Prevalence of Depression in People Living with HIV/AIDS Undergoing ART and Factors Associated with it

Depression and Its Predictors in Adults Receiving Antiretroviral Therapy

Background and aim Depression is a common psychiatric morbidity seen in adults living with HIV/AIDS. Several contextual factors have been implicated in the pathogenesis of depression in HIV-positive adults, these factors could be clinical, treatment-related, or socio-demographic in nature. Due to the debilitating nature of depression and its adverse effect on antiretroviral treatment adherence, HIV-positive adults living with depression are at risk of sub-optimal treatment response and, consequently, poor health outcomes. This suggests that there is a need for more research on depression and its risk factors in HIV-positive adults, as this could inform the promotion of preventive measures against the disorder, as well as early identification and treatment of affected persons. This study aimed to determine the prevalence and predictors of depression among HIV-positive adults receiving antiretroviral therapy. Methods This was a cross-sectional study of 257 HIV-positive adults conducted at the Hematology Clinic of the Lagos State University Teaching Hospital, Ikeja, Nigeria. Respondents were selected using a systematic random sampling method. Study instruments used were as follows: the Patient Health Questionnaire (PHQ-9), the four-item Morisky Medication Adherence Scale (MMAS-4), the Multidimensional Perceived Social Support Scale (MPSSS), and a socio-demographic/clinical data questionnaire. Data were analyzed using the EPI-Info statistical analysis software version 7.0 (Atlanta, GA: Centers for Disease Control and Prevention). Univariate, bivariate, and multivariate analyses were done to determine the prevalence and predictors of depression among HIV-positive adults. Results The prevalence of depression was 54%, and predictors of depression were being unmarried (n=91, OR=10.9, 95% CI=4.6-26.2, p=0.000), female gender (n=119, OR=5.8, 95% CI=2.2-15.5, p=0.000), low social support (n=57, OR=11.2, 95% CI=4.1-30.8, p=0.000), and unemployment (n=27, OR=0.2, 95% CI=0.1-0.7, p=0.007). Conclusion Depression is frequently reported among HIV-positive adults, and its occurrence may be influenced by clinical, social, and demographic-related factors. These variables need to be considered in patient care at antiretroviral clinics in order to achieve a good treatment prognosis. Furthermore, future research may focus on intervention studies on depression in HIV-positive adults, especially in those with increased vulnerability to depression.

Depression, anxiety, and stress among HIV-positive pregnant women during the COVID-19 pandemic: a hospital-based cross-sectional study in India

BACKGROUND

The COVID-19 pandemic has caused an unparalleled increase in psychological distress among everyone and everywhere. Perinatal depression, anxiety, and stress (DAS) are more prominent among HIV-positive pregnant women and are associated with poor maternal and neonatal outcomes. Therefore, this study aimed to assess the prevalence and explore the factors associated with DAS among HIV-positive pregnant women in India.

METHODS

A multicentric, cross-sectional, analytical study was conducted among all HIV-positive pregnant women, aged more than 18 years, taking antiretroviral therapy, and attending antenatal care visits at two hospitals that are offering HIV care services in Anantapur District, Andhra Pradesh, India. Women who were unable to communicate were mentally ill, and refused to give consent were excluded. The study was conducted for a period of eighteen months from April 2020 to September 2021. A validated and interview-based data collection form was used to capture sociodemographic, obstetric profiles, clinical and support-related profiles, and COVID-19 stressors among study participants. The DASS-21 scale was used to assess depression, anxiety, and stress among study participants. Univariable and multivariable Poisson regression analyses were used to identify factors associated with DAS among study participants.

RESULTS

The prevalence of depression, anxiety, and stress among HIV-positive pregnant women was found to be 50.3% (95% CI 23.6-76.4), 56.2% (95% CI 28.3-80.3), and 42.2% (95% CI 18.5-69.9), respectively. A multivariate Poisson regression analysis showed that participants living in a rural area (adj. PR 1.43,1.08-1.91), primigravidae (adj. PR 1.37, 1.09-1.72), less number of ANC visits (adj. PR 1.41, 1.12-1.76), identified HIV during pregnancy (adj. PR 1.42, 1.13-1.77), non-disclosure of HIV status with one's partner (adj. PR 1.43, 1.11-1.83), no partner support (adj. PR 1.84, 1.31-2.59), and having a negative HIV status sexual partner (adj. PR 1.35, 1.02-1.79) were all significantly associated with depression. Factors such as lack of partner support (adj. PR 1.48, 1.09-1.99) and known HIV status during pregnancy (adj. PR 1.24, 1.01-1.52) were significantly associated with anxiety. Participants who had less ANC visits (adj. PR 1.50, 1.12-2.02), non-disclosure of HIV status with partner (adj. PR 1.47, 1.08-2.02), known HIV status during pregnancy (adj. PR 1.62, 1.23-2.15), negative HIV status of sexual partner (adj. PR 1.44, 1.02-2.02), and no partner's support (adj. PR 1.85, 1.25-2.74) were significantly associated with stress.

CONCLUSION

The study concludes that about one-third of the HIV-positive pregnant women reported anxiety, and more than half of the women were feeling stressed and depressed during COVID-19. Factors such as residence and primigravidae were linked with antenatal depression. Whereas variables like ANC visits, knowing HIV status during pregnancy, non-disclosure of HIV status, no partner's support, and sexual partner HIV negative status were associated with depression and stress. The anxiety symptoms are very high among women who are HIV positive during pregnancy, and not having a partner's support. Demographic, clinical, and support-related determinants and COVID-19 stressors of DAS provide insights for interventions to reduce the burden of mental health problems among HIV-positive pregnant women.

Burnout Among Service Providers for People Living with HIV: Factors Related to Coping and Resilience

Individuals who provide services for people living with HIV (PLWH) face numerous work-related challenges, including psychosocial and structural factors affecting the quality of care that they provide. Little is known about the factors that relate to burnout among service providers for PLWH. The current study seeks to examine the factors associated with burnout and the role of resilience and coping in the context of burnout. Via convenience sampling, data was collected from 28 professionals (e.g., peer counselors, HIV testers, case managers/case workers, group facilitators, or social workers) serving PLWH in the USA. Participants completed quantitative measures on sociodemographics, organizational factors, discrimination, trauma, depression, and burnout. A sub-sample of 19 participants provided in-depth qualitative data via semi-structured interviews on burnout, coping, and resilience as a buffer against the effects of burnout. Thematic content analysis revealed themes on the factors related to burnout (e.g., discrimination, limited financial and housing resources, and COVID-19), rejuvenating factors, coping with burnout, and intervention strategies. Additionally, Pearson's product moment correlations revealed significant associations between mental health variables such as depressive and posttraumatic stress disorder symptomology with (a) discrimination and microaggressions and (b) burnout. The current study highlights challenges to providing HIV care, including structural barriers and discrimination that are doubly impactful to the professionals in this sample who share identities with the PLWH whom they serve. These findings may inform the development of an intervention targeting burnout among individuals providing services to PLWH and motivate change to remove structural barriers and improve quality of care for PLWH.

Sera from people with HIV and depression induce commensurate metabolic alterations in astrocytes: toward precision diagnoses and therapies

Objectives

People with HIV (PWH) have high rates of depression and neurocognitive impairment (NCI) despite viral suppression on antiretroviral therapy (ART). Mounting evidence suggests that immunometabolic disruptions may contribute to these conditions in some PWH. We hypothesized that metabolic dysfunction in astrocytes is associated with depressive symptoms and cognitive function in PWH.

Methods

Human astrocytes were exposed to sera from PWH (n=40) with varying degrees of depressive symptomatology and cognitive function. MitoTrackerTM Deep Red FM (MT) was used to visualize mitochondrial activity and glial fibrillary acidic protein (GFAP) as an indicator of astrocyte reactivity using the high-throughput fluorescent microscopy and image analyses platform, CellInsight CX5 (CX5). The Seahorse platform was used to assess glycolytic and mitochondrial metabolism.

Results

More severe depression, as indexed by higher Beck's Depression Inventory (BDI-II) scores, was associated with lower MT signal measures. Better cognitive function, as assessed by neuropsychiatric testing t-scores, was associated with increased MT signal measures. GFAP intensity negatively correlated with several cognitive t-scores. Age positively correlated with (higher) MT signal measures and GFAP intensity. Worse depressive symptoms (higher BDI-II scores) were associated with decreased oxygen consumption rate and spare respiratory capacity, concomitant with increased extracellular acidification rate in astrocytes.

