Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

A Booklet Self-Help Intervention for People Living with HIV and Depressive Symptoms in Botswana: A Randomized Controlled Trial

In low- and middle-income countries (LMICs), there is a scarcity of psychological treatment options for people living with HIV (PLWH) with depressive symptoms. Self-help programs for depressive symptoms, in particular, are cost-effective and scalable, and therefore a promising tool in the treatment of depressive symptoms for people in low-resourced countries. This paper presents the results of a study that examined the effectiveness of a guided self-help program in reducing depressive symptoms in PLWH in Botswana. A Randomized Controlled Trial (RCT) was conducted on a sample of PLWH who were screened at HIV treatment centers in Botswana. The RCT had two conditions: an intervention group that received the self-help program with coaching and an attention-only control group. In both groups, a pre-test, post-test, and 3-month follow-up measurement were administered. Patients in the intervention group followed a booklet Cognitive Behavioral Therapy (CBT)-based self-help program. Seventy-two participants were included in the study. The results indicated significantly larger decreases in depressive symptoms in the intervention group than in the attention-only control group, both in the short and longer term, with large effect sizes. In addition, there were significant reductions in anxiety symptoms in the intervention group compared to the control group. The user satisfaction was high. Implementing this low-cost and scalable self-help program in a LMIC such as Botswana is critical in bridging the existing mental health treatment gap. This clinical Trial was registered with the Netherlands Trial registry, number NTR5407on August 23, 2018.

Depressive symptoms and its determinants among people living with HIV in Africa: systematic review and meta-analysis

BACKGROUND

In Africa, depressive symptoms are prevalent among people living with HIV (PLHIV), significantly impacting their adherence and overall quality of life. The combined burden of HIV and depressive symptoms worsens health outcomes, leading to an increased risk of morbidity and mortality.

OBJECTIVES

To estimate the pooled prevalence and identify the associated factors of depressive symptoms among people living with HIV in Africa.

METHODS

In this study, we reviewed articles that evaluated the prevalence of depressive symptoms and its contributing variables. The primary studies were searched using the following databases: African Journal Online, Science Direct, EMBASE, Google Scholar, and PubMed. A Microsoft Excel spreadsheet was employed to extract the data, which was then exported to STATA version 14 for further analysis. While publication bias was examined using a funnel plot and Egger's test, heterogeneity was tested using the I2 test.

RESULTS

The estimated pooled prevalence of depressive symptoms among people living with HIV was determined to be 33.32%. Based on the sub-group analysis the higher prevalence of depressive symptoms was found in East Africa, and perinatal women. Furthermore, being female, experiencing stigma, having poor social support, a CD4 count < 200, and comorbid chronic illnesses were significant predictors of depressive symptoms.

CONCLUSION

This review concluded that one-third of people living with HIV in Africa suffered from depressive symptoms. Additionally, individuals experiencing stigma, poor social support, a CD4 count < 200, and comorbid chronic illnesses, as well as females suffered more from depressive symptoms. Therefore, mental health assessments should address these factors.

PROSPERO REGISTRATION NUMBER

CRD42024516528.

Genetic Determinants Of Major Depressive Disorder (MDD) Among Adult Persons Living With HIV In Uganda

Background

Major Depressive Disorder (MDD) has a heritable component, with estimates of heritability ranging from 30% to 40%. Depression is a significant comorbidity in people living with HIV (PLWHIV), increasing the risk of suicide-related behaviors. This study investigated the genetic risk loci associated with MDD among adults living with HIV in Uganda, where limited data exist on this relationship.

Methods

The case-control study analyzed 282 samples (139 MDD cases and 143 controls), assessed for MDD at baseline, six months, and one year using the Mini International Neuropsychiatric Interview. Blood samples were collected at these intervals, with DNA genotyping conducted in South Africa using the H3Africa array. Data were analyzed using PLINK2 and GEMMA for quality control and genome-wide association analysis respectively, followed by functional mapping with FUMA.

Results

While no significant single nucleotide polymorphisms (SNPs) were identified at the genome-wide threshold, six SNPs were found to be suggestively associated with MDD. These SNPs, which have been associated with other psychiatric conditions like Alzheimer's, alcohol use disorder, and bipolar disorder and have not previously been linked to MDD.

Conclusion

The study suggests the potential for novel MDD genetic risk loci discovery in PLWHIV and people of African ancestry, especially with larger sample sizes.

Depressive Symptoms and HIV Viral Suppression: A Systematic Review and Meta-analysis

Previous research suggests that depression impacts HIV outcomes, including viral suppression. This meta-analysis quantifies the association between depression and HIV viral suppression. A systematic literature search was conducted in PubMed, Web of Science, EBSCO, and OVID to identify studies published through 2012 to 2022. The software Rayyan was used to evaluate eligibility of studies, and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for abstracting data. A random effects meta-analysis was performed using Review Manager 5.4.1. Of the 1911 articles screened, 16 studies were included covering 80,103 participants. The results showed individuals without depression were more likely to achieve HIV viral suppression or undetectable viral load compared to individuals with depression (OR 1.30; 95%CI 1.15, 1.48; I2 = 76%). Subgroup analysis indicated this effect was significant among the general population of people living with HIV (n = 75,353; OR 1.32; 95%CI 1.12, 1.55; I2 = 85%) and cisgender women living with HIV (n = 4553; OR 1.28; 95%CI 1.09, 1.50; I2 = 16%), but not among cisgender men living with HIV (most identified as men who have sex with men) (n = 197; OR 2.13; 95%CI 0.43, 10.61; I2 = 83%). This meta-analysis shows a significant positive association between the absence of depression and achieving HIV viral suppression overall and among the subgroup of cisgender women. Public health interventions for people living with HIV should include strategies to identify and address the depressive symptoms that impact adherence to treatment, increase the risk of psycho-behavioral co-morbidities, and exacerbate social or structural factors impeding viral suppression.

The association of HIV status and depressive symptoms in the Ndlovu Cohort study

HIV majorly contributes to the disease burden in South Africa. Depressive symptoms are common in people living with HIV (PLHIV). Few studies compared depressive symptoms between PLHIV and those without HIV. The aim of the study was to examine the association of HIV status and depressive symptoms. Moreover, the study aimed to explore the comparison between HIV-negative participants and the different HIV-positive sub-groups regarding their depressive symptoms. A cross-sectional analysis was conducted among PLHIV and HIV-negative participants in rural South Africa, using the baseline data of the Ndlovu Cohort study. Data was collected on demographics, socioeconomic status, and depressive symptoms using the PHQ-9 questionnaire. A score of 10 and above indicated depressive symptoms. Logistic regression analysis on the relationship between HIV status and depressive symptoms was used while adjusting for age, sex, level of education, employment status, income, and ever smoking. The study included 1,927 participants; 46% were PLHIV and 239 (12.5%) had depressive symptoms. PLHIV were more likely to have depressive symptoms than HIV-negative participants (OR 1.34, 95% CI 1.01-1.77). This association was not statistically significant after adjusting for confounders (OR 1.22, 95% CI 0.92-1.63). Compared to HIV-negative participants, ART (antiretroviral treatment) naïve participants had statistically significant higher odds of depressive symptoms (OR 1.84, 95% CI 1.20-2.78). This association remained after adjusting for confounders (OR 1.72, 95% CI 1.11-2.61). There was no statistically significant difference in depressive symptoms between HIV-negative participants and those on ART, regardless of treatment regimen. In general, higher odds of depressive symptoms in ART-naïve PLHIV could reflect poor coping with diagnosis of HIV. Future research to investigate the relation between ART regimen and depressive symptoms, to establish causality and to identify changes over time, is warranted.

Socioeconomic inequality in the outcomes of a psychological intervention for depression for South Africans with a co-occurring chronic disease: A decomposition analysis

Task-shared psychological interventions are effective for reducing the severity of depression symptoms, but differences in treatment outcome by socioeconomic status is uncertain. This study examines socioeconomic inequalities (SEI) in depression outcomes among people with HIV and/or diabetes who participated in a cluster randomised controlled trial in the Western Cape Province of South Africa. The trial took place at 24 primary care clinics randomised to deliver a task-shared psychological intervention or treatment as usual (TAU). The trial enrolled 1119 participants meeting criteria for probable depression. Depression symptom severity was evaluated at baseline and 24-month follow-up. Using a concentration index (CI), SEIs in depression were assessed for the intervention and TAU arms. Demographic and socioeconomic variables were used to decompose the CI to identify contributors to SEI. Results indicate poorer participants at the intervention arm have significantly worse 24-month outcomes than wealthier counterparts (CI = - 0.080; SE = 0.025). Race (34.2%), unemployment (17.4%) and food insecurity (15%) were the main contributing factors. While policymakers need to invest in psychological interventions to reduce the burden caused by depression, this study suggests treatment outcomes may be different across the socioeconomic spectrum. Decomposition of these findings points to structural constraints, such as unemployment, as the key contributors towards poorer treatment outcomes. These findings suggest a need to combine psychological interventions with structural interventions that address the broader socio-economic determinants of mental health.

