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Omann LR, Dushimiyimana V, Musoni-Rwililiza E, Arnbjerg CJ, Niyonkuru VU, Iyamuremye JD, Gasana M, Carlsson J, Kallestrup P, Kraef C. Prevalence of Mental Health Disorders and Their Associated Risk Factors Among People Living with HIV in Rwanda: A Cross-Sectional Study. AIDS Behav 2024:10.1007/s10461-024-04358-3. [PMID: 38736005 DOI: 10.1007/s10461-024-04358-3] [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: 04/24/2024] [Indexed: 05/14/2024]
Abstract
While life expectancy of people living with HIV is increasing, their burden of non-communicable diseases, including mental health disorders, is growing as well. The aim of this study is to investigate the prevalence and identify the risk factors associated with mental health disorders among this population in Rwanda. This cross-sectional study enrolled people living with HIV from 12 HIV clinics across Rwanda using random sampling. Trained HIV nurses conducted the Mini International Neuropsychiatric Interview to estimate the prevalence of major depressive episode, post-traumatic stress disorder, and generalized anxiety disorder. Sociodemographic, psychosocial, and HIV-related data were also collected. Associated risk factors for being diagnosed with one of the mental health disorders were assessed using modified Poisson regression with robust error variance. Of 428 participants, 70 (16.4%) had at least one mental health disorder with major depressive episode being most prevalent (n = 60, 14.0%). Almost all participants were adherent to antiretroviral therapy (n = 424, 99.1%) and virally suppressed (n = 412, 96.9%). Of those diagnosed with a mental health disorder, only few were aware of (n = 4, 5.7%) or under treatment for this mental health disorder (n = 5, 7.2%). Mental health disorders were associated with experiences of HIV-related stigma and discrimination (aRR = 2.14, 95%CI 1.30-3.53, p = 0.003). The results demonstrate underdiagnosis and undertreatment of mental health disorders among Rwandan People Living with HIV. Using HIV nurses to diagnose mental health disorders could serve as a low-cost strategy for integrating mental health care with existing HIV services and could inspire the implementation in other low-resource settings.
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Affiliation(s)
- Laura Risbjerg Omann
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark.
| | | | - Emmanuel Musoni-Rwililiza
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
- College of Medicine and Health Sciences University of Rwanda, Kigali, Rwanda
- Mental Health Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Caroline Juhl Arnbjerg
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
- College of Medicine and Health Sciences University of Rwanda, Kigali, Rwanda
| | | | | | | | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Kallestrup
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus, Denmark
| | - Christian Kraef
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Bernard C, Mané I, Ziadeh S, Tine JM, Diaw A, Benzekri N, Ndiaye I, Samba O, Font H, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Perceptions, facilitators and barriers to the implementation of interpersonal group therapy to treat depression among people living with HIV in Senegal: a qualitative study. Front Public Health 2024; 12:1295181. [PMID: 38327573 PMCID: PMC10848853 DOI: 10.3389/fpubh.2024.1295181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Background Depression is highly prevalent in people living with HIV (PLWH) but remains under treated in Sub-Saharan Africa. In this context, we conducted the first study of Group Interpersonal Therapy (IPT) to treat depression in PLWH in Senegal. We assessed the perceptions and experiences of patients and group facilitators, as well as barriers to implementation. Methods This study was conducted at the Fann National University Hospital Center in Dakar, the urban capital of Senegal. Qualitative data were collected during the implementation phase (February to June 2020 and then from January to February 2021), with a 6-month pause due to the COVID-19 pandemic. Twenty-five patients and three group facilitators were individually interviewed by a socio-anthropologist. Qualitative data were analyzed thematically. Results Group IPT was perceived as successful and beneficial by patients and facilitators. Patients reported positive experiences with group IPT and sustained outcomes. Beyond improving depressive symptoms, patients reported improvements in their social and professional lives, and the development of skills to prevent relapse. Group facilitators noted the benefits of therapy for their patients and for their professional skills, reporting greater clinical competence and improved supportive skills. Challenges to intervention implementation included confidentiality and patient privacy concerns, healthcare accessibility issues, and time demands. Conclusion In this first qualitative study of group IPT for depression in PLWH in Senegal, participants described both positive experiences with the intervention and challenges to its implementation. Future studies, conducted in suburban and rural communities outside of Dakar, would further inform the implementation of IPT in Senegal.
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Affiliation(s)
- Charlotte Bernard
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Idrissa Mané
- CNRS, Université de Pau et des Pays de l’Adour, Pau, France
| | - Salaheddine Ziadeh
- Université Libanaise, Faculté de Santé Publique, Sidon, Lebanon
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - Abibatou Diaw
- Centre de Traitement ambulatoire, CHNU de Fann, Dakar, Senegal
| | - Noëlle Benzekri
- Department of Medicine-Infectious Diseases, University of Washington, Seattle, WA, United States
| | | | - Oumar Samba
- Service de psychiatrie, CHNU de Fann, Dakar, Senegal
| | - Hélène Font
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | | | | | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - François Dabis
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Moussa Seydi
- Service des maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
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Alum EU, Obeagu EI, Ugwu OP, Samson AO, Adepoju AO, Amusa MO. Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift. Medicine (Baltimore) 2023; 102:e35673. [PMID: 37832059 PMCID: PMC10578718 DOI: 10.1097/md.0000000000035673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is a public health challenge that can degenerate into acquired immunodeficiency syndrome (AIDS) if not properly managed. HIV infection shortens life expectancy to about 5 to 10 years compared to noninfected individuals. People living with HIV/AIDS (PLWHA) are prone to several health challenges as a result of a deranged immune system culminating in high morbidity and mortality. Depression is a common feature of PLWHA. Depression heightens the emergence of opportunistic infections in HIV-infected individuals, accelerates the progression to AIDS, and increased suicidal tendencies, morbidity, and mortality. Food insecurity with its resultant undernutrition contributes to HIV/AIDS-related deaths. Undernourished PLWHA are more prone to opportunistic infections due to poor immunity. Interestingly, proper diet intake can boost immunity, slow the progression of AIDS and opportunistic infections, enhance body weight, and retard depression tendencies. Undernutrition can also be ameliorated by incorporating nutritional counseling and oral nutrient supplementation in routine HIV/AIDS checkups. Therefore, to increase HIV/AIDS management outcomes, the integration of nutrition counseling, dietary supplements, and mental health services should be embraced. Thus, HIV/AIDS care centers should amplify these services. In this article, we isolated relevant studies from various databases, illuminated the interwoven relationship between HIV/AIDS, depression, and undernutrition, and also reemphasized the need for adequate nutritional intervention in the battle against HIV/AIDS. Thus, this study provides a reawakening call to focus on incorporating nutritional guides and mental health care in HIV/AIDS management protocols.