Conclusions

These findings show that factors in the sera of PWH alter mitochondrial activity in cultured human astrocytes, suggesting that mechanisms that alter mitochondrial and astrocyte homeostasis can be detected peripherally. Thus, in vitro cultures may provide a model to identify neuropathogenic mechanisms of depression or neurocognitive impairment in PWH and test personalized therapeutics for neurologic and psychiatric disorders.

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.

Depressive Symptoms among People Living with HIV Attending ART Centers of Lumbini Province, Nepal: A Cross-Sectional Study

Background

Depression is a common mental disorder and is a leading cause of disability globally. Depressive symptoms among people living with HIV can be a significant barrier to ART initiation and thus lead to poor ART adherence. Global studies have found the prevalence of depressive symptoms among people living with HIV ranges from 12 to 63%. The real scenario of Nepal still needs to be explored. Thus, this study aimed to identify the prevalence and predictors of depression in individuals with HIV.

Methods

An institutional-based cross-sectional study was carried out from August to December 2020 among 406 people living with HIV attending ART centers in Lumbini province. Participants were selected using a systematic random sampling technique and surveyed with a structured questionnaire consisting of sociodemographic variables, HIV AIDS-related variables, and 21 items Beck Depression Inventory tool. The odds ratio was used as the ultimate measure of association, with a 95% confidence interval computed to establish statistical significance. A multivariate regression analysis was carried out to identify the final predictors of depressive symptoms.

Results

The study found that 26.8% of the respondents had depressive symptoms. Those who were literate (AOR = 0.24, 95% CI: 0.10-0.61), in the poorest wealth quintile (AOR = 7.28, 95% CI: 2.22-23.87), initiated ART within 12 months (AOR = 1.88, 95% CI: 1.03-3.42), had CD4 cell counts below 200 (AOR = 2.50, 95% CI: 1.54-4.06), and had a time difference of 3 months or less between HIV diagnosis and ART initiation (AOR = 0.50, 95% CI: 0.29-0.86) were independently associated with depressive symptoms.

Conclusion

Routine screening for depressive symptoms should be integrated into national HIV prevention and control programs for people living with HIV. An enabling environment should be created to facilitate the rapid enrollment of individuals newly diagnosed with HIV in ART services, thereby reducing the time gap between HIV diagnosis and ART initiation.

Insomnia and common mental disorder among patients with pre-existing chronic non-communicable diseases in southern Ethiopia: a survey during COVID-19 pandemic

Background

COVID-19 has been causing significant mental health problems and other health-related issues. Despite the fact that COVID-19 has a significant impact on chronic disease patients, there is scant research on insomnia, common mental health disorders (CMD), and their associated factors among chronic disease patients.

Objective

The purpose of this study was to assess the prevalence of insomnia and common mental disorders (CMD) and their associated factors among patients with pre-existing chronic NCDs in Sidama, southern Ethiopia.

Methods

A multicenter cross-sectional study was undertaken between June 1 and September 1, 2021. The study included 633 participants. CMD and insomnia were assessed using a 20-item Self-Reported Questionnaire (SRQ-20) and a 7-item Insomnia Severity Index (ISI) scale, respectively. To describe the various variables, descriptive statistics were used. We performed multivariable logistic regression analysis to identify independent factors associated with CMD and insomnia. A value of p < 0.05 was considered statistically significant at a 95% confidence interval.

Results

The prevalence of insomnia and CMD was found to be 39.3% and 46.8%, respectively. Being merchant (AOR = 0.33; 95% CI = 0.13, 0.82), having a diagnosis of diabetes mellitus (AOR = 1.89; 95% CI = 1.04, 3.46), comorbid diagnosis (AOR = 3.96; 95% CI = 2.27, 6.89), low social support (poor (AOR = 3.37; 95% CI = 1.51, 7.57) and moderate (AOR = 3.13; 95% CI = 1.46, 6.69)), symptoms of insomnia (AOR = 12.08; 95% CI = 7.41, 19.72) and poor quality of life (QOL) (AOR = 1.67; 95% CI = 1.04, 2.72) were independent predictors of CMD. We also found out that, having cardiovascular disorders (CVDs) (AOR = 2.48; 95% CI = 1.18, 5.19), CMD (AOR = 12.09; 95% CI = 7.46, 19.61), and poor QOL (AOR = 2.04; 95% CI = 1.27, 3.26) were significantly associated with insomnia symptoms.

Conclusion

Our study suggests that substantially high prevalence of CMD and insomnia. Significant association between CMD and occupation, diagnosis, comorbidity, social support, insomnia, and QOL were found. We also revealed that having CVDs, CMD, and poor QOL were significantly associated with insomnia symptoms. Therefore, dealing with the mental health problems of patients with chronic NCDs is an essential component of public health intervention during the COVID-19 pandemic.

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population

PURPOSE

Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed.

FINDINGS

Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91-5.03), hypertension (aPR 7.20; 95% CI: 6.28-8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62-2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes.

ORIGINALITY/VALUE

The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.

Depression among People Living With HIV/AIDS Undergoing Antiretroviral Therapy at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

HIV affects mental health in multiple ways, including its direct pathophysiological effects, associated stigma, impacts on social, and economic dimensions, medications used for long durations and multiple secondary physical health issues that affect the clients and comorbid substance use. In the post-COVID era, in our socio-cultural and geographical context, depression among these populations needs assessment to evaluate their mental health care needs. The objective of this study was to find out the prevalence of depression among people living with HIV/AIDS undergoing antiretroviral therapy at a tertiary care centre.

Methods

This was a descriptive cross-sectional study conducted at a tertiary care centre from December 2021 to November 2022 after taking ethical approval from Institutional Review Committee (Reference number: 078/79-006) from the same institute. Convenience sampling method was used. Clients 18 years and above under antiretroviral therapy were included and those acutely medically ill were excluded. The PHQ-9 was used as a self-administered, valid, screening tool for the assessment of depressive symptoms. Point estimate and 95% Confidence Interval were calculated.

Results

Among 183 participants, the prevalence of depression was 19 (10.4%) (5.98-14.82, 95% Confidence Interval).

Conclusions

Depression was found higher among people living with HIV/AIDS as compared to the other studies done in similar settings. Assessment and timely management of depression could be an important step in improving lives and the effectiveness of HIV/AIDS intervention efforts, ultimately improving access to mental health care and universal health coverage.

Keywords

depression; HIV; prevalence.

The Mediating Effect of Changes in Depression Symptoms on the Relationship between Health-Related Quality of Life and Alcohol Consumption: Findings from a Longitudinal Study among Men Living with HIV in India

Heavy alcohol use is negatively affecting antiretroviral therapy adherence, mental health and health-related quality of life among people living with HIV (PLWH). This paper aims to test the mediation model examining whether changes in depression symptoms mediate in the relationship between health-related quality of life and alcohol use among male PLWH who consume alcohol in India. The study is guided by the stress-coping model, which posits that individuals facing stress may turn to maladaptive coping mechanisms such as alcohol use to alleviate their distress, which includes depression and a low health-related quality of life due to various physical, psychological, and social factors associated with the HIV infection. This study used the data from a randomized controlled clinical trial entitled 'Alcohol and ART adherence: Assessment, Intervention, and Modeling in India'. Participants completed surveys assessing demographic characteristics, health-related quality of life, depressive symptoms, and alcohol use. Multiple simple mediation models were investigated to examine whether changes in depression symptoms mediated the association between the changes in health-related quality of life and alcohol use after a 9-month follow-up. A total of 940 male PLWH were recruited and interviewed, with 564 participants in the intervention group and 376 participants in the control group. After a 9-month intervention, the mediation results showed that, among intervention participants, a decrease in depressiove symptoms mediated the relationship between improved health-related quality of life and lower alcohol use. However, among control participants, changes in depressive symptoms did not mediate the relationship between changes in health-related quality of life and alcohol use. The study findings have practical and theoretical implications. From a practical perspective, the results suggest that interventions aimed at simultaneously improving HRQoL and depressive symptoms among male PLWH with alcohol use may help reduce alcohol consumption. Therefore, interventions that address depressive symptoms in addition to improving HRQoL may have an even greater impact on reducing alcohol use among this population. Theoretically, the study supports the use of the stress-coping theory in understanding the association between HRQoL, mental health, and alcohol use among male PLWH, contributing to existing literature on a gap in our understanding of the interactions among these factors among PLWH.

Prevalence of and factors associated with depression among adult patients living with HIV/AIDs undergoing ART unit in Banadir hospital, Mogadishu Somalia

BACKGROUND

Depression is the most common psychiatric disorder in HIV/AIDs patients, and its prevalence is three times higher in HIV/AIDs patients. Globally, over 35 million people were living with HIV/AIDs, 24.7 million were in Sub-Saharan Africa. The study aims to estimate the prevalence and determine factors associated with depression among HIV/AIDs adult patients in the ART unit at Banadir Hospital Mogadishu, Somalia.