Accuracy of Alternative PHQ-9 Scoring Algorithms to Screen for Depression in People Living With HIV in Sub-Saharan Africa

BACKGROUND

Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The 9-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH.

SETTING

Five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal, and the Republic of Congo.

METHODS

Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity and area under the curve (AUC) of the traditional PHQ-9 scoring (positive screening - score ≥ 10), were compared to alternative scoring algorithms including (1) the presence of ≥1 mood symptom (PHQ-9 items 1 and 2) combined with ≥2 other symptoms listed in the PHQ-9, and (2) a simplified recoding of each 4-response item into 2 categories (absence/presence).

RESULTS

A total of 735 participants were included [54% women, median age 42 years (interquartile range 34-50)]. Depression was diagnosed by a psychiatrist in 95 (13%) participants. Alternative scoring sensitivities (0.59-0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC was significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability.

CONCLUSIONS

As a primary screening test, new scoring algorithms seemed to improve the PHQ-9 sensitivity in identifying depression and reducing heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.

Costs analysis of integrating group interpersonal therapy into HIV care services in Senegal

INTRODUCTION

Group Interpersonal Therapy (IPT), an evidence-based treatment of depression recommended by the WHO mhGAP Intervention Guide, was implemented through a task-shifting approach in Senegal, as a treatment for depressed people living with HIV (PLWH). Since a description of the resources used and the implementation costs incurred is necessary to inform policymakers better, this study aimed to estimate the costs associated with its implementation.

METHODS

Intervention costs were analyzed using an "ingredients-based costing approach" from the provider's perspective. We identified and described the start-up and implementation costs for the initial phase and a projection over 5 years (implementation at capacity). We estimated total annual costs and cost per beneficiary. We conducted a scenario analysis to highlight some cost uncertainties and their impacts.

RESULTS

The total annual costs were estimated at $4064 for the initial phase and $8161 for the implementation at capacity. The training was the main cost driver representing approximately 60% of the total annual costs. The cost per beneficiary receiving group IPT was estimated at $65 for the implementation at capacity. The scenario analysis also illustrated the importance of parameters like the screening strategy, training activities, and allocation to cover transport costs mobilized by participants.

CONCLUSION

This cost analysis highlighted the costs and cost allocations required to implement group IPT in Senegal to treat depression in PLWH. This preliminary work should enable policymakers to identify the optimal resources to be mobilized to implement and ensure the sustainability of this therapy in HIV at a country-level program.

Early Outcomes of Mental Health Screening Integrated Into Routine HIV Care in Malawi

Mental health (MH) disorders are highly prevalent among people living with HIV and can have a negative impact on antiretroviral therapy (ART) outcomes. Malawi's Ministry of Health introduced MH screening in national HIV management guidelines in 2022. We describe early experience with integrated MH screening at ART clinics that have scarce human resources and limited capacity of specialist MH units. ART staff in 15 facilities were trained to use the Patient Health Questionnaire-9 (depression) and the Alcohol Use Disorders Identification Test (harmful alcohol use) screening instruments, MH registers were developed for tracking screening results and referrals, and existing MH referral units were engaged. Based on screening results, ART clients received counseling by lay cadre staff (for mild symptoms) or intensive counseling by trained psychosocial counselors and referrals to specialist MH units (for moderate to severe symptoms). From October 2022 through July 2023, 9,826 ART clients were screened from the following priority groups: returning to care after an interruption in treatment (50%), newly diagnosed (38%), and viral load ≥1,000 copies/mL (12%). Of those screened, 59% were female and 14% were aged 12-19 years. Screening coverage was 85% (9,826/11,553) among the 3 priority groups. All of the individuals who screened positive for moderate/severe depression (1.1%; n=106) or high risk for harmful alcohol use (2.3%; n=227) were referred to specialist MH units. In conclusion, thorough preparation led to high MH screening coverage among ART priority groups, and the number of referrals to specialist MH units was low. MH screening was feasible at Malawi ART clinics. Next steps include studying the clinical impact of integrated MH screening on MH outcomes and ART outcomes (retention in care and viral suppression) and scaling up integrated MH screening to all ART clinics.

The factor structure of the Centre for Epidemiological Studies Depression Scale (CESD-R-20) among South African antiretroviral therapy users

Depression is a significant concern for people living with HIV and AIDS as it is associated with negative health outcomes and suboptimal adherence to antiretroviral therapy (ART). To this extent, screening for depression is essential for early detection. The CESD-R-20 is a revised four-factor questionnaire developed to assess depressive symptoms in adults. This study explored the factor structure and psychometric properties of the CESD-R-20 among 685 individuals receiving ART. Data were collected at the Infectious Diseases Clinic of a large public hospital outside Cape Town from participants who had been receiving ART for at least six months. Exploratory factor analysis (EFA) of the CESD-R-20 was performed to identify its underlying factor structure. The EFA revealed a one-factor solution termed "depressive affect," comprising 19 items that encompassed the original factors. This finding suggests that depression is a cohesive construct rather than a collection of interconnected dimensions. The scale exhibited high internal consistency (Cronbach's alpha = 0.95) among the sample of persons living with HIV and AIDS. Our findings indicate that the CESD-R-20 can effectively measure depressive affect as a one-factor scale in South Africans receiving ART. The scale demonstrated strong internal consistency and is suitable for screening for depressive symptoms among persons living with HIV and AIDS.

Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: A qualitative analysis

Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via negative health outcomes for the birthing parent and adverse health outcomes for infants (e.g., low birth weight, preterm deliveries, malnourishment) as well as emotional and behavioral problems in children. Depression, posttraumatic stress disorder (PTSD), and other mental health disorders may also compromise engagement in HIV prevention behaviors during the perinatal period, when HIV acquisition risk increases. This is particularly important in SA, where almost a quarter of women between ages 15 to 49 have HIV. There is little research exploring the anticipated impacts mental health symptoms have on one's ability to emotionally connect or caregive after delivery; this critical information will enable providers to support women and their mental health during the transition from pregnancy to postpartum. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby's wellbeing, their ability to bond with their baby, and their ability to meet their baby's needs. Following the principles of thematic analysis, we identified three main themes that described these relationships: (1) a strong perceived connection between maternal mental health and baby's wellbeing; (2) perceived strains on bonding with the baby; and (3) negative impact of mental health on likelihood of completing parenting tasks. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.

"Someone who hates themself doesn't come for their drugs": Experiences of mental health along the HIV care continuum in South-Central, Uganda

INTRODUCTION

Poor mental health occurs more frequently among people living with HIV. Understanding what mental health problems occur and at what point during the continuum of HIV care is critical to ensure these problems are identified and appropriately addressed. We explored how mental health is experienced along the HIV care continuum in Rakai, Uganda.

METHODS

We conducted qualitative semi-structured in-depth interviews with 20 adults living with HIV and 10 health workers from March to December 2020. Interviews followed a timeline approach. Responses were analyzed using content analysis.

RESULTS

At the time of HIV diagnosis, nearly all participants described a range of strong emotions, including shock, fear and intense worry. Most participants described continued fear and intense worry leading up to, and at the time of, ART initiation. However, they said these emotions often subside after ART is initiated and viral suppression is achieved. Across interviews and at multiple points of the continuum, participants discussed how fear and worry led individuals to be "thinking too much" or be in "deep thoughts" and experience self-hatred. Individuals who stopped taking ART were thought to have more severe mental health problems ("madness", psychosis, suicidality). Participants were divided about the mental health of persons who returned to care after disengagement.

CONCLUSION

In this setting, mental health problems experienced by people living with HIV are dynamic across the care continuum. With expanded HIV testing campaigns and Universal Test and Treat policies, targeted interventions for psychosocial support at the time of testing and ART initiation remain critical.

