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Filiatreau LM, Ebasone PV, Dzudie A, Wainberg M, Yotebieng M, Anastos K, Parcesepe AM. Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon. AIDS Behav 2024:10.1007/s10461-024-04375-2. [PMID: 38767726 DOI: 10.1007/s10461-024-04375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.
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Affiliation(s)
- Lindsey M Filiatreau
- School of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Grimes KEL, Ebasone PV, Dzudie A, Nash D, Wainberg ML, Pence BW, Barrington C, Pefura E, Yotebieng M, Anastos K, Nsame D, Ajeh R, Nyenti A, Parcesepe AM. Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives. BMC Health Serv Res 2024; 24:519. [PMID: 38658992 PMCID: PMC11044447 DOI: 10.1186/s12913-024-10775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.
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Affiliation(s)
- Kathryn E L Grimes
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | | | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Parcesepe AM, Stockton M, Remch M, Wester CW, Bernard C, Ross J, Haas AD, Ajeh R, Althoff KN, Enane L, Pape W, Minga A, Kwobah E, Tlali M, Tanuma J, Nsonde D, Freeman A, Duda SN, Nash D, Lancaster K. Availability of screening and treatment for common mental disorders in HIV clinic settings: data from the global International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium, 2016-2017 and 2020. J Int AIDS Soc 2023; 26:e26147. [PMID: 37535703 PMCID: PMC10399924 DOI: 10.1002/jia2.26147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020. METHODS In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys. RESULTS Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048). CONCLUSIONS Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- University of North Carolina at Chapel HillCarolina Population CenterChapel HillNorth CarolinaUSA
| | | | - Molly Remch
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - C. William Wester
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Charlotte Bernard
- University of BordeauxNational Institute for Health and Medical ResearchResearch Institute for Sustainable DevelopmentBordeaux Population Health Research CentreBordeauxFrance
| | - Jeremy Ross
- TREAT Asia/amfARThe Foundation for AIDS ResearchBangkokThailand
| | - Andreas D. Haas
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland
| | - Rogers Ajeh
- Clinical Research Education and Networking ConsultancyYaoundeCameroon
| | - Keri N. Althoff
- Johns Hopkins UniversityBloomberg School of Public HealthBaltimoreMarylandUSA
| | - Leslie Enane
- Department of PediatricsThe Ryan White Center for Pediatric Infectious Disease and Global HealthIndiana University School of MedicineIndianapolisIndianaUSA
| | - William Pape
- Groupe Haitien d''Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO)Port au PrinceHaiti
| | - Albert Minga
- Centre Medical de Suivi de Donneurs de Sang/CNTS/PRIMO‐CIAbidjanCote D''Ivoire
| | - Edith Kwobah
- Department of Mental HealthMoi Teaching and Referral HospitalEldoretKenya
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research (CIDER)School of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Junko Tanuma
- Division of the AIDS Medical Information of AIDS Clinical CareNational Center for Global Health and MedicineTokyoJapan
| | | | - Aimee Freeman
- Johns Hopkins UniversityBloomberg School of Public HealthBaltimoreMarylandUSA
| | - Stephany N. Duda
- Department of Biomedical InformaticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Denis Nash
- City University of New YorkInstitute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | | | - the IeDEA Consortium
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Parcesepe AM, Filiatreau LM, Gomez A, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon. AIDS Behav 2023; 27:2360-2369. [PMID: 36609704 PMCID: PMC10224854 DOI: 10.1007/s10461-022-03963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/09/2023]
Abstract
Little is known about the coping strategies used among people with HIV (PWH), especially in sub-Saharan Africa, and the extent to which adaptive or maladaptive coping strategies are associated with symptoms of mental health disorders. We interviewed 426 PWH initiating HIV care in Cameroon and reported the prevalence of adaptive and maladaptive coping strategies, overall and by presence of symptoms of depression, anxiety, and PTSD. Log binominal regression was used to estimate the association between each type of coping strategy (adaptive or maladaptive) and symptoms of each mental health disorder, separately. Adaptive and maladaptive coping strategies were commonly reported among PWH enrolling in HIV care in Cameroon. Across all mental health disorders assessed, greater maladaptive coping was associated with higher prevalence of depression, anxiety, and PTSD. Adaptive coping was not associated with symptoms of any of the mental health disorders assessed in bivariate or multivariable models. Our study found that PWH endorsed a range of concurrent adaptive and maladaptive coping strategies. Future efforts should explore the extent to which coping strategies change throughout the HIV care continuum. Interventions to reduce maladaptive coping have the potential to improve the mental health of PWH in Cameroon.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Gomez
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Dumchev K, Guo X, Ha TV, Djoerban Z, Zeziulin O, Go VF, Sarasvita R, Metzger DS, Latkin CA, Rose SM, Piwowar-Manning E, Richardson P, Hanscom B, Lancaster KE, Miller WC, Hoffman IF. Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial. BMC Infect Dis 2023; 23:319. [PMID: 37170118 PMCID: PMC10173611 DOI: 10.1186/s12879-023-08201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. METHODS The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. RESULTS The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1-13.3] and 2.1 [1.3-3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7-39.0] and 5.8 [3.5-9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5-17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2-0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2-5.0]) and study arm (intervention versus control aHR = 0.4 [0.2-0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0-0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9-7.4]). CONCLUSIONS The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.
