Incorporating services for common mental disorders and substance use disorders for people living with HIV along the HIV treatment cascade (original) (raw)
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Journal of the International AIDS Society, 2018
Integration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia-Pacific and sub-Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post-traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders. Most sites (n = 76, 80%) were in...
AIDS and Behavior, 2012
This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.
HIV-depression: A Shadow Over 90-90-90 UNAIDS Program
There are 36.9 million people living with HIV (PLWHIV) according to a 2017 WHO estimation; 70% of the affected population is living in low and middle-income countries (LMIC). Depression, alcohol/ substance abuse and neurocognitive deficit are the three most common psychiatric disorders found in PLWHIV in said countries. Depression is the most prevalent, with a rate over 30%. It is of high interest then, to study the way in which this high prevalence has an impact on initiatives for the prevention and treatment of HIV infection, such as the 90-90-90 program of UN-OMS. The way to do this, is to focus on the current state of the depression treatment cascade observed in PLWHIV, and its link with adherence to antiviral treatment 1 .
Prevalence, impact, and management of depression and anxiety in patients with HIV: a review
Neurobehavioral HIV Medicine, 2016
The prevalence of depression and anxiety in people living with HIV/AIDS (PLWHA) ranges from 7.2% to 71.9% and 4.5% to 82.3%, respectively. This wide variation is attributed to differences in sample size and characteristics, and methodology for assessment of anxiety and depression. Moreover, anxiety and depression increase the morbidity of HIV by poor adherence to treatment and various other significant mechanisms. Early identification and effective management of these disorders is associated with improved antiretroviral adherence and improved quality of life in PLWHA. Different treatment modalities, including pharmacological and nonpharmacological therapies, are used for the management of anxiety and depression in PLWHA. Benzodiazepines are indicated for short periods of time. Clonazepam and lorazepam are safe in terms of drug-drug interactions and may be preferred. Selective serotonin reuptake inhibitors are safer than tricyclic antidepressants. Though the different selective serotonin reuptake inhibitors are supposed to be equally effective, to avoid interactions with antiretrovirals, the better options are sertraline, citalopram, and escitalopram. Various nonpharmacological therapies, including cognitive behavior therapy, interpersonal therapy, supportive psychotherapy, cognitive-behavioral-oriented group psychotherapy, experiential group psychotherapy, cognitive-behavioral stress management, stress management interventions, cognitive remediation therapy, mindfulness-based therapy, and aerobic and resistance exercise have been reported to be useful in treating depression among PLWHA. However, definitive evidence to decide which nonpharmacological intervention is most beneficial for the management of anxiety and depression in PLWHA is still required.
Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV
Current HIV/AIDS Reports
Purpose of the review By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches. Recent findings After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms. Conclusion Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.
Indian Journal of Public Health, 2019
IntRoductIon Globally, there were approximately 36.7 (34.0-39.8) million people living with HIV (PLHA) at the end of 2015, including around 1.8 million people becoming newly infected with HIV in that year. [1] Among PLHIV, significant proportions of people live as HIV serodiscordant couples where one among the couple is HIV infected. [2] India is home to around 2.1 million PLHA, of which almost 1.3 million (59.5%) are men. [3] It is estimated that around 44% of HIV-infected individuals in India have uninfected partners. [2] This implies that more than half a million women are living in HIV serodiscordant relationship in India. Majority of the studies carried out among serodiscordant couples have focused entirely on the prevention of HIV transmission to uninfected partners. There is little focus on the mental health needs of the uninfected partners. [4-7] While there is increasing research highlighting the importance of addressing mental health needs of HIV-infected people to improve treatment outcomes, [8] there is lack of understanding of mental health needs of uninfected partner in serodiscordant settings. Living in serodiscordant relationship, particularly in long-term relationship, can generate unique stressors adversely affecting the mental health. Partners in such setting struggle to maintain relationship with constant fear of HIV transmission. Dilemma of altered reproductive possibilities, shifts in Background: India is home to 2.1 million people living with HIV with an estimated 44% people having an uninfected partner. Living in HIV serodiscordant setting can be stressful, especially for women and can lead to several common mental disorders (CMDs). However, the occurrence of CMD in this population is not studied in India. Objectives: The study aimed to assess the occurrence of CMD in HIV-uninfected women living in HIV serodiscordant setting. A sample of 152 HIV-uninfected women who are wives of HIV-infected men attending an HIV clinic were interviewed by trained interviewers. Methods: The International Classification of Diseases-10 diagnosis of any of the CMDs was done using standard structured diagnostic interview MINI 5.0.0. Current, past, and lifetime occurrence was estimated for various CMDs. Chi-square and point-biserial correlation coefficients were used to understand the relationship between various sociodemographic and HIV-related factors with current CMD. Results: The current, past, and lifetime occurrence of at least one CMD was 35.5%, 49.3%, and 62.5%, respectively. Common diagnoses were mixed anxiety-depressive disorder, major depressive disorder, and posttraumatic stress disorder. Of the women with CMD, 22% had accompanying suicidality. Conclusions: The high rate of occurrence of CMD observed among the study population calls for more attention on the policy and program level to address the mental health needs of this population. Globally, more number of HIV-infected people are now linked to the care. This provides an opportunity to incorporate mental health care into routine HIV care.