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Affiliation(s)
- Esther U. Alum
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
- Department of Biochemistry, Faculty of Science, Ebonyi State University, Ebonyi State, Nigeria
| | | | - Okechukwu P.C. Ugwu
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
| | | | | | - Mariam O. Amusa
- Department of Botany and Plant Biotechnology, University of Johannesburg, Johannesburg, South Africa
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Bernard C, Font H, Ziadeh S, Tine JM, Diaw A, Ndiaye I, Samba O, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Management of depression in people living with HIV/AIDS in Senegal: Acceptability, feasibility and benefits of group interpersonal therapy. Glob Ment Health (Camb) 2023; 10:e36. [PMID: 37854409 PMCID: PMC10579691 DOI: 10.1017/gmh.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 10/20/2023] Open
Abstract
Depression is highly prevalent in people living with HIV (PLWH) and has negative consequences for daily life and care. We evaluated for the first time the acceptability, feasibility and benefits of group interpersonal therapy (IPT), combined with a task-shifting approach, to treat depression in PLWH in Senegal. PLWH with depression received group IPT following the World Health Organization protocol. Acceptability and feasibility criteria were defined from the literature data. The PHQ-9, the WHODAS, and the 12-item-stigma scale were used, pre- and post-treatment, including a 3-month follow-up, to assess depressive symptom severity, functioning and stigma, respectively. General linear mixed models were used to describe changes in outcomes over time. Of 69 participants, 60 completed group IPT. Refusal to enroll and dropout rates were 6.6 and 12.7%, respectively. Ninety-seven percent of participants attended at least seven out of eight sessions. Patients and facilitators endorsed group IPT, with willingness to recommend it. Depressive symptoms and disability improved drastically and sustainably. We showed that group IPT is well accepted and feasible in Senegal as treatment for depression in PLWH. Combined with a task-shifting approach, it can narrow the gap in mental health treatment. Implementation may be enhanced by refining patient identification procedures and increasing treatment accessibility.
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Affiliation(s)
- Charlotte Bernard
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Hélène Font
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Salaheddine Ziadeh
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
- Faculté de Santé Publique, Université Libanaise, Sidon, Lebanon
| | - Judicaël M. Tine
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
| | - Abibatou Diaw
- Centre de Traitement Ambulatoire, CHNU de Fann, Dakar, Senegal
| | | | - Oumar Samba
- Service de Psychiatrie, CHNU de Fann, Dakar, Senegal
| | | | | | - Helena Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Ndeye F. Ngom
- Centre de Traitement Ambulatoire, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
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Hong C, Ochoa AM, Wilson BDM, Wu ESC, Thomas D, Holloway IW. The associations between HIV stigma and mental health symptoms, life satisfaction, and quality of life among Black sexual minority men with HIV. Qual Life Res 2023; 32:1693-1702. [PMID: 36648570 PMCID: PMC10953729 DOI: 10.1007/s11136-023-03342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE With the advancement of antiretroviral therapy (ART), HIV/AIDS has become a manageable illness, similar to other chronic conditions. This study examined the associations between HIV stigma and patient-reported outcomes including mental health symptoms, life satisfaction, and quality of life among Black sexual minority men with HIV. METHODS We analyzed baseline data from a randomized comparison trial of a mobile app intervention aimed to address the social work and legal needs of Black sexual minority men with HIV in Los Angeles County. We used validated scales including the Berger HIV stigma scale, the Patient Health Questionnaire-9 & the General Anxiety Disorder-7, the Satisfaction with Life Scale, and the Ladder Scale to assess HIV stigma, depressive symptoms, anxiety, life satisfaction, and quality of life, and we conducted multivariable linear regression to examine their associations. RESULTS Participants experienced HIV stigma especially about disclosure concerns (e.g., 81.9% participants indicated "I am very careful who I tell that I have HIV") and public attitudes (52.3% believed "Most people with HIV are rejected when others find out"). In the multivariable models, higher overall stigma scores were associated with higher likelihood of experiencing depression (adjusted b = 0.235, p < 0.001) and anxiety (adjusted b = 0.188, p = 0.002), and lower life satisfaction (adjusted b = - 0.236, p < 0.001) and quality of life (adjusted b = - 0.053, p = 0.013), adjusting for clinical characteristics including ART initiation, viral load suppression, and medication adherence. In addition, being attacked or harassed in the past year were significantly associated with lower life satisfaction and quality of life (adjusted b = - 3.028, p = 0.046; adjusted b = - 1.438, p = 0.002). CONCLUSION Our findings highlight the need for focused HIV stigma reduction interventions to promote the overall well-being of Black sexual minority men with HIV. Strategies to promote the patient-reported outcomes may benefit from trauma-informed approaches.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA.