METHOD

A hospital-based cross-sectional study was conducted between 1 May and 1 July 2022. Samples were recruited from the HIV/AIDs adult patients attending in ART unit at Banadir Hospital, Mogadishu, Somalia. A validated research tool, including sociodemographic, behavioral, clinical, and psycho-social characteristics, three items social support scale, an 11-item HIV stigma scale, and patient health questions-9 (PHQ-9) were used. The interview was conducted privet room in the ART unit. Logistic regression was used to determine factors associated with depression at the significance level a = 0.050.

RESULT

The overall prevalence of depression among HIV/AIDs patients was 33.5% (95%CI = 28.1-39.0). In the multivariable logistic regression, three factors were associated with depression; the odds of depression were 3.415 times (95%CI=1.465-7.960) greater for those with poor social support than those with moderate-strong social support. Those with moderate and poor treatment adherence had 14.307 times (95%CI=5.361-38.182) greater odds of depression than those with good treatment adherence. Those who use substances had 3.422 times (95%CI=1.727-6.781) greater odds of having depression than those who did not.

CONCLUSION

People living with HIV in Mogadishu, Somalia, suffer from depression. The implementation to reduce depression should be focused on empowering social support, developing an appropriate approach to increase treatment adherence, and reducing or eliminating substance use.

Psychological distress among people living with chronic medical illness and the general population, Northwest Ethiopia: A comparative cross-sectional study

BACKGROUND

Psychological distress is often linked to and negatively affects the outcomes of chronic medical conditions; however, data on psychological distress and its predictors among individuals with chronic medical illnesses are scarce in developing countries like Ethiopia. The main objective of this study was to assess the magnitude and predictors of psychological distress among people living with chronic medical illness and the general population.

METHODS

A comparative cross-sectional study was conducted in Mecha demographic research center, Northwest Ethiopia. The participants were selected from the general population and outpatient departments. Kessler-10 (K-10) was used to assess psychological distress.

RESULT

The magnitude of psychological distress among people living with chronic medical illness and those from the general population was 62.0% and 35.1%, respectively. The odds of psychological distress in people living with chronic medical illness was three times more than the one in the general population. Divorced marital status, family history of chronic medical illness, and low social support were statistically significantly associated with psychological distress in both groups.

CONCLUSION

The magnitude of psychological distress was significantly higher among people living with chronic medical illness. Routine screening of such cases for psychological distress during their visits for their medical illness helps take appropriate therapeutic interventions.

Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region

Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.

Depressive symptoms among people living with HIV in permanent supportive housing: Findings from a community-based participatory study in Vancouver, Canada

Permanent supportive housing (PSH) is an intervention addressing housing needs among marginally housed individuals. Little is known about whether and how PSH influences depressive symptoms among people living with HIV (PLHIV). This article shares results from a community-based study that, in 2016-2017, interviewed 24 residents of a PSH facility designated for PLHIV in Vancouver, Canada. The themes of taking control; social connectedness; conviviality; and relationships and supports described how the PSH environment affected depressive symptoms among the residents.

The Role of Online Support Groups in Helping Individuals Affected by HIV and AIDS: Scoping Review of the Literature

BACKGROUND

Online support groups provide opportunities for individuals affected by HIV and AIDS to seek information, advice, and support from peers. However, whether and how engagement with online support groups helps individuals affected by HIV and AIDS remains unclear, as does the nature of the evidence on this topic.

OBJECTIVE

This scoping review sought to explore whether engagement with HIV and AIDS-related online support groups benefits members in terms of psychosocial well-being and illness management, whether members experienced any negative aspects of these groups, and what types of social support are exchanged within HIV and AIDS-related online support groups.

METHODS

A scoping review of English-language articles (including both qualitative and quantitative studies) was undertaken using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The databases searched included MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (Cochrane Register of Controlled Trials), and Scopus. Key findings were synthesized using a narrative and thematic approach.

RESULTS

A total of 22 papers met the inclusion criteria from an initial pool of 3332 abstracts. These papers included 23% (5/22) quantitative studies, 9% (2/22) mixed methods studies, and 68% (15/22) qualitative studies published between 2007 and 2019. Cross-sectional evidence suggests that engagement with HIV and AIDS-related online support groups is empowering for members and may lead to a range of psychosocial benefits. Furthermore, qualitative evidence suggests that these groups provide an opportunity to connect with similar people and share experiences. This can help improve self-worth, reduce stigma, facilitate improved illness management, and gain greater confidence when interacting with health professionals. However, online support groups are not without their limitations as qualitative evidence suggests that users may encounter examples of interpersonal conflict between members as well as be exposed to challenging content. Finally, HIV and AIDS-related online support groups are avenues through which individuals can solicit support, most commonly informational or emotional.

CONCLUSIONS

HIV and AIDS-related online support groups may have some benefits for members, particularly in terms of providing social support. There is a need for a systematic review of this literature that includes an assessment of the methodological quality of the available evidence.

Using Focus Group Feedback to Identify Patient-Centered Initiatives for Older Persons with HIV

Objectives: This study assessed how few community-based programs target older people living with HIV.Methods: We conducted four focus groups comprised of people 50 and older with HIV (N = 32; gay/bisexual men, heterosexual men, women, and Spanish-speakers) to inform HIV program development by exploring the services in which participants were actively involved, along with the services they wanted to receive.Results: Using inductive thematic qualitative analysis, four themes were identified pertaining to program development: (a) types of currently utilized HIV service organizations; (b) dissatisfaction with HIV programming and services; (c) participants' preferred programming, courses, groups, or activities; and (d) desire to serve as peer mentors.Conclusions: Results highlight the need for community-based organizations to address social engagement and isolation among older people living with HIV.Clinical implications: These findings exemplify the need for programs to be specifically designed for OPH, and created with the primary goals of socialization and helping develop social support networks.

Triple Burden of Neurocognitive Impairment and Co-occurring Depression and Anxiety Among People Living With HIV in Bahir Dar, Ethiopia: A Multicenter Study

Background

Neurocognitive impairment is associated with psychological morbidities, such as depression and anxiety, among people living with HIV. The presence of these comorbidities affects viral load suppression, treatment adherence, quality of life, treatment outcomes, and functionality. Despite this fact, there is a dearth of studies that examined the triple burden of neurocognitive impairment and co-occurring depression and anxiety among antiretroviral therapy attendees in Ethiopia. This study aimed to assess the magnitude of HIV-associated neurocognitive impairment and co-occurring depression and anxiety at the same time among people living with HIV/AIDS.

Method

We conducted an institution-based multicenter cross-sectional study in Bahir Dar, Northwest Ethiopia. A total of 410 study participants were selected using a systematic random sampling technique. Neurocognitive impairment was assessed using the International HIV Dementia Scale. Co-occurring depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. A semi-structured questionnaire was applied to collect data on sociodemographic and clinical-related characteristics. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression.

Results

Two-thirds (66.8%) of the people living with HIV had neurocognitive impairment. The prevalence of co-occurring depression and anxiety was found in 39.8%. Women with HIV, people with comorbid chronic medical illness, and those under a second-line treatment regimen were factors associated with neurocognitive impairment. Furthermore, pill burden, second-line treatment regimen, HIV clinical stages, social support, HIV-perceived stigma, and neurocognitive impairment were associated factors with co-occurring depression and anxiety.

Conclusions

We found a high prevalence of neurocognitive impairment and co-occurring depression and anxiety among people living with HIV/AIDs. Further research is needed to assess the clinical course of neurocognitive impairment and co-occurring depression and anxiety.

Association between Internalized Stigma and Depression among People Living with HIV in Thailand

Internalized stigma and depression are among the most common mental health problems in people living with HIV (PLHIV). This study aimed to examine the association between depression and overall internalized stigma, as well as different aspects of internalized stigma in PLHIV. The study included 400 PLHIV receiving care in Bangkok and Chiang Mai, Thailand. Data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation coefficients. The results indicated the PLHIV with mild depression had lower median scores for the social relationship internalized stigma subscale than PLHIV with major depressive disorder (p = 0.009). Total HIV internalized stigma scores were significantly correlated with PHQ-9 scores in the mild depression group (r = 0.327, p = 0.004). Depression and internalized stigma were prevalent and associated, especially in the area of social relationships. Health personnel should be aware of possible depression in PLHIV who have internalized stigma. Intervention to promote understanding and social support for PLHIV is warranted.

isiXhosa Translation of the Patient Health Questionnaire (PHQ-9): A Pilot Study of Psychometric Properties [Stage 1]

Depression is a debilitating illness, and stigma associated with it often prevents people from seeking support. Easy-to-administer and culturally-specific diagnostic tools can allow for early screening for depression in primary care clinics, especially in resource-limited settings. In this pilot study, we will produce the first open-access isiXhosa-language version of the nine-item Patient Health Questionnaire (PHQ-9), a well-validated measure of depression incidence and severity, using a transcultural translation framework. We will validate this isiXhosa PHQ-9 in a small sample of adolescents living with HIV in Cape Town, South Africa who speak isiXhosa at home. Participants have previously completed the ASEBA Youth Self Report (YSR) form, and responses from the YSR will be used as a gold standard to validate the isiXhosa PHQ-9. If validated through this Registered Report, this isiXhosa PHQ-9 may be an invaluable culturally-specific tool for clinicians serving Xhosa people in identifying clinical or sub-clinical depression.

Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study

Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions. Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships. Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety. Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.

HIV-Associated Apathy/Depression and Neurocognitive Impairments Reflect Persistent Dopamine Deficits

Individuals living with human immunodeficiency virus type 1 (HIV-1) are often plagued by debilitating neurocognitive impairments and affective alterations;the pathophysiology underlying these deficits likely includes dopaminergic system dysfunction. The present review utilized four interrelated aims to critically examine the evidence for dopaminergic alterations following HIV-1 viral protein exposure. First, basal dopamine (DA) values are dependent upon both brain region andexperimental approach (i.e., high-performance liquid chromatography, microdialysis or fast-scan cyclic voltammetry). Second, neurochemical measurements overwhelmingly support decreased DA concentrations following chronic HIV-1 viral protein exposure. Neurocognitive impairments, including alterations in pre-attentive processes and attention, as well as apathetic behaviors, provide an additional line of evidence for dopaminergic deficits in HIV-1. Third, to date, there is no compelling evidence that combination antiretroviral therapy (cART), the primary treatment regimen for HIV-1 seropositive individuals, has any direct pharmacological action on the dopaminergic system. Fourth, the infection of microglia by HIV-1 viral proteins may mechanistically underlie the dopamine deficit observed following chronic HIV-1 viral protein exposure. An inclusive and critical evaluation of the literature, therefore, supports the fundamental conclusion that long-term HIV-1 viral protein exposure leads to a decreased dopaminergic state, which continues to persist despite the advent of cART. Thus, effective treatment of HIV-1-associated apathy/depression and neurocognitive impairments must focus on strategies for rectifying decreases in dopamine function.

Prevalence of Depressive Symptoms and Its Associated Factors among People Living with HIV Attending Public Hospitals of Nekemte Town, Western Ethiopia, 2021

Background

Depressive symptoms are the most common mental illness among people living with HIV/AIDS. Depressive symptoms impact negatively on the course of HIV infection and can lead to suicide and increased risk of mortality when it is a severe form. Although depressive symptoms are common among HIV/AIDS patients, only a few studies have been conducted in Ethiopia and no study, particularly at Nekemte town public hospitals. Therefore, this study was aimed at assessing the prevalence and risk factors for depressive symptoms among people living with HIV/AIDS attending Nekemte town public hospitals, Western Ethiopia. Methods. An institution-based cross-sectional study design was conducted on 425 HIV/AIDS patients at Nekemte town public hospitals, from March 30 to May 30, 2019. Data were collected through interviews and patient document reviews. The nine-item Patient Health Questionnaire (PHQ-9) was used to collect information concerning depressive symptoms and was defined by a PHQ-9 score ≥ 5. HIV stigma and discrimination scales were used to measure stigma. Social support was described by a sum score of the Oslo3 social support scale (OSS-3). The collected data was entered into EpiData Windows version 4.1 and then exported to Statistical Package for the Social Sciences (SPSS) Windows version 24.0 for analysis. All variables found to be significant at the bivariable level (p value < 0.25) were entered into a multivariable logistic regression model. p values of <0.05 and 95% confidence level were used to determine statistical significance.

Results

Out of the total of 384 study participants who participated in the study, 165 (42.96%) had depressive symptoms. Self-reported sleeping problems (AOR = 7.04, 95% CI: 3.23, 15.33), CD4 level of <200 (AOR = 5.45, 95% CI: 2.06, 14.42), poor social support (AOR = 2.79, 95% CI: 1.17, 6.67), and perceived stigma (AOR = 9.11, 95% CI: 1.17, 17.33) were significantly associated with depressive symptoms among HIV/AIDS patients at Nekemte town public hospitals.

Conclusion

The level of depressive symptoms among HIV/AIDS patients in this study was high. Self-reported sleeping problems, CD4 level, social support, and perceived stigma were found to be significantly associated with depressive symptoms among HIV patients. Health care professionals should have to strengthen the linkage of mental health with antiretroviral therapy (ART) clinic to early detect and treat depressive symptoms.

Depressive symptoms among people with HIV/AIDS in Northwest Ethiopia: comparative study

OBJECTIVES

The objective of this study was to compare depressive symptoms among people with HIV/AIDS and the general population sample. We also assessed the factors associated with depressive symptoms.

DESIGN

A comparative cross-sectional study was conducted.

SETTINGS

Antiretroviral therapy clinics in three primary healthcare facilities and semi-urban area in Northwest Ethiopia.

PARTICIPANTS

A total of 1115 participants (558 people with HIV/AIDS and 557 comparison group) aged 18 years and above were recruited. A total of 1026 participants (530 people with HIV/AIDS and 496 comparison group) completed the interview. We excluded people with known HIV-positive status from the comparison group.

OUTCOME MEASURE

Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. The proportion of depressive symptoms was compared between samples of the general population and people with HIV/AIDS using χ2 statistics. Multivariable logistic regression analysis was done to examine the associated factors.

RESULTS

The overall prevalence of depressive symptoms was 13.3% (11.2%-15.4%). The prevalence was significantly higher in people with HIV/AIDS compared with the community sample (16.6% vs 12.3%), p=0.001. The difference was also significant in the multivariable logistic regression (OR 1.7). For the overall sample, depressive symptoms were significantly associated with older age, being single, divorced/widowed marital status, and poor social support.

CONCLUSIONS

Depressive symptoms were higher in people with HIV/AIDS compared with the general population. It is necessary to include mental healthcare and screening for depression in routine HIV/AIDS care.

Correlation between Beck Depression Inventory and World Health Organization Quality of Life-BREF Scores in Stage III of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients at Central Public Hospital of Pusyansus RSUP Haji Adam Malik Medan

Background: Depression is the psychiatric complication that mostly associated with HIV disease. For people in HIV positive infection stage, unstable and declining physical conditions followed by the appearance of physical symptoms and intense social pressure from the environment can be a source of stress that results in depression. After entering the stage of AIDS, depression is more susceptible to experience because of worsening health conditions. Furthermore, patients also often feel that their life will be not long so that everything that happen in his or her life will be in vain which will have an impact on their quality of life. Objective: To determine the correlation between Beck Depression Inventory (BDI) II and World Health Organization Quality of Life (WHOQOL-BREF) scores in stage III of HIV / AIDS patients at Pusyansus RSUP Haji Adam Malik Medan. Methods:This study is a cross-sectional study using a correlative analytic design, which was conducted at the Pusyansus Haji Adam Malik Hospital Medan, North Sumatra from May 2019 to November 2019. The research subjects were 65 people diagnosed with HIV / AIDS stage III. The degree of depression was measured based on the Beck Depression Inventory (BDI) II and the quality of life was measured based on the World Health Organization Quality of Life (WHOQOL-BREF). Conclusion: There is a significant correlation between Beck Depression Inventory (BDI) II score and World Health Organization Quality of Life (WHOQOL-BREF) score in HIV / AIDS patients stage III at the RSUP Haji Adam Malik Medan Hospital.

Chronic SSRI treatment reverses HIV-1 protein-mediated synaptodendritic damage

HIV-1 infection affects approximately 37 million individuals, and approximately 50% of seropositive individuals will develop symptoms of clinical depression and/or apathy. Dysfunctions of both serotonergic and dopaminergic neurotransmission have been implicated in the pathogenesis of motivational alterations. The present study evaluated the efficacy of a SSRI (escitalopram) in the HIV-1 transgenic (Tg) rat. Behavioral, neurochemical, and neuroanatomical outcomes with respect to HIV-1 and sex were evaluated to determine the efficacy of chronic escitalopram treatment. Escitalopram treatment restored function in each of the behavioral tasks that were sensitive to HIV-1-induced impairments. Further, escitalopram treatment restored HIV-1-mediated synaptodendritic damage in the nucleus accumbens; treatment with escitalopram significantly increased dendritic proliferation in HIV-1 Tg rats. However, restoration did not consistently occur with the neurochemical analysis in the HIV-1 rat. Taken together, these results suggest a role for SSRI therapies in repairing long-term HIV-1 protein-mediated neuronal damage and restoring function.