An assessment of rates of psychiatric morbidity and functioning in HIV disease
General Hospital Psychiatry, 1995
This study examined demography, rates of psycho-~thorogy, and ~nctiona~ ~mpa~rment in HrV-s~o~sit~ve women and men in a large, urban, public out~tient infectious disease clinic. Fiffy-three percent of the women and 70% of the men met Structured Clinical Interview for DSM-III-R criteria for psychiatric disorders. Current mood disorders were the most ~~uenf d~ugnoses, hollowed by psych~ctive subsfance abuse/dependence disorders and psychotic disorders. Sevenfysix percent of the women and 90% of the men had previous psych~af~c histories, including 59% of the wonzen and 55% of the men who had psychiufric histories prior to their knowledge of HIV seroconversion. Depressed subjects reported significant impairment in physical, social, and role functioning. Similarly, impuirmen~ in physical functioning was highly correlated with ala-r~rfed anxiety ~~toms. These data suggest considerable past and current psychiatric comorbidiry in HIVinfected indiuiduab seeking medical care, and draw attention to the need for recognition and aggressive psychiatric treatment, parficular~y for those depressed and anxious ~afients wifh im~ired ~ncfioni~g.
PsycEXTRA Dataset
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.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006
Background: Mood and anxiety disorders, particularly depression, and substance abuse (SA) commonly co-occur with HIV infection. Appropriate policy and program planning require accurate prevalence estimates. Yet most estimates are based on screening instruments, which are likely to overstate true prevalence. Setting: Large academic medical center in Southeast. Participants: A total of 1,125 patients, representing 80% of HIVpositive patients seen over a 2.5-year period, completed the Substance Abuse-Mental Illness Symptoms Screener, a brief screening instrument for probable mood, anxiety, and SA disorders. Separately, 148 participants in a validation study completed the Substance Abuse-Mental Illness Symptoms Screener and a reference standard diagnostic tool, the Structured Clinical Interview for DSM-IV. Methods: Using the validation study sample, we developed logistic regression models to predict any Structured Clinical Interview for DSM-IV mood/anxiety disorder, any SA, and certain specific diagnoses. Explanatory variables included sociodemographic and clinical information and responses to Substance Abuse-Mental Illness Symptoms Screener questions. We applied coefficients from these models to the full clinic sample to obtain 12-month clinic-wide diagnosis prevalence estimates. Results: We estimate that in the preceding year, 39% of clinic patients had a mood/anxiety diagnosis and 21% had an SA diagnosis, including 8% with both. Of patients with a mood/anxiety diagnosis, 76% had clinically relevant depression and 11% had posttraumatic stress disorder. Conclusions: The burden of psychiatric disorders in this mixed urban and rural clinic population in the southeastern United States is comparable to that reported from other HIV-positive populations and significantly exceeds general population estimates. Because psychiatric disorders have important implications for clinical management of HIV/AIDS, these results suggest the potential benefit of routine integration of mental health identification and treatment into HIV service sites.
Background: Recently, extensive research has been reported the higher rate of depression and anxiety among people living with HIV/AIDS (PLWHAs) as compared to the general population. However, no single study has been carried out to investigate whether this disparity is a real difference or it happens due to lack of measurement invariance. This study aims to assess the measurement invariance of the Beck Anxiety Inventory (BAI) and 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) questionnaires across PLWHAs and healthy individuals. Methods: One hundred and fifty PLWHAs and 500 healthy individuals filled out the Persian version of the BAI and CESD-10 questionnaires. Multi-group multiple-indicators multiple-causes model (MG-MIMIC) was used to assess measurement invariance across PLWHAs and healthy people. Results: Our findings revealed that PLWHAs and healthy individuals perceived the meaning of all the items in the BAI and CESD-10 questionnaires similarly. In addition, although depression scores were significantly higher in PLWHAs as opposed to the healthy individuals, no significant difference was observed in anxiety scores of these two groups. Conclusions: The current study suggests that the BAI and CESD-10 are invariant measures across PLWHAs and healthy people which can be used for meaningful cross-group comparison. Therefore, in comparison to healthy individuals, higher depression score of PLWHAs is a real difference. It is highly recommended that health professionals develop therapeutic interventions and psychological supports to promote the mental health of PLWHAs which alleviate their depressive symptoms.