Prevalence and associated factors of common mental disorders among adult patients attending HIV follow up service in Harar town, Eastern Ethiopia: a cross-sectional study

Prevalence of common mental disorder and its association with perceived stigma and social support among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

BACKGROUND

When common mental disorders (CMD) co-occur with HIV/AIDS, they can complicate patient diagnosis, help-seeking behaviors, quality of life, treatment outcomes, and drug adherence. Thus, estimating the pooled prevalence of CMD and its association with perceived stigma and social support among people living with HIV/AIDS (PLWHA) in Ethiopia could potentially support policymakers and health professionals to understand the disease burden and set a solution to improve the mental well-being of PLWHA.

METHODS

Popular databases such as PubMed, SCOPUS, EMBASE, and Psych-INFO as well as Google Scholar, AJOL, CINAHL, PILOTS and Web of Science were searched for the relevant articles conducted in Ethiopia. We included cross-sectional, case-control, and cohort studies in the review. The Comprehensive Meta-Analysis software version 3.0 was used to pool the results of the included studies. The Q- and I2-statistics were used to assess the heterogeneity between the included studies. We employed a random-effects meta-analysis model to estimate the pooled prevalence of CMD and to account for heterogeneity among the included studies. We also conducted a leave-one-out analyses, and stratified meta-analyses by gender (male and female).

RESULTS

The studies included in this systematic review and meta-analysis were published between 2009 and 2021, recruiting a total of 5625 participants. The pooled estimated prevalence of CMD among PLWHA in Ethiopia was 26.1% (95% CI 18.1-36.0). The pooled estimated prevalence of CMD was significantly higher among females, at 39.5% (95% CI 21.2-39.0), compared to males, 26.9% (95% CI 15.6-31.7). Moreover, the pooled estimated prevalence of CMD in PLWHA ranged from 23.5 to 28.9% in the leave-one-out sensitivity analysis, indicating that the removal of any single study did not significantly affect the pooled estimate. The pooled effects (AOR) of Perceived HIV stigma and poor perceived social support on common mental disorder were 2.91, 95% CI (1.35-6.29) and 5.56, 95% CI (1.89-16.39), respectively.

CONCLUSION

People living with HIV/AIDS (PLWHA) who received poor social support and those with HIV-related perceived stigma were found to have strong association with CMD. Therefore, it is advisable that all PLWHA attending ART clinic should be screened for CMD, social support and HIV-related perceived stigma.

Coping strategies, challenges and potential interventions among adult patients with HIV and mental illness comorbidity in southwestern Uganda

HIV and mental illness comorbidity presents significant healthcare challenges, especially in low- and middle-income countries where healthcare systems often address individual conditions rather than comorbidities. This results in poor coping, increased vulnerability and diminished health-related quality of life. This study investigated coping strategies, challenges and potential interventions for individuals with HIV-mental illness comorbidity in Southwestern Uganda. The study included purposively selected people with HIV and mental illnesses seeking care in health facilities across Southwestern Uganda. Data from in-depth, semi-structured interviews were transcribed verbatim and entered into ATLAS.ti-7 for analysis. Thematic analysis was employed, generating codes from the transcripts to develop themes. The data revealed three categories: coping strategies, challenges and potential interventions. Three key coping strategies emerged: conscious avoidance of emotional stressors, maintaining emotional stability through social interactions and reliance on prayer. Challenges included social isolation, financial crises, vulnerability to abuse and medication management issues. Respondents recommended scaling up mass educational programmes to increase awareness of causes, preventive measures and association between the two comorbidities, together with implementing financial aid initiatives as viable interventions. These findings highlight the importance of addressing comorbidities together for improved emotional stability and underscore the value of the proposed potential interventions for healthcare systems and policymakers.

Exploring HIV status as a mediator in the relationship of psychological distress with socio-demographic and health related factors in South Africa: findings from the 2012 nationally representative population-based household survey

BACKGROUND

Psychological distress as measured by mental disorders like depression and anxiety is more prevalent in people living with HIV (PLHIV) than in the general population. However, the relationship between mental disorders and HIV is complex and bidirectional. Improved understanding of the relationship between mental disorders and HIV is important for designing interventions for this group. This paper explores the interrelationships of psychological distress with HIV and associated socio-demographic and health-related factors.

METHODS

This secondary data analysis used the 2012 South African population-based household survey on HIV collected using a cross-sectional multi-stage stratified cluster sampling design. Generalized structural equation modelling (G-SEM) path analysis was used to explore the direct and indirect relationships of socio-demographic, health and HIV-related factors with psychological distress as measured by Kessler 10 scale using HIV status as a moderator variable.