Systematic Review of Shoulder Imaging Abnormalities in Asymptomatic Adult Shoulders (SCRUTINY): Abnormalities of the glenohumeral joint

OBJECTIVE

The primary objective was to determine the population prevalence of glenohumeral joint imaging abnormalities in asymptomatic adults.

METHOD

We systematically reviewed studies reporting the prevalence of X-ray, ultrasound (US), computed tomography, and magnetic resonance imaging (MRI) abnormalities in adults without shoulder symptoms (PROSPERO registration number CRD42018090041). This report presents the glenohumeral joint imaging findings. We searched Ovid MEDLINE, Embase, CINAHL and Web of Science from inception to June 2023 and assessed risk of bias using a tool designed for prevalence studies. The primary analysis was planned for the general population. The certainty of evidence was assessed using a modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) for prognostic studies.

RESULTS

Thirty-five studies (4 X-ray, 10 US, 20 MRI, 1 X-ray and MRI) reported useable prevalence data. Two studies were population-based (846 shoulders), 15 studies included miscellaneous study populations (1715 shoulders) and 18 included athletes (727 shoulders). All were judged to be at high risk of bias. Clinical diversity precluded pooling. Population prevalence of glenohumeral osteoarthritis ranged from 15% to 75% (2 studies, 846 shoulders, 1 X-ray, 1 X-ray and MRI; low certainty evidence). Prevalence of labral abnormalities, humeral head cysts and long head of biceps tendon abnormalities were 20%, 5%, 30% respectively (1 study, 20 shoulders, X-ray and MRI; very low certainty evidence).

CONCLUSION

The population-based prevalence of glenohumeral joint imaging abnormalities in asymptomatic individuals remains uncertain, but may range between 30% and 75%. Better estimates are needed to inform best evidence-based management of people with shoulder pain.

Validation of screening instruments for common mental disorders and suicide risk in south African primary care settings

INTRODUCTION

In South Africa, there is limited mental health infrastructure and resources. Valid screening tools are needed to facilitate identification and linkage to care. We evaluated the performance of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5), and the Columbia Suicide Severity Rating Scale (C-SSRS) among adults in South Africa against a diagnostic gold standard.

METHODS

Adults present at healthcare facilities were screened with the PHQ-9, GAD-7, PC-PTSD-5, and the C-SSRS. Nurses used a structured diagnostic interview to identify depression, anxiety, panic disorder, PTSD and elevated suicide risk. We assessed the internal consistency, criterion validity, and the sensitivity and specificity of these tools.

RESULTS

Of the 1885 participants, the prevalence of common mental disorders and suicide risk was 24.4 % and 14.9 %, respectively. The PHQ-9, GAD-7, and PC-PTSD-5 showed good internal consistency (0.80-0.89). All screeners demonstrated good criterion validity. For depression, a cut-off of ≥5 on the PHQ-9 yielded sensitivity of 84.24 %, while ≥10 yielded sensitivity of 48.77 %. For anxiety, the GAD-7 performed similarly. A cut-off of ≥4 on the PC-PTSD yielded sensitivity of 61.96 %. The C-SSRS yielded lower sensitivity than expected.

LIMITATIONS

The prevalence data is not generalizable to the larger South African adult population given the use of a targeted, healthcare facility-based sampling and recruitment strategy.

CONCLUSIONS

The performance of the PHQ-9, GAD-7, and PC-PTSD-5 demonstrated good internal consistency and criterion validity, though sensitivity and specificity trade-offs were enhanced with lower cut-offs. Further research into suicide risk screening is warranted.

Prevalence and co-occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low- and middle-income countries: a cross-sectional study

INTRODUCTION

Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co-occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co-occurrence of MSDs among ageing PWH remains limited, particularly in low- and middle-income countries (LMICs).

METHODS

We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co-occurrence of unhealthy alcohol use (AUDIT-C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ-9 ≥10), anxiety (GAD-7 ≥10) and post-traumatic stress disorder (PTSD) (PCL-5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio-demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use.

RESULTS

Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men.

CONCLUSIONS

Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.

Depression is associated with poor self-reported adherence to antiretroviral therapy among people living with HIV attending an HIV clinic in the UK: results from a cross-sectional study

Contemporary evidence is needed to assess whether the prevalence of depression remains high among people living with HIV in the United Kingdom despite recent efforts to improve patients' mental health, and if depression is negatively associated with individuals' adherence to antiretroviral therapy. In a secondary analysis of a cross-sectional clinic-based survey of alcohol consumption and associated health behaviour among people living with HIV in London, of the 221 respondents, 106 (48%) had poor self-reported adherence to antiretroviral therapy (CASE Index) and 69 (31%) screened positive for depression (PHQ-9). Poor self-reported adherence to ART was 72% higher among participants who screened positive for depression in comparison with participants who screened negative. Respondents who were younger, unemployed, and reported problematic drug use were more likely to screen positive for depression. Screening and management of depression as a part of routine HIV care may support adherence to antiretroviral therapy.

Person-centred care for older adults living with HIV in sub-Saharan Africa

More than a fifth of people living with HIV in the US President's Emergency Plan for AIDS Relief-supported programmes are older individuals, defined as aged 50 years and older, yet optimal person-centred models of care for older adults with HIV in sub-Saharan Africa, including screening and treatment for geriatric syndromes and common comorbidities associated with ageing, remain undefined. This Position Paper explores the disproportionate burden of comorbidities and geriatric syndromes faced by older adults with HIV, with a special focus on women. We seek to motivate global interest in improving quality of life for older people with HIV by presenting available research and identifying research gaps for common geriatric syndromes, including frailty and cognitive decline, and multimorbidity among older people with HIV in sub-Saharan Africa. We share two successful models of holistic care for older people with HIV that are ongoing in Zimbabwe and Kenya. Lastly, we provide policy, research, and implementation considerations to best serve this growing population.

The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: an analytical cross-sectional study in Ivory Coast (the VIRAGE study)

INTRODUCTION

People living with HIV (PLWH) live longer and face new health challenges resulting from the confluence of chronic HIV infection and the natural effect of aging and comorbidities. However, there is a dearth of information on the long-term impact of HIV infection on the health and wellbeing of PLWH in sub-Saharan Africa. This research aimed to fill this gap by reporting on physical, functional and social outcomes among PLWH treated at a referral center in Abidjan, Ivory Coast, and comparing them with those of a control group.

METHODS

Body composition, functional capacity, sarcopenia, limitations in daily activities and social participation were assessed among 300 PLWH (aged ≥ 30 years) and 200 uninfected adults of similar age and sex. The associations between these outcomes and participants' socioeconomic characteristics, HIV history and physical activity level were assessed using generalized additive models adjusted for age and sex.

RESULTS

The median age was 51 years, and the median antiretroviral therapy duration was 15 years. Compared to controls, PLWH reported higher levels of physical activity (p < 0.0001). They had a lower muscle index (adjusted p < 0.0001) and grip strength (adjusted p < 0.0001) but achieved similar performance on the 6-min walk test (6MWT, p = 0.2). Among PLWH, physical activity level was positively associated with better performance in the 6MWT (p = 0.006) and greater hand grip strength (p = 0.04). The difference in physical performance according to the level of physical activity appeared mainly after the age of 60. PLWH reported similar rates of activity limitations (p = 0.8), lower depression levels and greater scores for social functioning (p = 0.02).

CONCLUSION

In this study, PLWH achieved high levels of physical activity, which may explain why they maintained good physical performance and social functioning despite having a higher risk of sarcopenia. These results have important implications for resource-limited health systems and show avenues for chronic care models.

TRIAL REGISTRATION

This study was registered on the ClinicalTrials.gov website (NCT05199831, first registration the 20/01/2022).

Perceived stigma and depression among the HIV-positive adult people in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Depression is one of the most common psychiatric disorders, affecting approximately 60% of people infected with the human immunodeficiency virus (HIV). Low and middle-income countries (LMICs), including Ethiopia, bear a disproportionate burden of depression among HIV/AIDS patients. Several factors, including perceived stigma, have been linked to increased depression among HIV/AIDS patients. Therefore, we aimed to estimate the pooled effect of perceived stigma on depression among HIV/AIDS patients in Ethiopia.

METHODS

For this systematic review and meta-analysis, we systematically retrieved all relevant studies starting from January 1, 2000 to June 1, 2022 from PubMed, HINARI, and Google Scholar. This review included observational studies that reported the effect of perceived stigma on the prevalence of depression among HIV-positive adults in Ethiopia. The effect estimate of the pooled effect of perceived stigma on depression was conducted using DerSimonian-Laird's random effect model using STATA/MP version 16. An adjusted odds ratio (AOR), along with a 95% confidence interval (CI), was conducted to estimate the strength of the association between perceived stigma and depression.

