affects coping and health-related outcomes. A cross-sectional survey was conducted to examine the associations between illness perception and PTG among 225 NHMSM in Chengdu, China. Linear regression analyses indicated that the constructs of emotional representation subscale (β = -0.49) and five cognitive representation subscales (timeline, consequence, identity, attribution to god's punishment/will, and attribution to chance/luck) (β = -0.13 to -0.37) were negative correlates of PTG, while four other constructs of cognitive representation (coherence, treatment control, personal control, and attribution to carelessness) were positive correlates (β = 0.15 to 0.51). No moderating effects were observed. The associations between five cognitive representation subscales and PTG were fully-mediated via emotional representation. The results indicate that interventions promoting PTG among NHMSM are warranted and should alter illness perception, emotional representation in particular. Future studies should clarify relationships between cognitive representation and emotional representation, and extend similar research to other health-related outcomes and HIV-positive populations.

Prevalence of depression or depressive symptoms among people living with HIV/AIDS in China: a systematic review and meta-analysis

BACKGROUND

The number of people living with HIV/AIDS (PLHA) in China continues to increase. Depression, a common mental disorder in this population, may confer a higher likelihood of worse health outcomes. An estimate of the prevalence of this disorder among PLHA is required to guide public health policy, but the published results vary widely and lack accuracy in China. The goal of this study was to estimate the pooled prevalence of depression or depressive symptoms among PLHA in China.

METHODS

A systematic literature search of several databases was conducted from inception to June 2017, focusing on studies reporting on depression or depressive symptoms among PLHA in China. The risk of bias of individual studies was assessed using a modified version of the Newcastle-Ottawa scale. The overall prevalence estimates were pooled using random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis and meta-regression.

RESULTS

Seventy-four observational studies including a total of 20,635 PLHA were included. The pooled prevalence of depression or depressive symptoms was 50.8% (95% CI: 46.0-55.5%) among general PLHA, 43.9% (95% CI: 36.2-51.9%) among HIV-positive men who have sex with men, 85.6% (95% CI: 64.1-95.2%) among HIV-positive former blood/plasma donors, and 51.6% (95% CI: 31.9-70.8%) among other HIV-positive populations. Significant heterogeneity was detected across studies regarding these prevalence estimates. Heterogeneity in the prevalence of depression among the general population of PLHA was partially explained by the geographic location and baseline survey year.

CONCLUSIONS

Because of the significant heterogeneity detected across studies regarding these prevalence estimates of depression or depressive symptoms, the results must be interpreted with caution. Our findings suggest that the estimates of depression or depressive symptoms among PLHA in China are considerable, which highlights the need to integrate screening and providing treatment for mental disorders in the treatment package offered to PLHA, which would ultimately lead to better health outcomes in PLHA.

Association Between Depression and Antiretroviral Therapy Use Among People Living with HIV: A Meta-analysis

Depression is common among people living with HIV (PLHIV). Studies on the relationship between depression and use of antiretroviral therapy (ART) are inconclusive. A meta-analysis was conducted to summarize the relationship between depression and ART use among PLHIV. Ten electronic databases, conference abstracts, and dissertations were searched. A random effects meta-analysis was performed to pool the odds ratio estimates from eligible studies. Subgroup analyses and meta-regression were conducted for moderator analysis. Sensitivity analysis was performed to find influential studies. A funnel plot, the Egger test, and the trim and fill analysis were used to detect publication bias. The pooled sample size was 7375 PLHIV from nine eligible studies. The pooled prevalence of depression was 41% (95% confidence interval [CI] 29-53%). The pooled ART use rate was 52% (95% CI 37-67%). PLHIV with depression were 14% less likely (pooled odds ratio [OR] = 0.86; 95% CI 0.71-1.05) to use ART than those without depression. Subgroup analyses showed that depression was significantly associated with no ART use (pooled OR 0.84; 95% CI 0.71-0.99) among studies with a prospective study design (11 estimates from nine studies). Moderator analyses did not show any statistically significant effects. The publication bias analyses showed small study effects may not exist. Depression was associated with non-use of ART among PLHIV. Studies are needed to explore this association in other countries with varied populations, as most published studies have been conducted in the United States.

Relationship between illness representations and mental health among HIV-positive men who have sex with men

Illness representations play a significant role on mental health across various health conditions. The present study explores the associations between illness representations of HIV and mental health (suicidal ideation and depression), and the mediation effects of emotional representations on the associations between cognitive representations and mental health among men who have sex with men who were newly diagnosed with HIV (ND-MSM) in China. A total of 225 ND-MSM were recruited from a non-governmental organisation and were invited to complete a cross-sectional survey. Results showed that 48.0% had suicidal ideation since HIV diagnosis and 48.4% scored higher than the cut-off for mild depression or above. Stepwise regression analyses showed that higher levels of emotional representations of HIV and lower levels of treatment control were associated with both suicidal ideation and depression. Emotional representations were shown to mediate the associations between some cognitive representations variables and mental health. Findings suggest that both cognitive and emotional representations of HIV were important factors of mental health among ND-MSM. Interventions to promote the mental health of ND-MSM are warranted and should seek to improve their cognitive and emotional representations of HIV.