RESULTS

A total of 20,083 participants were included in the study, 21.7% reported psychological distress, of whom (32.6%) were HIV positive. In the final path model with HIV status as a moderator, psychological distress was significantly more likely among age group 25-49 years (AOR: 1.4 [95% CI 1.3-1.6]), age 50 years and older, (AOR: 1.4 [95% CI 1.2-1.6]), females (AOR: 1.6 [95% CI 1.4-1.8]), high risk drinkers (AOR: 1.9 [1.6-2.2]) hazardous drinkers (AOR: 4.4 [95% CI 3.1-6.3]), ever tested for HIV (AOR: 1.2 [95% CI 1.1-1.3]). Psychological distress was significantly less likely among the married [AOR: 0.8 (0.7-0.9)], other race groups [AOR: 0.5 (0.5-0.6)], those with secondary level education (AOR: 0.9 [95% CI 0.8-0.9]), and tertiary level education (AOR: 0.7 [95% CI 0.6-0.9]), those from rural informal [AOR: 0.8 (0.7-0.9)], and rural formal [AOR: 0.8 (0.7-0.9)] areas and those who rated their health as excellent/good [AOR: 0.4 (0.4-0.5)].

CONCLUSION

The findings highlight the importance of designing tailored interventions targeted at psychological distress among PLHIV especially the elderly, females, those with no education and / or low education attainment and those residing in informal urban areas.

Metabolic comorbidities and systemic arterial hypertension: the challenge faced by HIV patientson long-term use of antiretroviral therapy

OBJECTIVE

Our objective was to estimate the frequency of comorbidities and assess its relationship with exposure factors after a long-term of ART use.

METHODS

: A cross-sectional study with PLHIV (≥18 years-old), who initiated ART between 2001-2005 and attended an HIV/AIDS public-referral center (Belo Horizonte/Brazil) was performed. Demographic, clinical, therapeutic and lifestyle data were obtained through interviews, medical charts, public database, routine laboratory exams and bone densitometry. The outcome was the number of comorbidities: hyperglycemia, dyslipidemia, systemic arterial-hypertension (SAH) and low bone mineral density (BMD). Absolute/relative frequencies were calculated. Factors associated with the outcome were assessed by quasi-Poisson regression. RESULTS: Of the 98 participants, 53% were male, 79% over 43 years-old. Moderate physical-activity was observed in 82%, overweight/obesity in 50% and 58% used ART based on two nucleoside reverse transcriptase inhibitors (NRTI) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI). After a mean of 15.6 years of ART exposure, 207 comorbidities were identified and 93% participants presented at least one comorbidity (mean=2.1/participant). The most frequent overlapping was composed by two co-occurrences: dyslipidemia+hyperglycemia or dyslipidemia+SAH, n=36 in each co-occurrence. The quasi-Poisson regression showed an increase of 3% in the number of comorbidities per year of age (OR=1.03;95%CI=1.02-1.04) and 84% among PLHIV on moderate physical-activity (ref=heavy physical-activity) (OR=1.84;95%CI=1.08-3.13).

CONCLUSIONS

Our study shows that the aging slightly contributed to comorbidities. However, the practice of physical-activities is crucial to prevent chronic-diseases. Treatment and preventive measures should be encouraged to diminish the burden of disease and improve quality of life among PLHIV.

Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV

PURPOSE OF THE REVIEW

By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches.

RECENT FINDINGS

After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms.

CONCLUSION

Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.

Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

OBJECTIVE

In this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes.

DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA

The following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included.

DATA EXTRACTION AND SYNTHESIS

We extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies.

RESULTS

A total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%-59%), cognitive impairments (4%-61%) and frailty (3%-15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent.

CONCLUSIONS

This review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors.

PROSPERO REGISTRATION NUMBER

CRD42020145791.

Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

Background

Alcohol use is a common practice of almost all communities worldwide and it is more common among persons with HIV infection. Alcohol consumption among people with HIV/AIDS may result in poor treatment adherence, further immunity suppression and increase the risk of comorbid illness (diseases) which collectively diminish the anti-retroviral therapy responses. Although there are separate studies conducted regarding alcohol use among people with HIV/AIDS in Ethiopia, the finding results are highly variable and inconsistent. Therefore, conducting a systematic review and meta-analysis has a paramount importance to show the pooled prevalence of alcohol use and to identify its determinants among people with HIV/AIDS.