RESULTS

Eleven studies with a total of 4,153 HIV-positive adults were included for meta-analysis. The results of the meta-analysis revealed that the odds of depression were higher among patients with perceived stigma (AOR: 3.78, 95% CI: 2.73, 5.24). The pooled prevalence of depression among HIV/AIDS patients in Ethiopia was 39% (95% CI: 32%, 46%) (I2 = 98%, p ≤ 0.0001). The subgroup analysis revealed that the primary studies conducted in the Oromia region had the highest pooled prevalence of depression at 48% (95% CI: 32%, 63%).

CONCLUSION

The pooled estimates of the meta-analysis revealed that perceived stigma and depression were strongly associated. Stigma and depression screenings should be carried out for additional treatments and prevention, and programs supporting Ethiopia's PLWHA population should be strengthened.

The Intersection of Mental Health and Sexual and Gender Minority Identities for Older Adults Living with Human Immunodeficiency Virus: A Narrative Review

The transition of HIV into a chronic illness has brought to the forefront the pressing need to address the complex web of social determinants of HIV outcomes. A structured literature search and narrative review of studies describing intervention strategies for mental health among sexual/gender minority (SGM) older adults living with HIV (OALWH) published in the last decade identified 2 studies for inclusion. This narrative review identifies age-sensitive and culturally adapted therapies, mindfulness and meditation-based stress reduction, group therapy, digital mental health resources, and psilocybin-assisted group therapy as emerging intervention models tailored to meet the unique needs of SGM OALWH.

Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases among people living with human immunodeficiency virus in low- and middle-income countries in Africa: A scoping review

Objectives

To map the evidence on the barriers to and facilitators of diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries in Africa.

Introduction

Noncommunicable diseases are increasing among people living with HIV. Thus, strengthened and sustained diagnosis of noncommunicable diseases through integrated noncommunicable diseases and HIV care is needed to improve patient outcomes. However, there is paucity of evidence on the barriers and facilitators diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries.

Methods

The Arksey and O'Malley methodological framework was used. A comprehensive systematic search of academic databases (MEDLINE, Academic Search Complete, APA PsycInfo, CAB, and Health Source/Nursing) was performed via EBSCO search and PubMed. The articles were reviewed independently by three reviewers. The results were structured using Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework.

Results

A total of 152 articles were retrieved for full-text review. Forty-one articles met the inclusion criteria. The identified barriers were relevant to all the Capability-Opportunity-Motivation-Behavior constructs and 14 Theoretical Domains Framework domains. A lack of knowledge and awareness of noncommunicable diseases, fear of stigma, financial problems and out-of-pocket payments were the most cited patient-level barriers. Healthcare providers (knowledge and awareness gaps, skill and competence deficiencies, unwillingness, burnout, low motivation, and apathy) were frequently cited. Lack of equipment, noncommunicable disease medications and supply chain challenges, lack of integrated noncommunicable disease and HIV care, and shortage of trained healthcare providers were identified as health-system-level barriers.

Conclusion

This scoping review is the first to identify barriers and facilitators using a theoretical framework. The most cited barriers include a lack of integrated HIV and noncommunicable disease care, equipment and logistics chain challenges for noncommunicable diseases, patients' and healthcare providers' lack of knowledge and awareness of noncommunicable diseases, and healthcare provider's skill and competency deficiencies. Addressing these issues is crucial for improving patient outcomes and reducing the burden on healthcare providers and health systems.

Intimate partner violence, depression, hazardous alcohol use, and social support among people with HIV initiating HIV care in Cameroon

Intimate partner violence (IPV) has been associated with poor mental health among people with HIV (PWH) globally. Social support may be a strategy to foster mental health among PWH. Little is known about whether the relationship between IPV and mental health differs by IPV type or level of social support. Interviews were conducted with 426 PWH initiating HIV care in Cameroon. Log binomial regression analyses were used to estimate the association between four types of IPV (controlling behavior and emotional, physical, and sexual IPV) and symptoms of depression or hazardous alcohol use, separately by IPV type and level of social support. Over half (54.8%) of respondents experienced moderate/high levels of controlling behavior, 42.0% experienced emotional IPV, 28.2% experienced physical IPV and 23.7% experienced sexual IPV. Controlling behavior was associated with greater prevalence of depressive symptoms. This relationship did not vary meaningfully by level of social support (low: aPR 2.4 [95% CI 1.2, 4.9]; high: 1.7 [95% CI 1.0, 2.7]). Emotional and physical IPV were associated with greater prevalence of depressive symptoms among those with low social support (emotional IPV: aPR 1.9 [95% CI 1.0, 3.4]; physical IPV: aPR 1.8 [95% CI 1.2, 2.8]), but not among those with high social support (emotional IPV: aPR 1.0 [95% CI 0.7, 1.6]; physical IPV: aPR 1.0 [95% CI 0.6, 1.6]). Controlling behavior, emotional IPV, and physical IPV were associated with a greater prevalence of hazardous alcohol use, with moderately larger effect estimates among those with high compared to low social support. Sexual IPV was not associated with depressive symptoms or hazardous alcohol use. Services to screen and care for people experiencing IPV are urgently needed among PWH in Cameroon. Future research to identify barriers, feasibility, acceptability, and organizational readiness to integrate IPV and mental health services into HIV care settings is needed.

Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives

BACKGROUND

Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon.

METHODS

We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study.

RESULTS

Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon.

CONCLUSIONS

Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.

'It is a complex process, but it's very important to return these results to participants'. Stakeholders' perspectives on the ethical considerations for returning individual pharmacogenomics research results to people living with HIV

This study aimed to explore stakeholders' perspectives on the ethical considerations for returning individual pharmacogenomics research results to people living with HIV. A qualitative approach to investigation involved five focus group discussions with 30 Community representatives, 12 key informant interviews with researchers, and 12 in-depth interviews with research ethics committee members. In total, 54 stakeholders who were involved in pharmacogenomics research and HIV treatment and care contributed to the data collection between September 2021 and February 2022. The study explored five prominent themes: (i) defining the nature of research results to return to participants; (ii) preparing research participants to receive their results; (iii) obtaining informed consent for the return of results; (iv) opinions on health personnel to return the results to participants; and (v) opinions on how research results should be communicated to participants. Respondents identified various strategies for the return of individual results with minimal ethical risks including the setting up of a diverse and independent committee to undertake a risk-benefit assessment based on local context; ongoing discussions about the possible kinds of results and their implications throughout the study; and employing genetic counsellors to communicate results to participants. The strategies identified in this study should be further studied and independently verified.

Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies

INTRODUCTION

Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis.

RESULTS

A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10).

DISCUSSION

The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.

An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs.

OBJECTIVE

The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths' outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings.

METHODS

Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion.

RESULTS

Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants' feedback.

CONCLUSIONS

This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54635.

Mental health burden among females living with HIV and AIDS in sub-Saharan Africa: A systematic review

Mental health problems, particularly depression and anxiety, are common in women and young girls living with HIV/ AIDS particularly in low- and middle-income (LMICs) countries where women's vulnerability to psychiatric symptoms is heightened due to the prevalent intersectional stressors such as stigma and intimate partner violence. However, no synthesized evidence exists on the mental health burden of females living with HIV/AIDS (FLWHA) in Africa. This systematic review aimed to synthesize the current evidence on the mental health burden among FLWHA in sub-Saharan Africa. A systematic literature review of articles published from 2013-2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Five electronic databases; PubMed, MEDLINE with full text, Scopus, Academic Search Complete, and Health Source: Nursing Academic Edition were searched for articles published in English. Nineteen articles (15 quantitative, 3 qualitative, and 1 case study) from over 7 African countries met the inclusion criteria. The majority of the studies' quality was determined to be moderate. The prevalence of depression ranged from 5.9 to 61% and anxiety from 28.9 to 61%. Mental health burden was a logical outcome of HIV diagnosis. Predictors of mental health outcomes in the context of HIV/AIDS were identified as intimate partner violence (IPV), stigma, childhood traumas, sexual abuse, poverty, unemployment, and social isolation. Social support and resilience were identified as protective factors against mental illness in FLWHA. Mental illness had a deleterious effect on viral suppression rates among FLWHA, resulting in delayed initiation of antiretroviral therapy treatment and increased mortality but had no impact on immune reconstitution in the face of ART adherence. Given the high prevalence rates of depression and anxiety and their relationship with HIV progression, it is crucial that mental health care services are integrated into routine HIV care.