The Cost Effectiveness of Mental Health Treatment in the Lifetime of Older Adults with HIV in New York City: A Markov Approach

BACKGROUND

There are noticeable gaps in knowledge regarding the cost and effectiveness of integrated medical and behavioral services for older adults with HIV. Their lifespan is close to the population's level but their quality of life has sharply declined due to depression and substance use. Mental health disorders are widespread among an aging population with HIV.

OBJECTIVE

The aim of this study was to build a decision analytic model to evaluate medical interventions with and without mental health treatment using primary data of 139 older adults with HIV and health outcomes from the literature.

METHODS

We tracked the progression of depression and cumulative deaths among older adults with HIV using a Markov model with 50 annual cycles through three health states. Deterministic and probabilistic sensitivity analyses addressed uncertainty in estimating the parameters and around the model's assumptions.

RESULTS

An integrated medical and behavioral care system is cost effective at a willingness to pay of $50,000 per QALY compared with medical care only. The incremental cost was $516,452 and the incremental effectiveness was 38.8 quality-adjusted life-years (QALY), with an incremental cost-effectiveness ratio of $13,316 per QALY.

CONCLUSIONS

Appropriate and efficacious referrals to integrated medical + behavioral services, either in the same facility or connected to their primary care doctor, are instrumental to reverse loses in quality of life and avoid premature death. If mental health is left unattended, HIV would progress, causing declines in quality of life and ultimately triggering premature death. Reliable data on the cost and effectiveness of different types of HIV integrated services are needed.

Considering the Impact of Aging When Caring For and Treating Adults With HIV

The current study investigates how age impacts factors associated with successfully managing HIV. One hundred thirty adults with HIV were recruited for the study. Participants were divided into two groups, those age ≥50 and those age <50. Cognitive impairment and depressive symptoms were seen at higher rates in older adults, and the severity of depressive symptoms was also higher in older adults. Depressive symptoms impacted cognitive function to a higher degree in older adults compared to younger adults (r = -0.293, p = 0.018 vs. r = -0.109, p = 0.387). Polypharmacy was a greater concern in older adults, with 88% having polypharmacy compared with 60% of younger adults. Similarly, the prevalence of comorbidities was more than double in older adults compared to younger adults. Factors associated with aging complicate management of HIV. Gaining insight into the challenges of caring for this population will furnish nurses with information necessary to provide the best possible care for this growing population. [Journal of Gerontological Nursing, 46(4), 31-40.].

Cultural and linguistic adaptation of the multi-dimensional OXCAP-MH for outcome measurement of mental health among people living with HIV/AIDS in Uganda: the Luganda version

BACKGROUND

It is rare to find HIV/AIDS care providers in sub-Saharan Africa routinely providing mental health services, yet 8-30% of the people living with HIV have depression. In an ongoing trial to assess integration of collaborative care of depression into routine HIV services in Uganda, we will assess quality of life using the standard EQ-5D-5L, and the capability-based OxCAP-MH which has never been adapted nor used in a low-income setting. We present the results of the translation and validation process for cultural and linguistic appropriateness of the OxCAP-MH tool for people living with HIV/AIDS and depression in Uganda.

METHODS

The translation process used the Concept Elaboration document, the source English version of OxCAP-MH, and the Back-Translation Review template as provided during the user registration process of the OxCAP-MH, and adhered to the Translation and Linguistic Validation process of the OxCAP-MH, which was developed following the international principles of good practice for translation as per the International Society for Pharmacoeconomics and Outcomes Research's standards.

RESULTS

The final official Luganda version of the OxCAP-MH was obtained following a systematic iterative process, and is equivalent to the English version in content, but key concepts were translated to ensure cultural acceptability, feasibility and comprehension by Luganda-speaking people.

CONCLUSION

The newly developed Luganda version of the OxCAP-MH can be used both as an alternative or as an addition to health-related quality of life patient-reported outcome measures in research about people living with HIV with comorbid depression, as well as more broadly for mental health research.

Cognitive Performance and Neuro-Metabolites in HIV Using 3T Magnetic Resonance Spectroscopy: A Cross-Sectional Study from India

BACKGROUND

Cognitive impairment in patients with human immunodeficiency virus (HIV) is associated with higher morbidity. The prevalence of the metabolite changes in the brain associated with cognitive impairment in anti-retroviral therapy naïve patients with HIV is unknown.

OBJECTIVE

To estimate the prevalence of the neurometabolites associated with cognitive impairment in antiretroviral therapy (ART) naïve patients with HIV.

METHODS

We conducted a cross-sectional study among ART naïve patients with HIV aged 18-50 years in a tertiary care center in India. Cognition was tested using the Post Graduate Institute battery of brain dysfunction across five domains; memory, attention-information processing, abstraction executive, complex perceptual, and simple motor skills. We assessed the total N-acetyl aspartyl (tNAA), creatine (tCr) and glutamate + glutamine (Glx) using 3T magnetic resonance spectroscopy. Cognitive impairment was defined as an impairment in ≥2 domains.

RESULTS

Among 43 patients eligible for this study, the median age was 32 years (IQR 29, 40) and 30% were women. Median CD4 count and viral load were 317 cells/μL (IQR 157, 456) and 9.3 copies/ μL (IQR 1.4, 38), respectively. Impairment in at least one cognitive domain was present in 32 patients (74.4%). Impairment in simple motor skills and memory was present in 46.5% and 44% of patients, respectively. Cognitive impairment, defined by impairment in ≥2 domains, was found in 22 (51.2%) patients. There was a trend towards higher concentration of tNAA (7.3 vs. 7.0 mmol/kg), tGlx (9.1 vs. 8.2 mmol/kg), and tCr (5.5 vs. 5.2 mmol/kg) in the frontal lobe of patients with cognitive impairment vs. without cognitive impairment but it did not reach statistical significance (p>0.05 for all). There was no difference in the concentration of these metabolites in the two groups in the basal ganglia.

CONCLUSION

There is a high prevalence of cognitive impairment in ART naïve patients with HIV. There is no difference in metabolites in patients with or without cognitive impairment. Further studies, with longitudinal follow-up are required to understand the underlying pathophysiological mechanisms.

HIV Infection and Related Mental Disorders

Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.

Prevalence and Associated Factors of Depression among Patients with HIV/AIDS in Lahore, Pakistan: Cross-Sectional Study

Background

Depression is defined as a psychiatric disorder characterized by depressed mood, lack of concentration, diminished energy, disturbed sleep, and low self-esteem. Depression is more prevalent in HIV/AIDS patients than the general population. There is no published study available that reveals the present status of depression among HIV patients in Pakistan. As such, the present study was conducted to determine the prevalence and associated factors of depression among HIV/AIDS patients attending the HIV clinic of Jinnah Hospital, Lahore, Pakistan.

Methods

A hospital-based cross-sectional study was carried out from February to March 2019 in Lahore. Data were collected from 158 HIV/AIDS patients using a pretested, standardized, structured interviewer-administered questionnaire. Nonprobability convenience sampling was used to recruit the study participants. Depression was evaluated using the Patient Health Questionnaire. SPSS version 23 was used to analyze the data. Binary logistic regression models were used to determine the various factors associated with depression. AORs with 95% CIs were used to assess the magnitude of associations between depression and associated factors.

Results

The mean age of the study participants was 35.03 years±9.123. Prevalence of depression among HIV/AIDS patients was 32.2%. Living in a rural area (AOR 5.60, 95% CI 2.20, 14.15), fear of stigma and discrimination (AOR 3.505, 95% CI 1.364, 9.008), having worked abroad (AOR 3.017, 95% CI 1.134, 8.031), and history of substance abuse (AOR 4.147, 95% CI 1.673, 10.28) were significantly associated with depression.

Conclusion

The prevalence of depression among HIV/AIDS patients is very high in Pakistan. Therefore, it is suggested that guidelines formulated to screen and treat depression among HIV patients.

Integration of mental health services into HIV healthcare facilities among Thai adolescents and young adults living with HIV

Introduction

To assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV).

Methods

A multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age‐ and sex‐matched HIV‐uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9‐item (PHQ‐9) and Generalized Anxiety Disorder 7‐item scales (GAD‐7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ‐9 ≥9), significant anxiety symptoms (GAD‐7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow‐up assessment with PHQ‐9 and GAD‐7 was performed one year after psychiatric referral.

Results

From February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm³. At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co‐existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores (p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist‐confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post‐traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score.

Conclusions

With the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.