| | - Ayako Miyashita Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
| | - Bianca D M Wilson
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth S C Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
| | | | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
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Chillo P, Mlay J, Akanyirige PW, Majani N, Janabi M, Kaaya S, Hawkins C, Hirschhorn LR. Adapting and usability testing of the Kansas city cardiomyopathy questionnaire (KCCQ) in a heart failure clinic in Tanzania: the Swahili KCCQ. BMC Cardiovasc Disord 2023; 23:242. [PMID: 37149565 PMCID: PMC10163850 DOI: 10.1186/s12872-023-03265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/26/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The integration of patient-reported outcome measures (PROMS) into health care delivery systems is being increasingly recognized as an important component of quality, person-centered care, especially for chronic illnesses like congestive heart failure (CHF). However, while PROMS are increasingly being used to follow up CHF patients in high income countries, their use in sub-Saharan Africa is still limited. We adapted the Kansas City Cardiomyopathy Questionnaire (KCCQ-23), an internationally validated, CHF-specific PROM and tested its use in measuring outcomes in an outpatient CHF clinic at a cardiac referral hospital in Tanzania. METHODS Adaptation of the KCCQ-23 included translation into Swahili by linguistic experts, in-depth cognitive debriefing in native Swahili-speaking CHF patients, and input from Tanzanian Cardiologists, PROMS experts, and the tool developer. Using a cross-sectional design, we tested the usability and observed the results of the translated KCCQ-23 in a convenience sample of 60 CHF patients attending outpatient clinic at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam. RESULTS The survey was successfully completed by 59 (98.3%) of 60 enrolled participants. The mean (SD) age of participants was 54.9 (14.8) years (range 22-83), 30.5% were women and 72.2% had class 3 or 4 New York Heart Association (NYHA) symptoms at enrollment. The overall KCCQ-23 score was low, with a mean (SD) score of 21.7 (20.4) indicating generally very poor to poor patient reported outcomes in this population. The mean (SD) scores for the specific KCCQ-23 domains were 15.25 (24.2) for social limitation, 23.8 (27.4) for physical limitation, 27.1 (24.1) for quality of life and 40.7 (17.0) for self-efficacy. No socio-demographic or clinical characteristics were associated with their overall KCCQ-23 scores. Comparing the short version (KCCQ-12) with the full KCCQ-23 revealed excellent correlation between the two (r = 0.95; p < 0.0001). CONCLUSIONS We successfully translated a validated tool, the Swahili KCCQ, for use in improving the care of patients with CHF in Tanzania and a broader population of Swahili-speaking patients. Both the Swahili KCCQ-12 and KCCQ-23 can be used, with similar outcomes. Work to expand the use of the tool in the clinic and other settings is planned.
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Affiliation(s)
- Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.
| | - Jackson Mlay
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Mohamed Janabi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hawkins
- Feinberg School of Medicine, Northwestern University, Evanston, USA
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Ong JY, Yee A, Amer Nordin AS, Danaee M, Azwa RI. The prevalence of depression, anxiety and associated factors among adults with living human immunodeficiency virus in University Malaya Medical Centre. Int J STD AIDS 2022; 33:880-889. [PMID: 35801969 DOI: 10.1177/09564624221106528] [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: 11/15/2022]
Abstract
BACKGROUND This study estimates prevalence of depression and anxiety among adults living with Human Immunodeficiency Virus (HIV) in University Malaya Medical Centre (UMMC) and determines its associated factors. METHODS This cross-sectional study was conducted between August 2020 and January 2021, in the Infectious Disease clinic and ward. One hundred ninety-one patients were recruited via convenience sampling. Patients' sociodemographic were obtained, followed by Depression, Anxiety, Stress Scale -21 (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and M.I.N.I. international neuropsychiatric interview (M.I.N.I.) The cut off DASS-21 point for depression is ≥5, for anxiety, ≥ 4. Mann-Whitney U and Chi square test were used to analyse the association between variables, and logistic regression to find predictability. RESULTS Of the 191 participants, 89.5% outpatient, mean age 40 years (SD 0.742), 91.1% male, 65.4% single, 71.2% working, 46.1% Malaysian Chinese, 59.8% non- heterosexual, mean 6 years of being HIV positive; mean CD4 count 449/μL; mean viral load 116,690 (median = 20). 85.9% were taking antiretroviral therapy. The prevalence of depression was 35.1% (n = 67); anxiety was 42.9% (n = 82). Regression analysis revealed anxiety and stress increased odds of depression by 3.8 times (p = .001) and 12 times (p < .001) respectively. Those 40 years old and younger had 2.3 times odds of anxiety (p = .048). Increased social support from friends increased odds of anxiety by 1.7 times (p = .018). Depression and stress increased odds of anxiety by 4.4 times (p = .001) and 3.7 times (p = .008) respectively. CONCLUSIONS Depression and anxiety among people with HIV is often under-recognised. Early identification and treatment of the mental illness is warranted. Screening with DASS-21 is useful to detect depression in patients with HIV.
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Affiliation(s)
- Jen Yeung Ong
- Faculty of Medicine, Department of Psychological Medicine, University Malaya Centre for Addiction Sciences, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Yee
- Faculty of Medicine, Department of Psychological Medicine, University Malaya Centre for Addiction Sciences, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Faculty of Medicine, Department of Psychological Medicine, University Malaya Centre for Addiction Sciences, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Raja Iskandar Azwa
- Faculty of Medicine, Department of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Magnolini R, Senkoro E, Kalinjuma AV, Kitau O, Kivuma B, Samson L, Eichenberger A, Mollel GJ, Krinke E, Okuma J, Ndege R, Glass T, Mapesi H, Vanobberghen F, Battegay M, Weisser M. Stigma-directed services (Stig2Health) to improve 'linkage to care' for people living with HIV in rural Tanzania: study protocol for a nested pre-post implementation study within the Kilombero and Ulanga Antiretroviral Cohort. AAS Open Res 2022; 5:14. [PMID: 36420449 PMCID: PMC9648364 DOI: 10.12688/aasopenres.13353.1] [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: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: HIV-related stigma is a major barrier to the timely linkage and retention of patients in HIV care in sub-Saharan Africa, where most people living with HIV/AIDS reside. In this implementation study we aim to evaluate the effect of stigma-directed services on linkage to care and other health outcomes in newly diagnosed HIV-positive patients. Methods: In a nested project of the Kilombero and Ulanga Antiretroviral Cohort in rural Tanzania, we conduct a prospective observational pre-post study to assess the impact of a bundle of stigma-directed services for newly diagnosed HIV positive patients. Stigma-directed services, delivered by a lay person living with HIV, are i) post-test counseling, ii) post-test video-assisted teaching, iii) group support therapy and group health education, and iv) mobile health. Patients receiving stigma services (enrolled from 1 st February 2020 to 31 st August 2021) are compared to a historical control receiving the standard of care (enrolled from 1 st July 2017 to 1 st February 2019). The primary outcome is 'linkage to care'. Secondary endpoints are retention in care, viral suppression, death and clinical failure at 6-12 months (up to 31 st August 2022). Self-reported stigma and depression are assessed using the Berger Stigma scale and the PHQ-9 questionnaire, respectively. The sample size calculation was based on cohort data from 2018. Assuming a pre-intervention cohort of 511 newly diagnosed adults of whom 346 (68%) were in care and on antiretroviral treatment (ART) at 2 months, a 10% increase in linkage (from 70 to 80%), a two-sided type I error rate of 5%, and 90% power, 321 adults are required for the post-implementation group. Discussion: We expect that integration of stigma-directed services leads to an increase of proportions of patients in care and on ART. The findings will provide guidance on how to integrate stigma-directed services into routine care in rural sub-Saharan Africa.