Global prevalence of depressive symptoms among people living with HIV/AIDS: a systematic review and meta-analysis of the past five years

A clear and accurate assessment of depressive symptoms among people living with HIV/AIDS (PLWHA) in the past five years is essential to help develop reasonable and sound interventions to improve their depressive symptoms. PubMed, Web of Science, MEDLINE, Cochrane, Embase, CINAHL, and APA were searched from 1 January 2017 to 12 April 2022. The data were analyzed using STATA 15 Software to pool the global prevalence of depressive symptoms in PLWHA. Ultimately, 103785 PLWHA from 81 original studies were included. The pooled analysis showed that the global prevalence of depressive symptoms in PLWHA over the past five years was 0.35 (95% CI: 0.31-0.38), with differences in depressive symptoms in PLWHA by geographic location, gender, assessment instruments, alcohol use, smoking, marriage, co-morbid disease, financial situation, and educational level. Scientific and timely public health interventions should be developed among PLWHA to improve their depressive symptoms and thereby improve mental health and clinical outcomes.

Latent Profile Analysis of Cognitive Performance and Depressive Symptoms Among People with HIV

Depression and cognitive impairment are prevalent conditions among people with HIV (PWH), likely attributable to shared causes and common risk factors. Identifying subtypes of PWH with similar patterns of neurocognitive impairment (NCI) and depressive symptoms may inform development of patient-centered interventions that target-specific profiles. This study aimed to (1) classify PWH based on patterns of domain-specific NCI and depression; and (2) determine the relationship between latent class membership and pertinent clinical characteristics. PWH (N = 580, 86.2% male, 57.1% non-Hispanic White, 69.2% unemployed) completed a comprehensive neuropsychological test battery assessing global and domain-specific cognition. Domain-specific NCI was classified as deficit score >0.5. Participants completed the Beck Depression Inventory-II (BDI-II), and domain-specific BDI-II scores reflecting cognitive, affective, and somatic symptoms were computed. Latent profile analysis (LPA) was used to determine latent subgroups of NCI and depression. The optimal LPA solution consisted of five classes: minimal NCI and minimal depression (Class 1), amnestic and minimal depression (Class 2), severe multi-domain NCI and moderate depression (somatic and affective; Class 3), mild NCI and mild depression (Class 4), and moderate multi-domain NCI and severe depression (Class 5). Despite similar levels of functional impairment, Class 5 had a significant psychiatric profile, whereas Class 3 had a complex medical profile (i.e., higher frailty index, higher medications, greater proportion of AIDS diagnosis). In contrast, Class 1 had the lowest medication use and frailty index, with similar HIV disease characteristics to Classes 3 and 5. Our results suggest there are multiple pathways to cognitive and functional impairment among PWH with co-occurring depression and cognitive impairment, and these groups may respond differently to interventions. Of note, our sample was majority non-Hispanic White and male, which is nonrepresentative of the US population of PWH. Future interventions should consider a more integrated, person-centered approach that addresses cognitive and emotional health to optimize health outcomes in PWH.

Longitudinal Analysis of the Relationship Between Internalized HIV Stigma, Perceived Social Support, Resilience, and Depressive Symptoms Among People Living with HIV in China: A Four-Wave Model

Depression is one of the most common mental health problems among people living with HIV (PLWH). However, the longitudinal psychological mechanism underlying the link of internalized HIV stigma and depressive symptoms remains a research gap. This study attempted to articulate how and to what extent perceived social support and resilience mediate the longitudinal associations between internalized HIV stigma and depressive symptoms. A sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval and four waves of follow-up was used in the current study. Participants were asked to complete self-report questionnaires. The associations among main study variables were examined via a complete longitudinal mediation approach. Results indicated that the linkage between internalized HIV stigma at T1 and depressive symptoms at T4 was serially mediated by perceived social support at T2 and resilience at T3, and perceived social support at T2 and depressive symptoms at T3 serially mediated the relationship between resilience at T1 and internalized HIV stigma at T4. Depressive symptoms at a previous time point consistently predicted the levels of internalized HIV stigma at subsequent time points. The study highlights the complex interplay between internalized HIV stigma, mental health problems, and protective factors in a longitudinal context. The findings suggest the need to incorporate interventions aimed at enhancing social support and resilience in mental health programs for PLWH, as these factors may interrupt the pathway from internalized HIV stigma to depressive symptoms and potentially improve the overall psychological well-being of this population.

Perceptions, facilitators and barriers to the implementation of interpersonal group therapy to treat depression among people living with HIV in Senegal: a qualitative study

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.

Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia

Depression is the most frequently detected and preventable mental illness among people with human immunodeficiency syndrome, with rates two to four times higher than in the general population. Currently, depression is estimated to affect 350 million people worldwide. To assess the prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. An institutional-based cross-sectional study was conducted from April 01 to September 30, 2021, at Adama Hospital Medical College, Adama, Ethiopia. A total of 420 individuals were selected using a systematic random sampling technique. After informed consent was obtained from each study participant, data were collected through face-to-face interviews, observations, and document reviews. Subsequently, the data were entered into EPI-Info Version 7 and analyzed by Statistical Package for the Social Sciences version 21. Variables with p-values less than 0.25 in the univariable logistic regression analysis were subsequently included in the multivariable logistic regression analysis to account for potential confounding factors. The association was measured using adjusted odds ratio (AOR) with a 95% confidence interval (CI), and variables with p-values less than 0.05 were considered statistically significant. The prevalence of depression was 52.4% (95% CI 47.6-57.1). Factors significantly associated with depression among HIV-positive patients on antiretroviral therapy included employment status [AOR = 0.22(95% CI 0.13-0.36)], the patient's most CD4 count [AOR = 6.99 (95% CI 2.81-17.38)], duration of months on antiretroviral therapy [AOR = 5.05 (95% CI 2.38-10.74)] and presence of chronic non-communicable diseases [AOR = 7.90 (95% CI 4.21-14.85)]. The highest proportion of HIV-positive patients taking antiretroviral drugs exhibited depression. Employment was identified as a preventive factor, whereas having a low CD4 count, recently initiating antiretroviral therapy, and having chronic non-communicable diseases were associated with increased odds of depression among HIV-positive patients on antiretroviral therapy. There need to strengthen mental health screening and treat depression among HIV-positive patients, particularly by targeting identified factors.

Prevalence of depression among people living with HIV in rural hospitals in South-Western Nigeria-Association with clinico-demographic factors

Major depression is the most common neuropsychiatric disorder among people living with HIV (PLWH) and is predictive of high morbidity and mortality among them. This study estimated the prevalence and explored factors associated with depression among PLWH in two rural secondary health facilities providing anti-retroviral therapy (ART) services in Southwestern Nigeria between September and December 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to screen and identify PLWH aged 18 years or older with depression. Descriptive statistics, bivariate and multivariate analyses were performed with SPSS version 23. A total of 172 respondents were screened. The prevalence of depression was 16.3% (95% CI 11.1%, 22.7%). Mild, moderate, and moderately severe depression was identified in 17 (9.9%), 8(4.7%) and 3(1.7%) of the participants, respectively. One (0.6%) respondent had suicidal ideation. Of PLWH with any depression, 20/28(71.4%) were within the 40-59 years of age range. None of the participants was on antidepressants. The factor most associated with depression was hypertension, with adjusted odd ratios of 9.8(95% CI 3.5-27.3, p < 0.0001). The study highlights the importance of screening for the severity of depression among PLWH in rural hospitals providing ART services in Africa. PLWH with comorbid hypertension were more likely to suffer from some form of depression.

"Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa"

BACKGROUND

People with HIV (PHW) are at greater risk of depression than the general population. Insight into the time-to-treatment-response and predictors of response to psychotherapy may improve implementation in primary care.

METHODS

We assessed depression treatment response among 80 participants in a trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal antiretroviral therapy (ART) adherence. Participants self-reported depressive symptoms (CESD) at each therapy session. Clinicians assessed participants' depression (HAMD), along with potential predictors of response, every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each phase.

RESULTS

During the active treatment phase (CESD) we identified an early response (at session 2 and with continued trajectory of improvement) and a non-response group. There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR = 0.74, 95%CI[0.56-0.90], p = .009), and social support was associated with increased likelihood of early response (aOR = 2.24, 95%CI[1.07-5.46], p = .045).