Methods

A systematic search of electronic databases of PubMed/Medline, Science Direct, Hinnari and Cochrane library was employed. Additionally, the grey literature was searched from Google and Google Scholar. Data were extracted using a standardized data extraction format prepared in Microsoft Excel . STATA-version 14 statistical software was used for analysis. Heterogeneity of primary studies was found as evaluated using the I² test result. As a result, a random-effect meta-analysis model was used to estimate the pooled prevalence of alcohol use.

Results

A total of 22 primary studies which comprises 8,368 study participants were included in this systematic review and meta-analysis. The pooled prevalence of lifetime, current and hazardous alcohol use among HIV patients in Ethiopia were 36.42% [95% CI (19.96, 52.89)], 19.00% [95% CI (12.98, 25.01)] and 21.64% [95% CI (12.72, 30.55)], respectively. Khat chewing [OR = 3.53, (95% CI 1.31, 9.51)] and cigarette smoking [OR = 7.04, (95% CI 3.53, 14.04)] were found as statistically significant determinants of hazardous alcohol use among people with HIV infection.

Conclusions

The result of this review showed that alcohol drinking is highly practiced among people with HIV/AIDS in Ethiopia. The magnitude of alcohol use was highly variable based on the screening methods used to measure alcohol use. Comorbid substance use (khat and cigarette) increases the risk of alcohol consumption among HIV patients. This suggests a need for designing appropriate and culturally applicable intervention programs and policy responses.

Trial registration PROSPERO 2019, “CRD42019132524.”

Supplementary Information

The online version contains supplementary material available at 10.1186/s12954-021-00503-6.

Magnitude and predictors of common mental disorder among people with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Common mental disorders are frequent psychiatric comorbid conditions among people with HIV/AIDS. The presence of such psychiatric disorders negatively affects the treatment adherence, viral load suppression, quality of life, treatment outcomes and functionality of people with HIV/AIDS. However, available studies in Ethiopia have a great variation and inconsistency of reported results have been observed regarding the magnitude and associated factors of common mental disorder. Thus, conducting a systematic review and meta-analysis of existing literatures can have a paramount importance to show its summarized figure.

METHODS

Literatures search was performed using databases (PubMed/Medline, Science Direct and PsycINFO. Grey literatures were also searched from Google and Google Scholar. Data were extracted from primary studies using a data extraction format prepared in Microsoft Excel and exported to STATA-version 14 statistical software for analysis. The I2 test was used to assess the heterogeneity of primary articles. The result of the test showed that there was heterogeneity between primary studies. This leads us to execute a random effect meta-analysis to estimate the pooled prevalence of common mental disorder with corresponding 95% confidence interval.

RESULTS

A total of 13 primary studies comply with the inclusion criteria were included in this systematic review. The pooled prevalence of common mental disorder was found to be 28.83% (95% CI: 17.93, 39.73) among people with HIV/AIDS in Ethiopia. The highest prevalence of common mental disorder (35.20%) was observed among studies in which Kessler-10 was used as a screening tool. Single marital status (OR = 1.83; 95%CI: 1.03, 3.27), HIV/AIDS-related stigma (OR = 2.21; 95%CI: 1.68, 2.90) and current job unavailability (OR = 1.38; 95%CI: 1.01, 1.88) had statistically significant association with common mental disorder.

CONCLUSION

The result of this review showed that nearly one among three individuals with HIV/AIDS is suffering from common mental disorder in Ethiopia. This calls a need to integrate the mental health and psycho-social support into the HIV/AIDS care.

TRIAL REGISTRATION

PROSPERO- CRD42019132402. Registered on 05/08/2019.

Synthesis and Characterization of Long-Acting Darunavir Prodrugs

Antiretroviral therapy (ART) has improved the quality of life in patients infected with HIV-1. However, complete viral suppression within anatomical compartments remains unattainable. This is complicated by adverse side effects and poor adherence to lifelong therapy leading to the emergence of viral drug resistance. Thus, there is an immediate need for cellular and tissue-targeted long-acting (LA) ART formulations. Herein, we describe two LA prodrug formulations of darunavir (DRV), a potent antiretroviral protease inhibitor. Two classes of DRV prodrugs, M1DRV and M2DRV, were synthesized as lipophilic and hydrophobic prodrugs and stabilized into aqueous suspensions designated NM1DRV and NM2DRV. The formulations demonstrated enhanced intracellular prodrug levels with sustained drug retention and antiretroviral activities for 15 and 30 days compared to native DRV formulation in human monocyte-derived macrophages. Pharmacokinetics tests of NM1DRV and NM2DRV administered to mice demonstrated sustained drug levels in blood and tissues for 30 days. These data, taken together, support the idea that LA DRV with sustained antiretroviral responses through prodrug nanoformulations is achievable.