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Affiliation(s)
- Raphael Magnolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Elizabeth Senkoro
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Aneth Vedastus Kalinjuma
- Ifakara Health Institute, Ifakara, Tanzania
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Bernard Kivuma
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Leila Samson
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Anna Eichenberger
- Ifakara Health Institute, Ifakara, Tanzania
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Getrud Joseph Mollel
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Eileen Krinke
- University Psychiatric Clinics Basel, Basel, Switzerland
- University of Zurich, Zurich, Switzerland
| | - James Okuma
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Ndege
- Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Tracy Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Herry Mapesi
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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10
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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11
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Namagga JK, Rukundo GZ, Niyonzima V, Voss J. Depression and HIV associated neurocognitive disorders among HIV infected adults in rural southwestern Uganda: a cross-sectional quantitative study. BMC Psychiatry 2021; 21:350. [PMID: 34253176 PMCID: PMC8276422 DOI: 10.1186/s12888-021-03316-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-Associated Neurocognitive Disorder (HAND remains a pronounced consequence of HIV/AIDS despite improved life expectancies. This is often associated with several dysfunctions such as decrease of attention, mood alterations and psychomotor disturbances. Many factors, including age, gender, employment status, and psychiatric disorders, have been associated with HAND. Among the associated psychiatric disorders, depression is often more prevalent. It can influence not only quality of life, relationships and employment but also adherence to medical care. We assessed the prevalence of depression and its association with HAND among people living with HIV in rural Southwestern Uganda. METHODS This was a cross-sectional study that used Beck Depression Inventory-1 and International HIV Dementia Scale to assess depression and HAND respectively. We defined depression with a score of > 10 and HAND with a cutoff score of ≤10. We conducted data analysis using STATA version 12, and Pearson Chi-square test and logistic regression to determine associations between depression and HAND. The level of statistical significance was set at p ≤ 0.05. Ethical approval and administrative clearance were obtained from relevant bodies. RESULTS Of the 393 participants assessed for depression and HAND, 27% had depression and 58.3% screened positive for HAND. All levels of depression were more prevalent among female participants. We found a significant association between depression and HIV associated neurocognitive disorders (χ2 (3) = 9.0538 p = 0.029). CONCLUSION Our findings confirmed a high prevalence of depression in individuals with HAND which is a major component of the disease burden.
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Affiliation(s)
- Jane Kasozi Namagga
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Godfrey Zari Rukundo
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vallence Niyonzima
- grid.33440.300000 0001 0232 6272Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joachim Voss
- grid.67105.350000 0001 2164 3847Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106 USA
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12
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Mekonen T, Belete H, Fekadu W. Depressive symptoms among people with HIV/AIDS in Northwest Ethiopia: comparative study. BMJ Open 2021; 11:e048931. [PMID: 34210733 PMCID: PMC8252867 DOI: 10.1136/bmjopen-2021-048931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare depressive symptoms among people with HIV/AIDS and the general population sample. We also assessed the factors associated with depressive symptoms. DESIGN A comparative cross-sectional study was conducted. SETTINGS Antiretroviral therapy clinics in three primary healthcare facilities and semi-urban area in Northwest Ethiopia. PARTICIPANTS A total of 1115 participants (558 people with HIV/AIDS and 557 comparison group) aged 18 years and above were recruited. A total of 1026 participants (530 people with HIV/AIDS and 496 comparison group) completed the interview. We excluded people with known HIV-positive status from the comparison group. OUTCOME MEASURE Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. The proportion of depressive symptoms was compared between samples of the general population and people with HIV/AIDS using χ2 statistics. Multivariable logistic regression analysis was done to examine the associated factors. RESULTS The overall prevalence of depressive symptoms was 13.3% (11.2%-15.4%). The prevalence was significantly higher in people with HIV/AIDS compared with the community sample (16.6% vs 12.3%), p=0.001. The difference was also significant in the multivariable logistic regression (OR 1.7). For the overall sample, depressive symptoms were significantly associated with older age, being single, divorced/widowed marital status, and poor social support. CONCLUSIONS Depressive symptoms were higher in people with HIV/AIDS compared with the general population. It is necessary to include mental healthcare and screening for depression in routine HIV/AIDS care.
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Affiliation(s)
- Tesfa Mekonen
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habte Belete
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubalem Fekadu
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Bessong PO, Matume ND, Tebit DM. Potential challenges to sustained viral load suppression in the HIV treatment programme in South Africa: a narrative overview. AIDS Res Ther 2021; 18:1. [PMID: 33407664 PMCID: PMC7788882 DOI: 10.1186/s12981-020-00324-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background South Africa, with one of the highest HIV prevalences in the world, introduced the universal test and treat (UTT) programme in September 2016. Barriers to sustained viral suppression may include drug resistance in the pre-treated population, non-adherence, acquired resistance; pharmacokinetics and pharmacodynamics, and concurrent use of alternative treatments. Objective The purpose of this review is to highlight potential challenges to achieving sustained viral load suppression in South Africa (SA), a major expectation of the UTT initiative. Methodology Through the PRISMA approach, published articles from South Africa on transmitted drug resistance; adherence to ARV; host genetic factors in drug pharmacokinetics and pharmacodynamics, and interactions between ARV and herbal medicine were searched and reviewed. Results The level of drug resistance in the pre-treated population in South Africa has increased over the years, although it is heterogeneous across and within Provinces. At least one study has documented a pre-treated population with moderate (> 5%) or high (> 15%) levels of drug resistance in eight of the nine Provinces. The concurrent use of ARV and medicinal herbal preparation is fairly common in SA, and may be impacting negatively on adherence to ARV. Only few studies have investigated the association between the genetically diverse South African population and pharmacokinetics and pharmacodynamics of ARVs. Conclusion The increasing levels of drug resistant viruses in the pre-treated population poses a threat to viral load suppression and the sustainability of first line regimens. Drug resistance surveillance systems to track the emergence of resistant viruses, study the burden of prior exposure to ARV and the parallel use of alternative medicines, with the goal of minimizing resistance development and virologic failure are proposed for all the Provinces of South Africa. Optimal management of the different drivers of drug resistance in the pre-treated population, non-adherence, and acquired drug resistance will be beneficial in ensuring sustained viral suppression in at least 90% of those on treatment, a key component of the 90-90-90 strategy.