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Affiliation(s)
- Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tran Viet Ha
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zubairi Djoerban
- Depts. of Hematology, Medical Oncology, and Medicine, Univ. of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Oleksandr Zeziulin
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine
| | - Vivian F Go
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl A Latkin
- Dept. of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott M Rose
- Science Facilitation Department, Durham, North Carolina, FHI 360, USA
| | | | - Paul Richardson
- Dept. of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Irving F Hoffman
- Dept. of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mandlate FM, Greene MC, Pereira LF, Gouveia ML, Mari JJ, Cournos F, Duarte CS, Oquendo MA, Mello MF, Wainberg ML. Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study. BMC Psychiatry 2023; 23:274. [PMID: 37081470 PMCID: PMC10116733 DOI: 10.1186/s12888-023-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. METHODS This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. RESULTS 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. CONCLUSIONS In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.
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Affiliation(s)
- Flavio M. Mandlate
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, USA
| | - Maria Lidia Gouveia
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, USA
| | | | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marcelo Feijó Mello
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, USA
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Di Gennaro F, Marotta C, Saracino A, Occa E, Putoto G. Mental health needs of adolescents with HIV in Africa. THE LANCET HIV 2022; 9:e376. [DOI: 10.1016/s2352-3018(22)00130-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023]
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Di Gennaro F, Marotta C, Ramirez L, Cardoso H, Alamo C, Cinturao V, Bavaro DF, Mahotas DC, Lazzari M, Fernando C, Chimundi N, Atzori A, Chaguruca I, Tognon F, Guambe Dos Anjos H, De Meneghi G, Tribie M, Del Greco F, Namarime E, Occa E, Putoto G, Pozniak A, Saracino A. High Prevalence of Mental Health Disorders in Adolescents and Youth Living with HIV: An Observational Study from Eight Health Services in Sofala Province, Mozambique. AIDS Patient Care STDS 2022; 36:123-129. [PMID: 35438520 DOI: 10.1089/apc.2022.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adolescent mental health (MH) is a significant global health concern, which is extremely relevant when referring to adolescents and youth living with HIV (AYHIV). In Mozambique, ∼52% of the population is <18 years and the country has the world's eighth highest HIV prevalence (insert citation). We performed an observational study to evaluate anxiety, depression, post-traumatic stress disorder (PTSD) and alcohol-drug abuse in adolescents and youth assessing health services in Sofala Province, Mozambique. From November 20, 2019, to November 20, 2021, all adolescents and youth (10-24 years) accessing one of the psychological services offered at 8 Servicios Amigos dos Adolescentes (SAAJ) of the Sofala Province were screened by a psychologist using the following standardized tools: Generalized Anxiety Disorder-7 (GAD-7) for anxiety, Patient Health Questionnaire-9 (PHQ-9) for depression, Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) for PTSD, and Cut down, Annoyed, Guilty, and Eye-opener Adapted to Include Drugs (CAGE-AID) for alcohol-drug abuse. Overall, 2108 adolescents and youth were included in the study (63% female, median age: 19 years). Of them, 1096 (52%) were HIV positive. AYHIV had higher scores at the four tools tested and for concomitant MH disorders (GAD-7, PHQ-9, PTSD-5, and CAGE). The multivariable logistic regressions showed a greater probability to be GAD-7 > 10 for women, [adjusting odds ratio (AOR): 1.46, 95% confidence interval (CI): 1.01-2.10], for workers (AOR: 2.18, 95% CI: 1.12-4.23) and people living with HIV (AOR: 1.78, 95% CI: 1.25-2.54). Higher values of CAGE (≥2) and PTSD (≥3) seemed to be associated only with HIV-positive status (AOR: 4.87, 95% CI: 3.72-6.38 and AOR: 1.73, 95% CI: 1.28-237). These data further reinforce the urgent need for a global health policy action with focused intervention on MH in AYHIV patients.
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Affiliation(s)
- Francesco Di Gennaro
- Doctors with Africa CUAMM, Beira, Mozambique
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | | | | | | | - Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | | | | | | | | | - Francesca Tognon
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | | | | | | | | | | | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Anton Pozniak
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annalisa Saracino
- Doctors with Africa CUAMM, Beira, Mozambique
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
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