LIMITATIONS

Self-reported depression during the treatment phase may have resulted from social desirability bias.

CONCLUSIONS

Most participants responded to CBT-AD early during treatment (89 %) and had sustained improvements in depression by 4 months (80 %). Distress aversion was a risk factor for late response, and social support was protective. Future research is needed to assess the optimal dose of CBT-AD in resource limited settings.

Depression and HIV Care-seeking Behaviors in a Population-based Sample in North West Province, South Africa

Depression is associated with key HIV-related prevention and treatment behaviors in sub-Saharan Africa. We aimed to identify the association of depressive symptoms with HIV testing, linkage to care, and ART adherence among a representative sample of 18-49 year-olds in a high prevalence, rural area of South Africa. Utilizing logistic regression models (N = 1044), depressive symptoms were inversely associated with reported ever HIV testing (AOR 0.92, 95% CI 0.85-0.99; p = 0.04) and ART adherence (AOR 0.82, 95% CI: 0.73-0.91; p < 0.01) among women. For men, depressive symptoms were positively associated with linkage to care (AOR: 1.21, 95% CI: 1.09-1.34; p < 0.01). Depression may adversely impact ART adherence for HIV-positive women and reduce the likelihood of HIV testing for women not aware of their HIV status which, in settings with high HIV prevalence, carries severe consequences. For HIV-positive men, findings suggest that depression may encourage help-seeking behavior, thereby impacting their health system interactions. These findings underscore the need for health-care settings to factor mental health, such as depression, into their programs to address health-related outcomes, particularly for women.

Partner Cooperation, Conflict, Maternal Mental Health, and Parenting Behaviors in Rural Kenya: Towards a Two-Generational Understanding of Gender Transformation Benefits

Increasing partner cooperation is an established approach to reducing intimate partner violence. This strategy, known in the literature as "gender transformation," benefits mental and physical health of women and men. Less is known about the potential for gender transformation strategies to improve the nurturing context for children. We hypothesize that increasing partner cooperation, a common benefit of community-based empowerment programs, would decrease child maltreatment through reducing intimate partner conflict and improving maternal mental health. This study utilizes cohort data from women (n = 400) participating in a combined group-based microfinance program to assess potential mechanisms by which partner cooperation at T1 (June 2018) predicts less children maltreatment at T2 (June 2019). As hypothesized, partner cooperation predicts less subsequent child maltreatment-frequency of neglect, corporal punishment, physical assault, and psychological abuse in the past month. This association is mediated completely by subsequent more partner cooperation and less intimate partner conflict, maternal loneliness, and depression. Implications of this study include potential for combining multiple development areas-women's empowerment, intimate partner cooperation, mental health, and child nurturing contexts. Future study should assess these pathways in a cluster-based randomized trial, and explore how findings may inform policy and practice where these domains are less integrated.

Depression and perceived stress among perinatal women living with HIV in Nigeria

Background

Pregnancy and postpartum periods are crucial stages for women's mental health, and women living with HIV are particularly susceptible to depression and psychological stress due to various factors. This study investigated the prevalence and associated factors of depression and perceived stress among women living with HIV during their perinatal period in Ibadan, Nigeria.

Methods

A cross-sectional survey was conducted in three HIV treatment centers in Ibadan, Nigeria, among women living with HIV between the ages of 19 and 49 who were either pregnant or had given birth within the last 2 years. The study was conducted from September 2022 to December 2022. An interviewer-administered questionnaire was used to collect the data from the participants. Ethical approval and informed consent were obtained, and data were analyzed using the Statistical Package for Social Science version 26.

Results

The study included 402 participants, of whom 69.0 and 78.0% reported symptoms of depression and perceived stress, respectively. However, 15.2% of the participants have comorbid depression and stress. Positive partner status was significantly associated with lower perceived depression, while gestational age between 29 and 40 weeks was significantly associated with lower perceived stress. The co-occurrence of depression and perceived stress was associated with partner status, income level, family support, gestational age, and years on antiretroviral therapy.

Conclusion

The high prevalence of depression, perceived stress, and their co-occurrence among women living with HIV during the perinatal period call for incorporating mental health care into routine maternal healthcare for all women, particularly those living with HIV. This finding emphasizes the need for public health efforts to prioritize perinatal mental health and improve access to care and support for women and their partners.

Evaluation of the health-related quality of life and associated factors in Zimbabwean adults living with HIV: a cross-sectional study

OBJECTIVE

HIV remains a global burden, with the Sub-Saharan Africa (SSA) region reporting the largest number of people living with HIV/AIDS (PLHIV). An exponential improvement in the accessibility and uptake of antiretroviral treatment across SSA has significantly improved outcomes for PLHIV. Hence, HIV care goals have shifted from reducing mortality and morbidity to improving health-related quality of life (HRQoL). This study uses generic and condition-specific HRQoL outcomes to holistically determine the HRQoL of Zimbabwean adult PLHIV and associated factors. HRQoL is a dynamic subject construct that warrants continuous evaluation to provide meaningful feedback to various stakeholders. We enrolled 536 adult PLHIV in Zimbabwe. Collected data were analyzed through descriptive statistics and multivariate binary logistic regression.

RESULTS

Our study shows a high HRQoL perception by Zimbabwean PLHIV. Anxiety, depression, and poor environmental health were widely reported domains influencing HRQoL. Also, being aware of HIV status for over a year, not experiencing an adverse event, being married, having adequate finances and food security and having higher educational status were associated with higher HRQoL. It is essential to integrate mental health care into routine HIV care to improve treatment outcomes and HRQoL. Last, implementing bespoke multisectoral HRQoL-enhancement interventions is paramount.

Psychosocial interventions and their effectiveness on quality of life among elderly persons living with HIV in Africa South of the Sahara: Systematic review and meta -analysis protocol

BACKGROUND

The number of elderly people living with HIV (EPLHIV) has increased significantly as a result of antiretroviral treatment (ART) and this has brought about a variety of psychosocial challenges that have an impact on their quality of life (QoL). Various psychosocial interventions have been tried or implemented in Sub-Saharan Africa (SSA) to improve QoL of EPLHIV. However, there is paucity of data on the types and effectiveness of these interventions. This systematic review, therefore, aims to explore available psychosocial interventions in SSA and their effectiveness in improving the QoL of EPLHIV.

METHODS

We will search PubMed, PsycINFO, LILACS, Cochrane Library, Google Scholar, HINARI, Africa Journals Online, Scopus and Web of Science to retrieve publications on psychosocial interventions implemented to improve QoL of EPLHIV from inception of the identified databases to 31st December 2023 without language restrictions. Also, supplementary sources such as conference proceedings, preprint repositories, databases of dissertations, as well as WHO and governmental databases can be explored for additional studies. For unpublished studies, trial registries and experts would be contacted, and reference lists of retrieved papers will be manually searched. Retrieved studies will be deduplicated using Mendeley and exported to Rayyan. At least two reviewers will independently select studies, extract data and assess the quality of the included studies using validated tools. Dichotomous outcomes data will be assessed and reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference (MD) will be used; all reported with their 95% confidence interval (CI). Heterogeneity will be explored graphically by inspecting the overlapping of CIs and assessed quantitatively using the I2 statistic.

EXPECTED OUTCOMES

This systematic review will be the first to rigorously identify psychosocial intervention on QoL of EPLHIV in SSA and assess their effectiveness with the aim to provide regional and country- specific data that will inform the selection and implementation of appropriate and socially acceptable policies across countries in SSA. Key findings of the review are expected to contribute critical evidence on availability, types and effectiveness of psychosocial interventions for improving quality of life of vulnerable elderly persons in SSA living with HIV. Furthermore, the review will explore any variation and possible correlates of psychosocial interventions by age, sex, CD4 count (if available), setting and geographic location within SSA that will provide healthcare professionals with reliable evidence, with the ultimate goal of inspiring countries in SSA to adopt innovative interventions to improve HIV care.

TRIAL REGISTRATION

Systematic review registration: The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42021278218.

Reliability and validity of the Shona version of the Exercise Benefits and Barriers Scale in Zimbabwean adult people living with HIV/AIDS

Introduction

Despite the widely known benefits of physical activity (PA), only 25% of people living with HIV (PLHIV) meet the WHO-recommended minimum PA levels. Consequently, it is essential to understand PA barriers and facilitators using objective measures. Although the Exercise Benefits and Barriers Scale (EBBS) is extensively used, its psychometric evidence is fragmented and has not been previously validated in PLHIV. This study aimed to translate and validate the EBBS Shona version in Zimbabwean PLHIV.