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14
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Zani B, Fairall L, Petersen I, Folb N, Bhana A, Thornicroft G, Hanass-Hancock J, Lund C, Bachmann M. Predictors of receiving a diagnosis, referral and treatment of depression in people on antiretroviral therapy in South African primary care: a secondary analysis of data from a randomised trial. Trop Med Int Health 2020; 25:1450-1466. [PMID: 32985080 PMCID: PMC7756779 DOI: 10.1111/tmi.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care. Methods This is a secondary analysis of data from a randomised controlled trial of an intervention intended to improve detection and treatment of depression in primary care patients receiving ART. In this analysis, we combined cross‐sectional and longitudinal data from the intervention and control arms. Using regression models and adjusting for intra‐cluster correlation of outcomes, we investigated associations between socioeconomic characteristics, depressive symptoms, stress, disability and stigma, and receipt of a diagnosis, referral and treatment for depression. Results Of 2002 participants enrolled, 18% reported a previous diagnosis of depression by a healthcare worker and 10% reported having received counselling from a specialist mental health worker. Diagnosis, referral and counselling during the follow‐up period were appropriately targeted, being independently more frequent in participants with higher enrolment scores for depressive symptoms, stress or disability. Participants with higher stigma scores at enrolment were independently less likely to receive counselling. Severe socio‐economic deprivation was common but was not associated with treatment. Conclusion While the receipt of a diagnosis, referral and treatment for depression were uncommon, they seemed to be appropriately targeted. Socio‐economic deprivation was not associated with treatment.
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Affiliation(s)
- B Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - L Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,King's Global Health Institute, King's College London, London, UK.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - I Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - N Folb
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - A Bhana
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.,Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - G Thornicroft
- Centre for Global Mental Health, King's College London, London, UK
| | - J Hanass-Hancock
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.,School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C Lund
- Centre for Global Mental Health, King's College London, London, UK.,Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
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15
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Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, N’guessan Abouo F, Tanon A, Messou E, Seydi M, Dabis F, de Rekeneire N. Prevalence and factors associated with severe depressive symptoms in older west African people living with HIV. BMC Psychiatry 2020; 20:442. [PMID: 32912173 PMCID: PMC7481548 DOI: 10.1186/s12888-020-02837-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depression is one of the most common psychiatric disorders in people living with HIV (PLHIV). Depression has a negative impact on both mental and physical health and is mainly associated with suboptimal HIV treatment outcomes. To encourage successful aging and the achievement of the 3 × 90 objectives in older PLHIV, the psychological domain must not be neglected. In this context and as data are scarce in West Africa, this study aimed to evaluate the prevalence and the factors associated with severe depressive symptoms in older PLHIV living in this region of the world. METHODS Data from PLHIV aged ≥50 years and on ART since ≥6 months were collected in three clinics (two in Côte d'Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. The severity of depressive symptoms was measured using the Center for Epidemiological Studies Depression scale (CES-D), and associated factors were identified using logistic regressions. RESULTS The median age of the 334 PLHIV included in the study was 56.7 (53.5-61.1), 57.8% were female, and 87.1% had an undetectable viral load. The prevalence of severe depressive symptoms was 17.9% [95% Confidence Interval (95% CI): 13.8-22.0]. PLHIV with severe depressive symptoms were more likely to be unemployed (adjusted Odd Ratio (aOR) = 2.8; 95% CI: 1.4-5.7), and to be current or former tobacco smokers (aOR = 2.6; 95% CI: 1.3-5.4) but were less likely to be overweight or obese (aOR = 0.4; 95% CI: 0.2-0.8). CONCLUSIONS The prevalence of severe depressive symptoms is high among older PLHIV living in West Africa. Unemployed PLHIV and tobacco smokers should be seen as vulnerable and in need of additional support. Further studies are needed to describe in more details the reality of the aging experience for PLHIV living in SSA. The integration of screening and management of depression in the standard of care of PLHIV is crucial.
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Affiliation(s)
- Charlotte Bernard
- Bordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000, Bordeaux, France. .,Bordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000, Bordeaux, France.
| | - Hélène Font
- grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000 Bordeaux, France
| | - Zélica Diallo
- grid.411387.80000 0004 7664 5497Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Richard Ahonon
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d’Ivoire
| | - Judicaël Malick Tine
- Service de maladies infectieuses et tropicales, CRCF, CHNU de Fann, Dakar, Senegal
| | - Franklin N’guessan Abouo
- grid.411387.80000 0004 7664 5497Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Aristophane Tanon
- grid.411387.80000 0004 7664 5497Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Eugène Messou
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d’Ivoire
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CRCF, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000 Bordeaux, France
| | - Nathalie de Rekeneire
- grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XBordeaux Population Health Research Center, Univ. Bordeaux, ISPED, UMR 1219, F-33000 Bordeaux, France
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16
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Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis. AIDS Behav 2020; 24:1752-1764. [PMID: 31720956 DOI: 10.1007/s10461-019-02706-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite the substantial burden of HIV in Africa, and the knowledge that depression causes worse HIV outcomes, the burden of depression in people living with HIV in Africa is unknown. We searched Pubmed and four other databases using key terms: depression, Africa, HIV, and prevalence from 2008 to 2018. We summarized depression prevalence by country. We estimated the burden of depression using our prevalence data and 2018 UNAIDS HIV estimates. Our search yielded 70 articles across 16 African countries. The overall prevalence of major depression in those HIV-infected using a diagnostic interview was 15.3% (95% CI 12.5-17.1%). We estimate that 3.63 million (99.7% CI 3.15-4.19 million) individuals with HIV in Sub-Saharan Africa have major depression and provide country-level estimates. We estimate that 1.57 million (99.7% CI 1.37-1.82 million) DALYs are lost among people with depression and HIV in Sub-Saharan Africa. There is a significant burden of depression in Africans with HIV. Further work to screen for and treat depression in Sub-Saharan Africa is needed to improve HIV outcomes and achieve the 90-90-90 UNAIDS goals.