A Systematic Review and Meta-Analysis on Depression and Associated Factors among Adult HIV/AIDS-Positive Patients Attending ART Clinics of Ethiopia: 2021

INTRODUCTION

Depression is the most common mental health problem in people living with the human immune virus. It ranges from 11% to 63% in low- and middle-income countries. Depression was high in people living with HIV/AIDS in developing countries, especially in the Ethiopian context. Even though depression has negative consequences on HIV-positive patients, the care given for depression in resource-limited countries like Ethiopia is below the standard in their HIV care programs.

METHOD

International databases (Google Scholar, PubMed, Hinari, Embase, and Scopus) and Ethiopian university repository online have been covered in this review. Data were extracted using Microsoft Excel and analyzed by using the Stata version 14 software program. We detected the heterogeneity between studies using the I ² test. We checked publication bias using a funnel plot test.

RESULTS

The overall pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was 36.3% (95% CI: 28.4%, 44.2%) based on the random effect analysis. Adult HIV/AIDS patients having CD4count < 200(AOR = 5.1; 95% CI: 2.89, 8.99), widowed marital status (AOR = 3.7; 95% CI: 2.394, 5.789), medication nonadherence (AOR = 2.3; 95% CI: 1.63, 3.15), poor social support (2.986) (95% CI: 2.139, 4.169), perceived social stigma (2.938) (2.305, 3.743), opportunistic infections (3.010) (2.182, 4.151), and adverse drug reactions (4.013) (1.971, 8.167) were significantly associated with depression among adult HIV/AIDS patients on antiretroviral therapy, in Ethiopia. Conclusion and Recommendation. The pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was higher than the general population and is alarming for the government to take special consideration for HIV-positive patients. Depression assessment for all HIV-positive patients and integrating with mental health should be incorporated to ensure early detection, prevention, and treatment. Community-based and longitudinal study designs mainly focusing on the incidence and determinants of depression among adult HIV/AIDS patients should be done in the future.

Prevalence and Factors Associated with Depression among HIV/AIDS-Infected Patients Attending ART Clinic at Jimma University Medical Center, Jimma, Southwest Ethiopia

Background

HIV is a chronic life-threatening illness and, like other similar chronic and stigmatizing illnesses, can be stressful to manage. Depression is a common mental health problem that deteriorates the quality of life of people with HIV/AIDS and found to be a strong predictor for noncompliance to antiretroviral therapy treatment. Therefore, epidemiological evidence on the factors associated with depression among patients with HIV/AIDS can contribute towards effective and efficient preventive health care strategies for this population.

Objectives

To assess the prevalence and factors associated with depression among HIV/AIDS-infected patients attending ART clinic at Jimma University Medical Center, Jimma, Southwest Ethiopia, in 2018.

Methods

This study followed an institution-based cross-sectional quantitative study design. A simple random sampling method yielded 303 participants who were interviewed from April to May 2018, using a pretested questionnaire, followed by their card review. The SPSS version 23 was used for bivariate analysis which was used to find out the significance of association. Variables that showed association in bivariate analysis at p value < 0.25 were entered to multivariable logistic regressions to control for confounders, and the significance of association was determined by 95% confidence interval and p value < 0.05.

Results

The point prevalence of depression was 94 (31%). Variables like sex (AOR = 0.510 (95%CI = 0.264‐0.986)), marital status (AOR = 3.610 (95%CI = 1.649‐7.901)), opportunistic infection (AOR = 3.122 (95%CI = 1.700‐5.733)), and medication adherence (AOR = 0.470 (95%CI = 0.266‐0.831)) were significantly associated with depression. Conclusion and Recommendation. From the findings of this study, it is possible to conclude that depression was highly prevalent among people living with HIV/ADS. Sex, marital status, opportunistic infection, and medication adherence were found to be associated with depression and need attention from the health professional working in the ART clinic.

Quality of sleep and associated factors among people living with HIV/AIDS attending ART clinic at Hawassa University comprehensive specialized Hospital, Hawassa, SNNPR, Ethiopia

BACKGROUND

Sleep is a natural, restorative, physiological process that is characterized by perceptual disengagement from and unresponsiveness to whatever going around, which is reversible. Sleep quality refers to a sense of being rested and refreshed after waking up from sleep. People living with HIV/AIDS (PLWHA) are vulnerable to poor sleep quality as they suffer from social stigma and Anti-Retroviral drug side effects. The study aimed to examine the quality of sleep and its associated factors among people living with HIV/AIDS attending Anti-Retroviral Therapy (ART) clinic at Hawassa University comprehensive specialized hospital.

METHOD

Institutional based cross-sectional study was conducted among PLWHA attending ART clinic at Hawassa University comprehensive specialized hospital from May 1-30, 2019. A systematic random sampling technique was used to select an estimated 422 study participants and data was collected using interviewer-administered technique. Sleep Quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Data were entered and analyzed using SPSS 22 software. Bivariable and multivariable logistic regression model was fitted to identify factors associated with quality of sleep. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance with P-value less than 0.05.

RESULT

Out of 422 respondents, 389 participated in the study giving a response rate of 92.1%. The prevalence of poor quality of sleep among study participants was found to be 57.6% (95% CI: 54.72, 60.48). 31.9% (124) and 30.6% (119) of study participants had anxiety and depression respectively. Being between the age of 55-64 years (AOR = 5.7, 95% CI (1.9, 17.8), Age ≥ 65 (AOR:6.6, 95% CI (1.2, 36.9), Monthly income <1656 Ethiopian Birr (ETB) (AOR = 2.17, 95% CI (1.06, 4.4), having anxiety (AOR = 4.4, 95% CI (2.12, 9.2), having depression (AOR = 4.97, 95% CI (2.28, 10) and poor social support (AOR = 2.9, 95% CI (1.16, 7.3) were factors associated with poor quality of sleep.

CONCLUSION

The prevalence of poor quality of sleep among PLWHA was significantly high. Average monthly income, age, anxiety, depression, and social support were found to be significantly associated with poor sleep quality. Health care professionals working at the ART clinic need to assess the sleep pattern of ART clients, give psychoeducation on the prevention and management of sleep pattern problems.

Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia

BACKGROUND

Suicidal behavior is a prevalent psychiatric emergency in HIV-infected adults. Detection of suicidal ideation is important in planning early psychiatric intervention and optimizing HIV/AIDS management. Characterization of suicidal ideation among HIV-infected adults is crucial; however, practically there is no data in Indonesia, the country with the second largest burden of HIV/AIDS epidemic in Asia. This study aims to identify suicidal ideation and analyze the associated psychopathology and determining factors among HIV-infected adults in Indonesia.

METHODS

An observational cross-sectional study was conducted among HIV-infected adults aged 18-65 years old receiving antiretroviral therapy (ART). Measurement using Symptom Checklist-90 (SCL-90) was performed to assess the existing psychopathology. Firth's penalized logistic regression analysis was performed to identify factors associated with suicidal ideation.

RESULTS

A total of 86 subjects were recruited. Most subjects were male (65.1%), median age was 35 years, and median latest CD4 count was 463 cells/μl. Lifetime suicidal ideation was identified in 20 subjects (23.3%). Mean SCL-90 T-score for depressive and anxiety symptoms were both significantly higher among subjects with suicidal ideation (M = 60.75, SD = 12.0, p = 0.000 and M = 57.9, SD = 2.8, p = 0.001, respectively) compared to those without. Bivariate analyses showed that lifetime suicidal ideation was associated with depressive and anxiety symptoms, non-marital status, CD4 count < 500 cells/μl, and efavirenz use. Multivariate analysis identified that a single-point increase in SCL-90 depression symptoms score (AOR 1.16, 95% CI 4.5-123.6, p = 0.000) and efavirenz use (AOR 5.00, 95% CI 1.02-24.6, p = 0.048) were significant independent factors related to suicidal ideation.

CONCLUSION

Suicidal ideation is commonly found among Indonesian HIV-infected adults on ART. Depressive symptoms and efavirenz use are independent factors related to the presence of suicidal ideation. Thus, early screening of psychopathology as well as substitution of efavirenz with other ART regiment are recommended to prevent suicide and improve HIV/AIDS management outcome.