Methods

A cross-sectional study was used to recruit 567 PLHIV from four (4/9) randomly selected polyclinics (primary healthcare facilities) in urban Harare, Zimbabwe. We recruited adult patients (aged ≥18 years) with a confirmed diagnosis of HIV. Participants had to be willing to provide informed consent, not acutely unwell, and proficient in the Shona language. We used a forward-backwards translation method to translate the EBBS from English to Shona, a native Zimbabwean language. After cross-cultural adaptation, we pretested the draft version in 10 PLHIV to assess the face validity, understandability and cultural appropriateness using semi-structured interviews. Thereafter, the EBBS was administered to 567 consecutively-selected PLHIV. Factor analyses were performed for construct validity evaluation.

Results

Most participants were female (72.5%) and reached secondary/high school (78.8%), with a mean age of 39.9 (SD 12.1) years. The EBBS-Shona version yielded a four-factor solution consisting of three benefits factors and one barrier factor against the originally postulated six-factor structure. The EBBS-Shona yielded α = 0.85 and intraclass correlation coefficient = 0.86, demonstrating excellent reliability. Increased perception of exercise benefits was positively correlated with increased reports of physical activity, higher health-related quality of life and lower psychiatric morbidity; evidence for construct validity.

Discussion

This study demonstrates the validity and reliability of the EBBS-Shona version in Zimbabwean PLHIV. The EBBS-Shona version can be used for research and clinical purposes to glean data to inform the development, implementation, and evaluation of bespoke PA interventions for PLHIV.

Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis

BACKGROUND

Adverse childhood experiences and adult trauma, including sexual abuse, physical abuse, neglect, and interpersonal violence, are highly prevalent in low-resource settings and associated with adverse psychological outcomes. However, there is limited focus on the impact of ACEs and trauma on mental health in sub-Saharan Africa. Therefore, this study examines the impact of traumatic events and ACEs on depression, anxiety, and stress scores among outpatients receiving psychiatric care at two public mental health treatment facilities in Johannesburg, South Africa.

METHODS

A sample of 309 participants were recruited between January and June 2022 at Helen Joseph Hospital and Alexandra 18th Avenue Clinic. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 7-item General Anxiety Disorder scale (GAD-7) and the 10-item Perceived Stress Scale. We fitted modified Poisson and linear regression models to estimate the impact of ACEs and adult experiences of trauma on depression, anxiety, and stress scale scores.

RESULTS

47.57% (n = 147) of participants screened positive for anxiety, 44.66% (n = 138) for depression, and 17% (n = 54) for severe stress. More females screened positive for anxiety (65.31%), depression (65.94%), and stress (77.78%). Each ACE was associated with a 12% increased risk of depression, a 10% increased risk of anxiety, and a 17% increased risk of stress. In separately estimated models, each additional traumatic event during adulthood was associated with a 16% increased risk for depression, an 8% increased risk of anxiety, and a 26% increased risk of stress. Across all models, being male and self-reported physical health were consistently associated with a reduced risk for depression, anxiety, and stress.

CONCLUSIONS

ACEs and experiences of traumatic events as adults were associated with significantly increased risks of anxiety, depression, and severe stress. Given high exposure to ACEs and trauma and the associated impact on the mental health of individuals, families, and communities, there is a need to strengthen and scale innovative combination interventions that address multiple stressors impacting people in low-resource settings.

The prevalence and outcomes of depression in older HIV-positive adults in Northern Tanzania: a longitudinal study

Studies of depression and its outcomes in older people living with HIV (PLWH) are currently lacking in sub-Saharan Africa. This study aims to investigate the prevalence of psychiatric disorders in PLWH aged ≥ 50 years in Tanzania focussing on prevalence and 2-year outcomes of depression. PLWH aged ≥ 50 were systematically recruited from an outpatient clinic and assessed using the Mini-International Neuropsychiatric Interview (MINI). Neurological and functional impairment was assessed at year 2 follow-up. At baseline, 253 PLWH were recruited (72.3% female, median age 57, 95.5% on cART). DSM-IV depression was highly prevalent (20.9%), whereas other DSM-IV psychiatric disorders were uncommon. At follow-up (n = 162), incident cases of DSM-IV depression decreased from14.2 to 11.1% (χ2: 2.48, p = 0.29); this decline was not significant. Baseline depression was associated with increased functional and neurological impairment. At follow-up, depression was associated with negative life events (p = 0.001), neurological impairment (p < 0.001), and increased functional impairment (p = 0.018), but not with HIV and sociodemographic factors. In this setting, depression appears highly prevalent and associated with poorer neurological and functional outcomes and negative life events. Depression may be a future intervention target.

Availability of screening and treatment for common mental disorders in HIV clinic settings: data from the global International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium, 2016-2017 and 2020

INTRODUCTION

Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020.

METHODS

In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys.

RESULTS

Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048).

CONCLUSIONS

Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed.

Depression and Associated Factors among People Living with Human Immunodeficiency Virus Attending Antiretroviral Therapy in Public Health Facilities, Hosanna Town, Southern Ethiopia

Background

Among those infected with the human immunodeficiency virus, depression is one of the most prevalent mental health issues. Despite its high incidence, depression goes undiagnosed and untreated in the majority of HIV/AIDS patients, which has a negative impact on how well they adhere to their antiretroviral regimen.

Objective

To assess the magnitude of depression and associated factors among people attending antiretroviral therapy in public health facilities of Hosanna town, Hadiya Zone, Southern Ethiopia, 2019.

Methods

Institution-based cross-sectional study was conducted at public health facilities of Hosanna town from June 6 to July 6, 2019, among people living with HIV/AIDS aged 18 years and older who were on ART. A systematic sampling technique was used to select 392 participants. Data were collected using a pretested and standardized structured interviewer-administered questionnaire. Variables having a p value less than 0.2 in bivariate analysis were entered into the multiple logistic regression model. Odds ratio with 95% CI was computed, and variables with p value < 0.05 were considered as statistically significantly associated with depression.

Result

The prevalence of depression among HIV patients was 37.8%. Being female (AOR = 2.15, 95% CI (1.21, 3.84)), not disclosing their HIV status (AOR = 2.77, 95% CI (1.57, 4.89)), rural dwellers (AOR = 2.69, 95% CI (1.58, 4.57)), poor ART adherence (AOR = 1.89, 95% CI (1.10, 3.24)), having HIV-perceived stigma (AOR = 1.71, 95% CI (1.01, 2.88)), and poor social support (AOR = 1.85, 95% CI (1.11, 3.09)) were significantly associated with depression.

Conclusion

The magnitude of depression was high among PLWHIVs. Being female, rural dwellers, not disclosing HIV status, poor ART adherence, HIV-perceived stigma, and poor social support were significantly associated with depression. Enhancing adherence, counseling, and linking those patients who had poor social support to the concerned relatives for care and support is recommended. Providing health education both at the facility level and at the community level may reduce stigma and subsequently depression. Encouraging disclosing HIV status may help to prevent depression.

Effect of the Friendship Bench Intervention on Antiretroviral Therapy Outcomes and Mental Health Symptoms in Rural Zimbabwe: A Cluster Randomized Trial

Importance

Common mental disorders (CMD), which include depression and anxiety, are prevalent among people living with HIV and are associated with suboptimal antiretroviral therapy (ART) adherence.

Objective

To assess the effect of a lay health worker-led psychological intervention on ART adherence, virologic suppression, and mental health symptoms.

Design, Setting, and Participants

Open-label pragmatic cluster trial with 1:1 block randomization of 16 health facilities in rural Bikita, Zimbabwe. Recruitment occurred from October 2018 to December 2019, and participants were followed up for 12 months, ending in December 2020. Participants were adults aged 18 years and older, who spoke English or Shona, screened positive for CMD (Shona Symptoms Questionnaire [SSQ]-14 score ≥9), received first-line ART for 6 or more months, had no World Health Organization stage 4 disease, no psychosis, were not pregnant, and provided informed consent. Data were analyzed from March 2021 to February 2022.

Intervention

The Friendship Bench, consisting of 6 lay health worker-led weekly problem-solving therapy sessions and optional peer-led group support.