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17
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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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18
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Nyongesa MK, Mwangi P, Wanjala SW, Mutua AM, Newton CRJC, Abubakar A. Prevalence and correlates of depressive symptoms among adults living with HIV in rural Kilifi, Kenya. BMC Psychiatry 2019; 19:333. [PMID: 31675938 PMCID: PMC6825356 DOI: 10.1186/s12888-019-2339-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/23/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Published research on depression among people living with HIV/AIDS (PLWHA) from Africa is increasing, but data from Kenya remains scarce. This cross-sectional study measured the prevalence and correlates of depressive symptoms among PLWHA in rural Kilifi, on the Kenyan coast. METHODS Between February and April 2018, we consecutively recruited and interviewed 450 adults living with HIV and on combination antiretroviral therapy (cART). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9), with a positive depression screen defined as PHQ-9 score ≥ 10. Measures of psychosocial, health, and treatment characteristics were also administered. RESULTS The overall prevalence of depressive symptoms was 13.8% (95% Confidence Interval (95%CI): 10.9, 17.3). Multivariable logistic regression analysis identified current comorbid chronic illness (adjusted Odds Ratio (aOR) 5.72, 95% CI: 2.28, 14.34; p < 0.001), cART regimen (aOR 6.93, 95%CI: 2.34, 20.49; p < 0.001), perceived HIV-related stigma (aOR 1.10, 95%CI: 1.05, 1.14, p < 0.001) and difficulties accessing HIV care and treatment services (aOR 2.37, 95%CI: 1.14, 4.91; p = 0.02) as correlates of depressive symptoms. CONCLUSION The prevalence of depressive symptoms among adults living with HIV on the Kenyan coast is high. Those at high risk for elevated depressive symptoms (e.g., with comorbid chronic illnesses, on second-line cART, experiencing perceived HIV-stigma or with problems accessing HIV care) may benefit from early identification, treatment or referral, which requires integration of mental health programmes into HIV primary care.
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Affiliation(s)
- Moses K. Nyongesa
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya
| | - Paul Mwangi
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya
| | - Stanley W. Wanjala
- grid.449370.dDepartment of Social Sciences, Pwani University, Kilifi, Kenya
| | - Agnes M. Mutua
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya
| | - Charles R. J. C. Newton
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya ,grid.449370.dDepartment of Public Health, Pwani University, Kilifi, Kenya ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- 0000 0001 0155 5938grid.33058.3dCentre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya ,grid.449370.dDepartment of Public Health, Pwani University, Kilifi, Kenya ,0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
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19
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Tran BX, Ho RCM, Ho CSH, Latkin CA, Phan HT, Ha GH, Vu GT, Ying J, Zhang MWB. Depression among Patients with HIV/AIDS: Research Development and Effective Interventions (GAP RESEARCH). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101772. [PMID: 31109139 PMCID: PMC6571985 DOI: 10.3390/ijerph16101772] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 02/05/2023]
Abstract
Depression in people living with HIV (PLWH) has become an urgent issue and has attracted the attention of both physicians and epidemiologists. Currently, 39% of HIV patients are reported to suffer from depression. This population is more likely to experience worsening disease states and, thus, poorer health outcomes. In this study, we analyzed research growth and current understandings of depression among HIV-infected individuals. The number of papers and their impacts have been considerably grown in recent years, and a total of 4872 publications published from 1990–2017 were retrieved from the Web of Science database. Research landscapes related to this research field include risk behaviors and attributable causes of depression in HIV population, effects of depression on health outcomes of PLWH, and interventions and health services for these particular subjects. We identified a lack of empirical studies in countries where PLWH face a high risk of depression, and a modest level of interest in biomedical research. By demonstrating these research patterns, highlighting the research gaps and putting forward implications, this study provides a basis for future studies and interventions in addressing the critical issue of HIV epidemics.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119078, Singapore.
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | - Jiangbo Ying
- Family Medicine & Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639815, Singapore.
| | - Melvyn W B Zhang
- National Psychiatry Residency Program, Singapore 308440, Singapore.
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20
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Manne-Goehler J, Kakuhikire B, Abaasabyoona S, Bärnighausen TW, Okello S, Tsai AC, Siedner MJ. Depressive Symptoms Before and After Antiretroviral Therapy Initiation Among Older-Aged Individuals in Rural Uganda. AIDS Behav 2019; 23:564-571. [PMID: 30229388 DOI: 10.1007/s10461-018-2273-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study aims to characterize associations between depression symptom severity and HIV infection, both prior to and in years after ART initiation, among older adults. The Ugandan Non-Communicable Diseases & Aging Cohort Study (UGANDAC) is a study of 154 PLWH on ART and 142 community-based, HIV-negative controls. The Hopkins Checklist (HSCL), a 15-item depression scale, was used to screen for depression. We estimate differences in depressive symptoms by HIV and ART status and use multivariable log binomial regression to quantify differences in probable depression between PLWH on ART. HIV-infected and HIV-uninfected participants had a similar age (mean 52.0 vs. 51.9, p = 0.854) and sex distribution (47.4 vs. 47.9% female, p = 0.934). PLWH on ART had lower depression symptom severity than HIV-uninfected controls (mean score: 1.50 vs. 1.60, p = 0.006) and a lower prevalence of probable depression (21.4 vs. 33.8%, p = 0.017). Among 102 PLWH with pre-ART depression screening scores available, their mean depression symptom severity was similar to HIV-uninfected participants (mean 1.56 vs. 1.60, p = 0.512). In adjusted models, PLWH on ART had a lower prevalence of probable depression than HIV-negative controls [adjusted prevalence ratio: 0.68 (95% CI 0.47-0.99)]. In an observational cohort of PLWH over 40 on long-term ART and matched, community-based HIV-uninfected controls in rural Uganda, we found a lower prevalence of self-reported depression among aging PLWH on ART.