The Effects of Acceptance and Commitment Therapy (ACT) on Depression in TB-HIV Co-infection Patients

Introduction: The most common psychological problem in TB-HIV coinfection patients is depression. Acceptance and Commitment Therapy (ACT) is an intervention that encourages participants to change their relationships with their thoughts and physical sensations through mechanisms of acceptance and value-based action. This present study has been carried out to investigate the effectiveness of ACT in treating TB-HIV coinfection patients.Methods: This research was a quasi-experiment. This study involved 62 respondents diagnosed TB-HIV coinfection by doctor, experienced mild depression to severe depression, able to communicate well and have not hearing loss. ACT was given by a researcher with six sessions) one session per day) held in the intervention group. Data were collected using Beck Depression Inventory (BDI) questionnaires. Data analysis use paired t-test   to determine the differences in value of depression on pre-test and post-test in each group. Data were analyzed using the independent t-test to determine the effect of ACT on depression.Results: The majority of respondents were male (66.1%). Most of the early adult and older adult respondents had moderate depression, while middle-aged adult mostly had severe depression (50%). The fully unemployed respondents had severe depression (100%). The analysis results showed that there was a more significant decrease in depression in the intervention group given ACT compared to the control group (p value =0.00).Conclusion: ACT has an effect on reduce depression of TB-HIV coinfection patients. ACT is recommended to be developed as a nursing intervention that can be given to patients who are depressed.

HIV and Depression: Examining Medical Students Clinical Skills

Major depression is a prevalent psychiatric disorder among people living with HIV (PWH). Major depression symptoms, including suicidal ideation, can hinder clinical care engagement and anti-retroviral treatment adherence. Research suggests that inquiry about major depression symptomatology and suicidal ideation should be standard practice when offering primary care services to PWH. However, studies examining depression and suicidal ideation inquiry are scarce. This study's aim was to describe medical students' clinical skills for dealing with major depression symptomatology and suicidal ideation among PWH in Puerto Rico. A total of 100 4th year medical students participated in a Standardized Patient simulation with a trained actor posing as a PWH and with a previous major depression diagnosis. One-way frequency tables were used to characterize the sample and the percentage of each observed clinical skill. Two key findings stem from these results only 10% of the participants referred the patient to psychological/psychiatric treatment, and only 32% inquired about suicidal ideation. Our findings highlight the need for enhancing medical students' competencies regarding mental health issues, particularly when providing services to at risk populations such as PWH within primary care settings.

Barriers to implementing clinical trials on nonpharmacological treatments in developing countries: lessons learnt from addressing pain in HIV

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Pain affects over half of the people living with HIV/AIDS (LWHA), and pharmacological treatment has limited efficacy. Preliminary evidence supports nonpharmacological interventions. We previously piloted a multimodal intervention in amaXhosa women LWHA and chronic pain in South Africa with improvements seen in all outcomes, in both intervention and control groups. A multicentre, single-blind randomised controlled trial with 160 participants recruited was conducted to determine whether the multimodal peer-led intervention reduced pain in different populations of both male and female South Africans LWHA. Participants were followed up at weeks 4, 8, 12, 24, and 48 to evaluate effects on the primary outcome of pain, and on depression, self-efficacy, and health-related quality of life. We were unable to assess the efficacy of the intervention due to a 58% loss to follow-up (LTFU). Secondary analysis of the LTFU found that sociocultural factors were not predictive of LTFU. Depression, however, did associate with LTFU, with greater severity of depressive symptoms predicting LTFU at week 8 (P = 0.01). We were unable to evaluate the effectiveness of the intervention due to the high LTFU and the risk of retention bias. The different sociocultural context in South Africa may warrant a different approach to interventions for pain in HIV compared with resource-rich countries, including a concurrent strategy to address barriers to health care service delivery. We suggest that assessment of pain and depression need to occur simultaneously in those with pain in HIV. We suggest investigation of the effect of social inclusion on pain and depression.

Chronic Disease Self-Management Challenges among Rural Women Living with HIV/AIDS in Prakasam, Andhra Pradesh, India: A Qualitative Study

Rural women living with HIV/AIDS (WLHA) in India experience challenges self-managing HIV/AIDS in their rural communities. The purpose of this qualitative study was to explore factors influencing their care and antiretroviral treatment (ART) adherence. Themes that emerged from the qualitative focus groups among WLHA (N = 24) in rural Prakasam, Andhra Pradesh, India, included: (1) coming to know about HIV and other health conditions, (2) experiences being on ART, (3) challenges maintaining a nutritious diet, (4) factors affecting health care access and quality, and (5) seeking support for a better future. Chronic disease self-management in rural locales is challenging, given the number of barriers which rural women experience on a daily basis. These findings suggest a need for individual- and structural-level supports that will aid in assisting rural WLHA to self-manage HIV/AIDS as a chronic illness.

Factors associated with hostility among people living with HIV/AIDS in Northeast China: a cross-sectional study

Background

Hostility can result in negative outcomes in people living with HIV/AIDS (PLWHA); however, previous research on this topic is far from adequate. To contribute to existing knowledge on this aspect of PLWHA, the current study examined the prevalence of hostility and its potential influencing factors among PLWHA.

Methods

A cross-sectional questionnaire survey was undertaken on 218 HIV patients in Heilongjiang Province of China between March and August in 2013. A multiple logistic regression analysis was performed to identify factors associated with hostility.

Results

The prevalence of hostility was 17.0% among the participants. The three most alarming types of hostility included desiring to kill the person who infected them, blaming the infection on the society, and abandoning themselves to despair. A multiple logistic regression model identified that depression (OR = 3.845, 95% CI = 1.309–9.229), perceived stigma (OR = 3.281, 95% CI = 1.109–7.711), and fear of dying (OR = 2.710, 95% CI = 1.068–6.881) were the risk factors for hostility, while higher levels of trust-in-doctor (OR = 0.176, 95% CI = 0.060–0.517) and per capita household income (OR = 0.344, 95% CI = 0.119–0.991) were protective factors.

Conclusions

Our findings highlight the prominent influence of psychological, healthcare, and social factors on hostility among PLWHA. Interventions specifically targeted to reduce hostility should be provided, including incorporating psychological service into HIV management guidelines, enhancing PLWHA’s trust-in-doctor, establishing comprehensive services for PLWHA, reducing the social stigma against PLWHA, and paying more attention to PLWHA with financial problems. These interventions may improve the management and control of HIV/AIDS.

Selective monoaminergic and histaminergic circuit dysregulation following long-term HIV-1 protein exposure

Between 30 and 60% of HIV-seropositive individuals develop symptoms of clinical depression and/or apathy. Dopamine and serotonin are associated with motivational alterations; however, histamine is less well studied. In the present study, we used fast-scan cyclic voltammetry in HIV-1 transgenic (Tg) rats to simultaneously analyze the kinetics of nucleus accumbens dopamine (DA), prefrontal cortical serotonin (5-HT), and hypothalamic histamine (HA). For voltammetry, subjects were 15 HIV-1 Tg (7 male, 8 female) and 20 F344/N (11 male, 9 female) adult rats. Both serotonergic and dopaminergic release and reuptake kinetics were decreased in HIV-1 Tg animals relative to controls. In contrast, rates of histamine release and reuptake increased in HIV-1 Tg rats. Additionally, we used immunohistochemical (IHC) methods to identify histaminergic neurons in the tuberomammillary nucleus (TMN) of the hypothalamus. For IHC, subjects were 9 HIV-1 Tg (5 male, 4 female) and 9 F344/N (5 male, 4 female) adult rats. Although the total number of TMN histaminergic cells did not differ between HIV-1 Tg rats and F344/N controls, a significant sex effect was found, with females having an increased number of histaminergic neurons, relative to males. Collectively, these findings illustrate neurochemical alterations that potentially underlie or exacerbate the pathogenesis of clinical depression and/or apathy in HIV-1.

Mental health and HIV/AIDS: the need for an integrated response

Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.

Escitalopram population pharmacokinetics in people living with human immunodeficiency virus and in the psychiatric population: Drug-drug interactions and probability of target attainment

AIMS

The aims of this study were to characterize escitalopram pharmacokinetic profile, to identify factors influencing drug exposure, notably drug-drug interactions with antiretrovirals, and to simulate expected exposure under standard dosage regimen.

METHODS

A population pharmacokinetic analysis was performed using NONMEM. A total of 159 plasma concentration measurements were obtained from 39 human immunodeficiency virus (HIV)-infected and 71 uninfected psychiatric patients. The influence of age, weight, sex, HIV and psychiatric cohorts, racemic citalopram treatment, and comedications on oral clearance was examined. Simulations served to calculate the percentage of patients expected to be under- or over-exposed, considering established therapeutic targets (15-80 ng/mL).

RESULTS

A 1-compartment model with first-order absorption and elimination described the data adequately. The average escitalopram clearance and volume of distribution were 23.1 L/h (interindividual variability 51%), and 920 L, respectively. Escitalopram disposition did not differ between HIV-infected and uninfected patients, and was not affected by antiretroviral treatments. Coadministration of at least 1 proton-pump inhibitor (CYP2C19 inhibitor) modestly influenced escitalopram elimination (clearance decreased by 19%), with limited clinical relevance. Model-based simulations showed that, under a standard regimen of 10 mg once daily, a significant proportion of patients (56%) might be under-exposed.