Main Outcomes and Measures

The primary outcome was mean adherence during 2 to 6 months of follow-up, and the secondary outcomes were mean adherence during 1 to 12 months of follow-up, change in SSQ-14 and Patient Health Questionnaire (PHQ-9) scores (3, 6, 9, and 12 months), and viral load suppression (6 and 12 months).

Results

A total of 516 participants were recruited (244 in Friendship Bench and 272 in enhanced standard care facilities); 438 (84.9%) were female and the mean (SD) age was 45.6 (10.9) years. Mean (SD) adherence between 2 to 6 months was 89.9% (18.4%) in the Friendship Bench group and 87.2% (20.1%) in the control group. The intervention had no statistically significant effect on adherence between 2 to 6 months (unadjusted mean difference, 1.93 percentage points; 95% CI, -1.20 to 5.06 percentage points; P = .23), between months 1 to 12 (mean difference 0.79 percentage points; 95% CI, -2.14 to 3.71 percentage points; P = .60), or viral suppression. Declines in SSQ-14 scores from baseline to 3 months (difference, -1.65; 95% CI, -3.07 to -0.24), 6 months (difference, -1.57; 95% CI, -2.98 to -0.15), and 9 months (difference, -1.63; 95% CI, -3.05 to -0.22) were greater in the Friendship Bench than the standard care group (P < .05). There were no differences in the decline in the SSQ-14 scores from baseline to 12 months and in declines in PHQ-9 scores from baseline to 3, 6, 9, and 12 months.

Conclusions and Relevance

In this randomized trial of HIV-positive participants with CMD, the Friendship Bench intervention had no effect on adherence and viral suppression, possibly due to the absence of skill-based adherence training and a ceiling effect.

Trial Registration

ClinicalTrials.gov Identifier: NCT03704805.

Age-varying Associations of Depressive Symptoms and Heavy Episodic Drinking Throughout Adulthood Among People with HIV and Receiving care in Cameroon Within a National "treat all" Policy

Comorbid depression and heavy episodic drinking (HED) may threaten the success of "treat all" policies in sub-Saharan Africa as the population of people with HIV (PWH) ages. We investigated associations between depressive symptoms and heavy episodic drinking (HED) and the extent the relationship differed across ages among PWH receiving HIV care in Cameroon. We conducted a retrospective analysis of 18-60-year-old PWH on antiretroviral therapy in Cameroon from January 2016 to March 2020. Age-varying effect modelling was conducted to assess associations between depressive symptoms and HED across ages and by gender. Prevalence of depression and HED was highest at ages 20 and 25, respectively. After age 25, the magnitude of the association between depressive symptoms and HED was significant and increased until age 30 (aOR: 1.88, 95% CI: 1.48, 2.39), with associations remaining significant until age 55 (aOR: 1.64, 95% CI: 1.17, 2.29). Women had more variability and higher magnitudes of associations between depressive symptoms and HED than men. The interrelationship between depressive symptoms and HED was significant throughout most of adulthood for PWH receiving HIV care in Cameroon. Understanding age and gender trends in these associations can guide integration efforts in HIV care settings.

Management of depression in people living with HIV/AIDS in Senegal: Acceptability, feasibility and benefits of group interpersonal therapy

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.

Comparison of healthspan-related indicators between adults with and without HIV infection aged 18-59 in the United States: a secondary analysis of NAHNES 1999-March 2020

BACKGROUND

As persons with HIV (PWH) live longer they may experience a heightened burden of poor health. However, few studies have characterized the multi-dimentional health of PWH. Thus, we aimed to identify the extent and pattern of health disparities, both within HIV infection status and across age (or sex) specific groups.

METHODS

We used cross-sectional data from the US National Health and Nutrition Examination Survey, 1999-March 2020. The adjusted prevalence of six healthspan-related indicators-physical frailty, activities of daily living (ADL) disability, mobility disability, depression, multimorbidity, and all-cause death-was evaluated. Logistic regression and Cox proportional hazards analyses were used to investigate associations between HIV status and healthspan-related indicators, with adjustment for individual-level demographic characteristics and risk behaviors.

RESULTS

The analytic sample consisted of 33 200 adults (170 (0.51%) were PWH) aged 18-59 years in the United States. The mean (interquartile range) age was 35.1 (25.0-44.0) years, and 49.4% were male. PWH had higher adjusted prevalences for all of the 6 healthspan-related indicators, as compared to those without HIV, ranged from 17.4% (95% CI: 17.4%, 17.5%) vs. 2.7% (95%CI: 2.7%, 2.7%) for all-cause mortality, to 84.3% (95% CI: 84.0%, 84.5%) vs. 69.8% (95%CI: 69.7%, 69.8%) for mobility disability. While the prevalence difference was largest in ADL disability (23.4% (95% CI: 23.2%, 23.7%); P < 0.001), and least in multimorbidity (6.9% (95% CI: 6.8%, 7.0%); P < 0.001). Generally, the differences in prevalence by HIV status were greater in 50-59 years group than those in 18-29 group. Males with HIV suffered higher prevalence of depression and multimorbidity, while females with HIV were more vulnerable to functional limitation and disabilities. HIV infection was associated with higher odds for 3 of the 6 healthspan-related indicators after fully adjusted, such as physical frailty and depression. Sensitivity analyses did not change the health differences between adults with and without HIV infection.

CONCLUSIONS

In a large sample of U.S. community-dwelling adults, by identifying the extent and pattern of health disparities, we characterized the multi-dimentional health of PWHs, providing important public health implications for public policy that aims to improve health of persons with HIV and further reduce these disparities.

Mental health, substance use, and risky sexual behaviors among women living with HIV

INTRODUCTION

Risky sexual behavior has been explored in women living with HIV (WLHIV) internationally but is not well studied in WLHIV in the United States (U.S.). This merits further investigation due to the negative reproductive and HIV health outcomes associated with risky sexual behavior, such as the increased risk for HIV transmission and infertility from sexually transmitted infections (STIs). The aims of this study are to (1) describe sexual behaviors in a cohort of WLHIV in Florida, (2) determine whether demographic characteristics, substance use, and mental health symptoms are associated with risky sexual behavior in a cohort of WLHIV in Florida, and (3) explore whether the relationship between substance use and mental health symptoms and risky sexual behavior differs in reproductive-age (age 18-49), compared to non-reproductive-age WLHIV (age 50+).

DESIGN

This was a cross-sectional analysis of data from a multisite cohort study done in Florida.

METHODS

Data were collected from a sample of 304 participants who were recruited into the Florida Cohort Study from 9 clinical and community sites in Florida between 2014 to 2017. The predictor variables of interest were mental health symptoms, substance use, and demographic variables. The outcome variable of interest was risky sexual behavior which was defined as reporting ≥1 of the following: (1) at least one STI diagnosis in the past 12 months, (2) two or more sexual partners in the past 12 months, or (3) any inconsistent condom use in the past 12 months. Descriptive statistics, bivariate analysis, and logistic regression (p < 0.1) were conducted on the variables of interest.

RESULTS

The mean age of the sample was 47.8 years, and approximately half (51.6%) of the sample was of reproductive-age. Reporting ≥1 risky sexual behavior was reported in over half (51.6%) of the reproductive-age WLHIV in the sample and 32% of the non-reproductive-age WLHIV in the sample. Binge drinking, alcohol-related problems, marijuana use, and age were all significantly associated with self-reporting ≥1 risky sexual behaviors in all WLHIV. Self-reporting binge drinking, marijuana use, and a high alcohol-related problems score respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior in all WLHIV. Neither mental health symptoms nor race/ethnicity or education were significantly associated with self-reporting ≥1 risky sexual behavior in all WLHIV. Self-reporting severe anxiety symptoms and high alcohol-related problems scores respectively were associated with increased odds of self-reporting ≥1 risky sexual behavior only in reproductive-age WLHIV from the sample.

CONCLUSION

Marijuana use, binge drinking, and alcohol-related problems appear to have a relationship with risky sexual behavior in WLHIV regardless of age. Reproductive-age also appears to influence risky sexual behavior in WLHIV, and specific reporting severe anxiety symptoms and high alcohol-related problems in reproductive-age WLHIV increases the odds of engaging in risky sexual behavior.

CLINICAL SIGNIFICANCE

This study holds clinical significance for nurses and other clinicians working in reproductive health settings and clinics with WLHIV. Results indicate that it could be beneficial to do more screening for mental health symptoms (particularly anxiety) and alcohol use in younger reproductive-age WLHIV.