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Affiliation(s)
- Jennifer Manne-Goehler
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | | | - Till W Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, USA
| | - Mark J Siedner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital Center for Global Health, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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21
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Bigna JJ, Tounouga DN, Kenne AM, Djikeussi TK, Foka AJ, Um LN, Asangbeh SL, Sibetcheu AT, Kaze AD, Ndangang MS, Nansseu JR. Epidemiology of depressive disorders in people living with HIV in Africa: a systematic review and meta-analysis: Burden of depression in HIV in Africa. Gen Hosp Psychiatry 2019; 57:13-22. [PMID: 30654293 DOI: 10.1016/j.genhosppsych.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The burden of HIV infection is higher in Africa where 70% of people living with HIV (PLHIV) resides. Since depression can negatively impact the course of HIV infection, it is therefore important to accurately estimate its burden among PLHIV in the continent. METHODS We searched multiple databases to identify articles published between January 2000 and February 2018, reporting the prevalence of (major) depressive disorders in PLHIV residing in Africa. We used a random-effects meta-analysis model to pool studies. RESULTS Overall, 118 studies (60,476 participants, 19 countries) were included. There was no publication bias. The overall prevalence estimates of depressive disorders and probable major depressive disorders were 36.5% (95% CI 32.3-41.0; 101 studies) and 14.9% (12.1-17.9; 55 studies) respectively. The heterogeneity of the overall prevalence of depressive disorders was significantly explained by screening tool used, period (higher prevalence in recent studies) and distribution in sub-regions. The study setting, site, CD4 cell counts, age, sex, proportion of people with undetectable viral load were not sources of heterogeneity. CONCLUSIONS This study shows that more than one third of PLHIV face depressive disorders and half of them having major form, with heterogeneous distribution in the continent. As such, depressive disorders deserve more attention from HIV healthcare providers for improved detection and overall proper management.
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Affiliation(s)
- Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaounde, Cameroon.
| | | | | | - Tatiana K Djikeussi
- Department for the Control of Disease, Epidemics and Pandemics Diseases, Ministry of Public Health, Yaounde, Cameroon
| | - Audrey Joyce Foka
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Lewis N Um
- Mfou District Hospital, Ministry of Public Health, Mfou, Cameroon
| | - Serra Lem Asangbeh
- Department of Clinical Research, National Agency on Research for HIV and Viral Hepatitis, Yaounde, Cameroon
| | - Aurelie T Sibetcheu
- Department of Pediatrics and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Arnaud D Kaze
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Marie S Ndangang
- Department of Medical Information and Informatics, Rouen University Hospital, Rouen, France
| | - Jobert Richie Nansseu
- Department for the Control of Disease, Epidemics and Pandemics Diseases, Ministry of Public Health, Yaounde, Cameroon; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
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22
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Tlhajoane M, Eaton JW, Takaruza A, Rhead R, Maswera R, Schur N, Sherr L, Nyamukapa C, Gregson S. Prevalence and Associations of Psychological Distress, HIV Infection and HIV Care Service Utilization in East Zimbabwe. AIDS Behav 2018; 22:1485-1495. [PMID: 28194585 PMCID: PMC5902521 DOI: 10.1007/s10461-017-1705-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The correlation between mental health and sexual risk behaviours for HIV infection remains largely unknown in low and middle income settings. The present study determined the prevalence of psychological distress (PD) in a sub-Saharan African population with a generalized HIV epidemic, and investigated associations with HIV acquisition risk and uptake of HIV services using data from a cross-sectional survey of 13,252 adults. PD was measured using the Shona Symptom Questionnaire. Logistic regression was used to measure associations between PD and hypothesized covariates. The prevalence of PD was 4.5% (95% CI 3.9-5.1%) among men, and 12.9% (95% CI 12.2-13.6%) among women. PD was associated with sexual risk behaviours for HIV infection and HIV-infected individuals were more likely to suffer from PD. Amongst those initiated on anti-retroviral therapy, individuals with PD were less likely to adhere to treatment (91 vs. 96%; age- and site-type-adjusted odds ratio = 0.38; 95% CI 0.15, 0.99). Integrated HIV and mental health services may enhance HIV care and treatment outcomes in high HIV-prevalence populations in sub-Saharan Africa.
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Affiliation(s)
- Malebogo Tlhajoane
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Jeffrey W Eaton
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rebecca Rhead
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | | | - Nadine Schur
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Lorraine Sherr
- Institute of Epidemiology and Health, University College London, London, UK
| | - Constance Nyamukapa
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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23
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Hapunda G, Abubakar A, Pouwer F, van de Vijver F. Depressive Symptoms Are Negatively Associated with Glucose Testing and Eating Meals on Time among Individuals with Diabetes in Zambia. Diabetes Metab J 2017; 41:440-448. [PMID: 29199409 PMCID: PMC5741553 DOI: 10.4093/dmj.2017.41.6.440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Depression is an established risk factor for cardiovascular diseases and mortality among individuals living with diabetes, and impaired self-care behaviors may play a mediating role. In Africa, this association is not very well known. In this study, we examined the associations between depressive symptoms and different aspects of diabetes self-care in Zambian individuals with diabetes mellitus. METHODS A total of 157 individuals with diabetes mellitus participated. The sample was drawn from four city hospitals in Zambia. Diabetes self-care was assessed using the diabetes self-care inventory, and depression was assessed using the major depression inventory. RESULTS Fifty-nine percent of the sample had type 1 diabetes mellitus. Variations in self-care activities and behaviors were reported as least adhered to by individuals with type 1 and type 2 diabetes mellitus, in adolescent and adult patients. Regression analysis indicated that there was no association between total diabetes self-care and the depression total score. However, depression was associated with poor glucose testing and not eating meals on time by patients with diabetes. CONCLUSION Some variance on poor self-care was explained by demographic characteristics, specifically age, body mass index, and to some extent, socioeconomic status. Recognition and successful treatment of depression in patients with diabetes might help to optimize self-care behaviors, especially glucose testing and eating meals on time. However, this hypothesis needs further testing.
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Affiliation(s)
- Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia.
| | - Amina Abubakar
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
- Department of Public Health, Pwani University, Kilifi, Kenya
- Neuroassessment, Center for Geographic Medicine Research, Neurosciences Research Group, Kilifi, Kenya
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fons van de Vijver
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
- Work Well Unit, North-West University, Potchefstroom, South Africa
- School of Psychology, University of Queensland, Brisbane, Australia
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24
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Bernard C, Dabis F, de Rekeneire N. Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2017; 12:e0181960. [PMID: 28783739 PMCID: PMC5544236 DOI: 10.1371/journal.pone.0181960] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/10/2017] [Indexed: 11/18/2022] Open
Abstract
Depression, one of the most common psychiatric disorders, is two- to three-times more prevalent in people living with HIV (PLHIV) than in the general population in many settings as shown in western countries but remains neglected in sub-Saharan Africa (SSA). We aimed to summarize the available evidence on the prevalence of depression and associated factors according to the scales used and the treatment status in PLHIV in SSA. The pooled prevalence estimates of depression ranged between 9% and 32% in PLHIV on antiretroviral treatment (ART) and in untreated or mixed (treated/untreated) ones, with a substantial variability according to the measurement scale used and also for a given scale. Low socio-economic conditions in PLHIV on ART, female sex and immunosuppression in mixed/untreated PLHIV were frequently reported as associated factors but with no consensus. As depression could have deleterious consequences on the PLHIV life, it is critical to encourage its screening and management, integrating these dimensions in HIV care throughout SSA.