Substance use, anxiety, and self-management efficacy in HIV-positive individuals: A mediation analysis

Context

In China, the social stigma of both substance use and HIV remains major barriers. HIV+ individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV+ Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives.

Objectives

We examine the mediation relationship among substance use, anxiety, and self-management efficacy.

Method

A cross-sectional study design was used. 137 HIV+ individuals were recruited from two premier Chinese hospitals: Beijing's Ditan Hospital and Shanghai's Public Health Clinic Center (SPHCC).

Results

HIV+ substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety was mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recent effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy.

Conclusion

It is useful for healthcare providers to assess substance use behaviors in HIV+ individuals as well as provide support in managing anxiety in this population. Meanwhile, enhancing self-management efficacy to ensure healthy lifestyles may support achieving optimal lives with HIV.

Peer counselling versus standard-of-care on reducing high-risk behaviours among newly diagnosed HIV-positive men who have sex with men in Beijing, China: a randomized intervention study

INTRODUCTION

Reducing high-risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer- counselling in reducing high-risk behaviours among newly diagnosed HIV-positive Chinese men who have sex with men (MSM).

METHODS

We randomized 367 newly diagnosed HIV-positive men to either standard-of-care (SOC; n = 183) or peer-counselling intervention (n = 184), and followed them for 12 months (visit at 0-, 3-, 6-, 9- and 12-month). SOC participants received counselling on high-risk behaviour reduction by clinic staff. Intervention participants received both SOC and peer counselling. A generalized estimating equation was used to compare pre-post diagnosis high-risk behaviour change; logistic regression was used to assess the likelihood of practicing high-risk behaviours between intervention and SOC participants. Both intent-to-treat and per-protocol (full-dosage) approaches were used for the analyses.

RESULTS

For pre- and post-diagnosis comparisons, multiple partnership fell from 50% to 16% (p < 0.001), alcohol use before sex from 23% to 9% (p = 0.001), illicit drug use from 33% to 6% (p < 0.001), condomless anal sex from 47% to 4% (insertive from 23% to 2%; receptive from 36% to 3%; p < 0.001). In the intent-to-treat analysis accounting for repeated measures, peer counselling was more likely to reduce insertive anal sex (AOR = 0.65; 95% CI: 0.45 to 0.94), condomless anal sex (AOR = 0.27; 95% CI: 0.10 to 0.64) and illicit drug use (AOR = 0.32; 95% CI: 0.16 to 0.64). In the per-protocol analysis, peer counselling was associated with a lower likelihood of using illicit drug (OR = 0.23; 95% CI: 0.07 to 0.81) and having condomless vaginal sex with women (OR = 0.12; 95% CI: 0.07 to 0.98).

CONCLUSIONS

We observed a 14 to 43% decrease in the prevalence of selected high-risk behaviours after HIV diagnosis. Peer counselling had a greater impact in reducing condomless anal sex with men, illicit drug use and condomless vaginal sex with women over time. Future studies with exclusive peer-counselling arm are necessary to test its efficacy and effectiveness among Chinese MSM. Clinical Trial Number: NCT01904877.

The Double Burdens of Mental Health Among AIDS Patients With Fully Successful Immune Restoration: A Cross-Sectional Study of Anxiety and Depression in China

Background: Anxiety and depression continue to be significant comorbidities for people with HIV infection. We investigated the prevalence of and factors associated with anxiety and depression among adult HIV-infected patients across China. Methods: In this cross-sectional study, we described clinical and psychosocial variables related to depression and anxiety in 4103 HIV-infected persons. Doctors assessed anxiety and depression by asking patients whether they had experienced anxiety or depression in the prior month. Patients also self-administered the Hospital Anxiety and Depression (HAD) scale; those with score ≥8 on HAD-A/D were considered to be at high risk of anxiety or depression. Results: Associations between socio-demographic, psychosocial, and ART-related clinical factors and risk of depression or anxiety were investigated using multivariable logistic regression. Among patients assessed between 9/2014 and 11/2015, 27.4% had symptoms of anxiety, 32.9% had symptoms of depression, and 19.0% had both. Recentness of HIV diagnoses (P = 0.046) was associated with elevated odds of anxiety. Older age (P = 0.004), higher educational attainment (P < 0.001), employment (P = 0.001), support from family / friends (P < 0.001), and sleep disturbance (P < 0.001), and number of ART regimen switches (P = 0.046) were associated with risk of depression, while neither sex nor transmission route showed any associations. There were no significant associations with HIV-specific clinical factors including current CD4⁺ T cell count and current viral load. Conclusions: Prevalence of symptoms of anxiety and depression is high in this cohort of treatment-experienced HIV patients. Psychological and social-demographic factors, rather than HIV disease status, were associated with risk of depression and anxiety. This finding highlights the need to deliver interventions to address the mental health issues affecting HIV-infected persons with fully successful immune restoration across China.