CONCLUSION

The variability in escitalopram disposition is large and poorly explained by demographic, clinical and environmental covariates, thus suggesting a role for dosage individualization based on therapeutic drug monitoring in case of poor clinical response. Escitalopram disposition is modestly impacted by comedications and therefore no a priori dosage adjustments are needed in patients receiving antiretroviral treatments, including boosted regimens.

Depression Among Alcohol Consuming, HIV Positive Men on ART Treatment in India

Depression, as well as other psychosocial factors, remains largely unaddressed among people living with HIV (PLHIV) in low and middle-income countries. Depression is a common occurrence among PLHIV and is elevated in those who consume alcohol. This paper will document the presence of depressive symptoms in alcohol-consuming male PLHIV receiving antiretroviral treatment (ART) in India. It examines the correlates of depressive symptoms and uses the data from in-depth interviews to explain the nature of the statistical relationships obtained from an NIH-funded a multilevel, multi-centric intervention study. A cross-sectional, baseline survey was administered to 940 alcohol consuming, male PLHIV in five hospital-based ART Centers in urban Maharashtra, India via face to face interviews from October 2015 to April 2016. An additional 55 men were recruited independently to engage in in-depth interviews on alcohol use and other factors related to adherence. The results of the survey showed that approximately 38% of PLHIV reported having moderate to severe depressive symptoms. Depressive symptoms were positively associated with higher levels of family-related concerns (OR 1.18; 95% CI 1.12-1.23), work difficulties (OR 2.04; 95% CI 1.69-2.69) and HIV-related self-stigma (OR 1.05; 95% CI 1.03-1.07) and a lower level of ART service satisfaction (OR 0.58 95% CI 0.44-0.77). The results of in-depth interviews showed that PLHIV's tenshun (a Hindi term most closely corresponding to depressive symptoms) resulted from feelings of guilt and concerns about how family, friends, and neighbors might react to their HIV status and the potential for loss of a job as a result of disclosure of their HIV status at work. The level of depressive symptoms among male PLHIV involved in ART treatment points to the need to strengthen the psychological component of PLHIV treatment in India.

The prevalence and patterns of substance use by birth cohort among HIV-positive adults in Florida

OBJECTIVES

Antiretroviral therapy is affording longer lifespans for people living with HIV (PLWH), yet factors such as substance use play an increasing role in morbidity and mortality in this population. Though previous studies have examined substance use differences between age cohorts of PLWH, no study has examined the influence of birth cohort on current substance use patterns. Thus, this study investigated the prevalence of past 12-month self-reported substance use between four birth cohorts, <1970 (M age = 54.1), 1970s (M age = 41.5), 1980s (M age = 31.3 years old), and 1990s (M age = 23.2 years old) of PLWH in Florida.

METHODS

PLWH (N = 934) recruited from community health clinics in Florida completed a questionnaire assessing sociodemographics, health status, and substance use. Multivariate logistic regressions utilizing the <1970 cohort as the referent group examined the relationship between birth cohort and substance use.

RESULTS

The 1980s cohort had significantly greater odds of marijuana use compared to the oldest cohort (<1970s), while the three younger cohorts (1970s, 1980s, and 1990s) evidenced a significantly greater odds of ecstasy use compared to the oldest group. Contrastingly, the three younger birth cohorts reported significantly less crack use than the oldest cohort, while the youngest group (1990s) also demonstrated an 80% reduction in injection drug use compared to the oldest group.

CONCLUSION

The older cohort evidenced significantly greater crack and injection drug use, while the younger cohorts evidenced greater marijuana and ecstasy use. Therefore, it is important to develop age-specific substance use interventions among PLWH.

Optimal metrics for identifying long term patterns of depression in older HIV-infected and HIV-uninfected men who have sex with men

OBJECTIVES

Center of Epidemiologic Studies-Depression Scale (CES-D) provides a snapshot of symptom severity at a single point in time. However, the best way of using CES-D to classify long-term depression is unclear.

METHOD

To identify long-term depression among HIV-infected and HIV-uninfected 50+ year-old men who have sex with men (MSM) with at least 5 years of follow-up, we compared sensitivities and specificities of CES-D-based metrics (baseline CES-D; four consecutive CES-Ds; group-based trajectory models) thresholded at 16 and 20 to a clinician's evaluation of depression phenotype based on all available data including CES-D history, depression treatment history, drug use history, HIV disease factors, and demographic characteristics.

RESULTS

A positive depressive phenotype prevalence was common among HIV-infected (prevalence = 33.1%) and HIV-uninfected MSM (prevalence = 23.2%). Compared to the depressive phenotype, trajectory models of CES-D≥20 provided highest specificities among HIV-infected (specificity = 99.9%, 95% Confidence Interval [CI]:99.4%-100.0%) and HIV-uninfected MSM (specificity = 99.0%, 95% CI:97.4%-99.7%). Highest sensitivities resulted from classifying baseline CES-D ≥ 16 among HIV-infected MSM (sensitivity = 75.0%, 95% CI:67.3%-81.7%) and four consecutive CES-Ds ≥ 16 among HIV-uninfected MSM (sensitivity = 81.0%, 95% CI:73.7%-87.0%).

CONCLUSION

Choice of method should vary, depending on importance of false positive or negative rate for long-term depression in HIV-infected and HIV-uninfected MSM.

Two-third of inmates were depressed among HIV positive prisoners at central prison (Kaliti), Addis Ababa, Ethiopia

Objective

Depression is the most frequently observed psychiatric disorder among HIV positives and it is becoming worse in prisoners. The aim this study was to assess prevalence and associated factors of depression among HIV positive prisoners at central prison (Kaliti) Addis Ababa.

Result

The prevalence of depression was found to be 66.5% (95% CI 62, 71). Primary education [AOR = 4.17, 95% CI (1.648–10.483)], perceived stigma [AOR = 3.88, 95% CI (2.08–7.25)], history of chronic illness [AOR = 2.88, 95% CI (1.34–6.17)] and WHO clinical stage II [AOR = 2.47, 95% CI (1.19–5.12)] and length of stay in prison 4–6 years[AOR = 2.27, 95% CI (1.22–4.23)] and ≥ 10 years [AOR = 3.53, 95% CI (1.15–10.85)] were factors associated with depression. This study indicated that prevalence of depression among HIV positive prisoners in Addis Ababa prison was high. Educational status, perceived stigma, history of chronic illness, WHO clinical stage and length of stay in prison were factors associated with depression. Establishing psychiatry care to screen and manage mental health disorders at the prison is needed. Special attention has to be given for those with primary in education, advanced disease, perceived stigma, and history of chronic illness and stayed many years in prison.

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

BACKGROUND

In developed countries, there are well documented mental health impacts of HIV/AIDS and patients' quality of life. Acquiring HIV/AIDS can be a serious psychological trauma and can predispose a person to different mental disorders. Co-occurring mental illness complicates diagnosis, help-seeking, quality of care provided, treatment outcomes and adherence. However, in Ethiopia, studies about mental health problems in HIV/AIDS treatment settings are limited. The purpose of the current study is to determine the prevalence and associated factors of common mental disorders among adult HIV/AIDS patients undergoing HIV service in Harar town, eastern Ethiopia. Conducting this study is important as baseline information for the concerned stakeholders including health professionals and policymakers and in general to improve the quality of care for HIV/AID patients.

METHODS

Institution based cross-sectional study was conducted. We collected data from 420 adult patients through a face to face interviewing technique using a standardized questionnaire and review of medical records. Bivariable and multivariable (binary logistic regression) analyses were used to check the association between common mental disorders (CMDs) and independent variables. Variables which have a p-value < 0.05 during bivariable regression were entered into multivariable (binary logistic regression) and finally which have a p-value of < 0.05 under multivariable (binary logistic regression) were identified as statistically significant association at 95% of confidence interval.

RESULTS

All 420 patients were interviewed providing response rate 100%. The result revealed that (28.1%; 95% CI; 26.14, 30.06) of HIV/AIDS patients had CMD. In the final model, stage 4 HIV/AIDS (Adjusted Odds Ratio 3.37, 95% CI: 1.45, 7.83), family history of mental illness (AOR 2.65, 95% CI: 1.26, 5.54) and current drinking alcohol (AOR 5.1, 95% CI: 2.04, 12.79) were found having statistically significant association with CMD.

CONCLUSIONS

This study investigated the prevalence and associated factors of CMD among adults living with HIV/AIDS. HIV/AIDS stage, having family history of mental illness and current drinking alcohol were the main identified associated factors of CMD. These factors are important for the hospitals and other concerned bodies for providing prevention and appropriate intervention of common mental disorders among HIV/AIDS patients.