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Affiliation(s)
- Charlotte Bernard
- INSERM, Centre INSERM U1219-Epidémiologie-Biostatistique, Bordeaux, France
- University of Bordeaux, School of Public Health (ISPED), Bordeaux, France
| | - François Dabis
- INSERM, Centre INSERM U1219-Epidémiologie-Biostatistique, Bordeaux, France
- University of Bordeaux, School of Public Health (ISPED), Bordeaux, France
| | - Nathalie de Rekeneire
- INSERM, Centre INSERM U1219-Epidémiologie-Biostatistique, Bordeaux, France
- University of Bordeaux, School of Public Health (ISPED), Bordeaux, France
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25
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Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health 2016; 1:e000125. [PMID: 28588979 PMCID: PMC5321378 DOI: 10.1136/bmjgh-2016-000125] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of patients at high risk of suboptimal adherence and targeted interventions. The aim of this review was to identify and summarise determinants of adherence to ART among HIV-positive adults. DESIGN Systematic review of adherence to ART in SSA from January 2002 to October 2014. METHODS A systematic search was performed in 6 databases (PubMed, Cochrane Library, EMBASE, Web of Science, Popline, Global Health Library) for qualitative and quantitative articles. Risk of bias was assessed. A meta-analysis was conducted for pooled estimates of effect size on adherence determinants. RESULTS Of the 4052 articles screened, 146 were included for final analysis, reporting on determinants of 161 922 HIV patients with an average adherence score of 72.9%. Main determinants of non-adherence were use of alcohol, male gender, use of traditional/herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatisation, and poor social support. Promoters of adherence included counselling and education interventions, memory aids, and active disclosure among people living with HIV. Determinants of health status had conflicting influence on adherence. CONCLUSIONS The sociodemographic, psychosocial, health status, treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence. Clinics providing ART in SSA should therefore design targeted interventions addressing these determinants to optimise health outcomes.
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Affiliation(s)
- Tessa Heestermans
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Susan C Aitken
- Ndlovu Research Consortium, Elandsdoorn, South Africa
- Department of Medical Microbiology, University Medical Centre Utrecht, The Netherlands
| | - Sigrid C Vervoort
- University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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26
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Smith Fawzi MC, Ng L, Kanyanganzi F, Kirk C, Bizimana J, Cyamatare F, Mushashi C, Kim T, Kayiteshonga Y, Binagwaho A, Betancourt TS. Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda. Pediatrics 2016; 138:peds.2015-3235. [PMID: 27677570 PMCID: PMC5051202 DOI: 10.1542/peds.2015-3235] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda. METHODS A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (n = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence. RESULTS Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55-5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01-1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms. CONCLUSIONS The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.
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Affiliation(s)
- Mary C. Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren Ng
- Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Catherine Kirk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Felix Cyamatare
- Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
| | - Christina Mushashi
- Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda
| | - Taehoon Kim
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;,Dartmouth College, Hanover, New Hampshire; and,University of Global Health Equity, Kigali, Rwanda
| | - Theresa S. Betancourt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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van Zyl GU, Decloedt EH. Is HIV-1C a risk factor for protease inhibitor failure? Lancet HIV 2016; 3:e149-51. [PMID: 27036986 DOI: 10.1016/s2352-3018(16)00040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Gert U van Zyl
- Division of Medical Virology, Department Pathology, Stellenbosch University, Faculty of Medicine and Health Sciences, Parow, Cape Town 8000, South Africa; National Health Laboratory Services, Tygerberg, Cape Town, South Africa.
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Parow, Cape Town, South Africa
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28
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Castro EM, Santiago LE, Jiménez JC, Dávila-Vargas D, Rosal MC. A Social-Ecological View of Barriers and Facilitators for HIV Treatment Adherence: Interviews with Puerto Rican HIV Patients. PLoS One 2015; 10:e0125582. [PMID: 26422049 PMCID: PMC4589346 DOI: 10.1371/journal.pone.0125582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 03/25/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To identify perceived barriers and facilitators for HAART adherence among people living with HIV/AIDS in Southern Puerto Rico using a Social Ecological framework. Patients and Methods Individual in-depths interviews were conducted with 12 HIV patients with a history of HAART non-adherence. Interviews were audio-taped and transcribed. Content analysis was performed for each transcribed interview by three independent coders using a codebook. Using Atlas TI, super-codes and families were generated to facilitate the categorization tree as well as grounded analyses and density estimates Results Most participants reported a monthly income of $500 or less (n = 7), a high school education level (n = 7), being unemployed (n = 9) and being recipients of government health insurance (n = 11). Three out of six women reported living alone with their children and most men informed living with their parents or other relatives (n = 4). For the grounded analyses, the top four sub-categories linked to high number of quotations were mental health barriers (G = 32) followed by treatment regimen (G = 28), health system (G = 24) and interpersonal relations (G = 16). The top four sub-categories linked to high number of codes are treatment regimen (D = 4), health status perception (D = 3), interpersonal relations (D = 3) and health system (D = 3). Conclusion The results of this study suggest the interconnection of HIV treatment adherence barriers at various system levels. Future studies on HIV treatment barriers should explore these interactions and investigate the possible synergistic effect on non-adherent behavior
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Affiliation(s)
- Eida M. Castro
- Clinical Psychology Programs, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America
- Psychiatry Department, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America
- * E-mail:
| | - Lydia E. Santiago
- University of Puerto Rico Medical Science Campus School of Nursing, San Juan, Puerto Rico, United States of America
| | - Julio C. Jiménez
- Clinical Psychology Programs, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America
| | - Daira Dávila-Vargas
- Clinical Psychology Programs, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America
| | - Milagros C. Rosal
- University of Massachusetts Medical School, Worcester, Division of Preventive and Behavioral Medicine, Massachusetts, United States of America
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