Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature

Symptoms and Health-Related Quality of Life Among Older Adults Living With HIV

BACKGROUND

As individuals living with HIV age, they often experience both physical and psychological symptoms-along with potential reductions in social support-which can significantly affect their health-related quality of life (HRQOL)-a crucial measure in HIV care. However, research exploring the potential predictive roles of social support and symptom experiences in HRQOL among older people living with HIV (PLWH) is limited.

OBJECTIVES

This cross-sectional study aimed to investigate relationships between social support, symptom experiences, and HRQOL in older adults with HIV.

METHODS

Older adults with HIV aged ≥50 years completed surveys on demographic and HIV-related characteristics, social support, four symptoms, and HRQOL. Hierarchical multiple linear regression analyses were used to determine predictors for six HRQOL domains.

RESULTS

Among the 141 PLWH, significant associations were found between fatigue and health perceptions, physical functioning, and role functioning. Sleep disturbance was a significant predictor of health perceptions and social functioning. Anxiety displayed associations with physical functioning, role functioning, mental health, and pain. Depression was linked to health perceptions and mental health aspects of HRQOL. Notably, social support was not associated with any HRQOL domains.

DISCUSSION

These findings underscore the importance of assessing a range of common symptoms to enhance HRQOL among older adults living with HIV, necessitating tailored symptom management strategies for this growing population.

Avoidance and Rumination as Predictors of Substance Use, Mental Health, and Pain Outcomes Among People Living With HIV

Pain, substance use, and mental health conditions are common among people living with HIV (PLWH), and avoidance and rumination may influence the co-occurrence of these conditions. The present study examined longitudinal associations between avoidance/rumination and pain outcomes, anxiety, anger, and substance use among PLWH. Participants (N = 187) with chronic pain and depressive symptoms completed self-report assessments over a 1-year period. Greater avoidance/rumination was positively associated with mental health outcomes (anxiety, anger), pain interference, and alcohol use across participants after controlling for depression severity. At time points with greater avoidance/rumination than average, participants also reported increased pain severity and interference, anxiety and anger symptoms, and alcohol use. No associations were found between avoidance/rumination and cannabis use. Results suggest a mechanistic effect of avoidance/rumination, such that increases in avoidance/rumination correspond with poorer health outcomes among PLWH over time. Targeting avoidance/rumination through intervention approaches may be beneficial for addressing comorbid health conditions among PLWH. Additional research is necessary to investigate this possibility and further characterize the effects of avoidance/rumination on health outcomes for PLWH.

Mental health disparities in people living with human immunodeficiency virus: A cross-sectional study on physician-patient concordance and treatment regimens

BACKGROUND

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown.

METHODS

A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen's kappa test was used to assess the agreement between physicians and PLWH.

RESULTS

The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% (P <0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis (P <0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR] = 0.71, 95% CI: 0.59-0.87, P = 0.003) and a lower prevalence of anxiety issues (OR = 0.63, 95% CI: 0.52-0.76, P <0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR = 0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR = 0.81, 95% CI: 0.67-0.99).

CONCLUSION

Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.

Network analysis to prioritize issues for intervention to improve the health-related quality of life of people with HIV in Spain

OBJECTIVES

The objective is to assess the interconnectedness of a network of health-related quality of life (HRQoL) variables among people with HIV (PHIV) to identify key areas for which clinical interventions could improve HRQoL for this population.

METHODS

Between 2021 and 2023, we carried out a cross-sectional study within the Spanish CoRIS cohort. We conducted a weighted and undirected network analysis, which examines complex patterns of relationships and interconnections between variables, to assess a network of eight HRQoL dimensions from the validated Clinic Screening Tool for HIV (CST-HIV): anticipated stigma, psychological distress, sexuality, social support, material deprivation, sleep and fatigue, cognitive problems and physical symptoms.

RESULTS

A total of 347 participants, predominantly male (93.1%), currently working (79.0%), self-reported homosexual (72.6%) and college-educated (53.9%), were included in the study. Psychological distress showed the highest centrality in the network, indicating its strong connections with sleep and fatigue, cognitive problems and social support within the HRQoL network.

CONCLUSIONS

Psychological distress, sleep and fatigue, cognitive issues and social support were identified as key factors in an HRQoL network, indicating that interventions focused on these areas could significantly enhance overall well-being.

Is fear of disease progression associated with antiretroviral therapy adherence in persons with HIV/AIDS?

We examined the mediating role of depression and anxiety on the relationship between fear of disease progression (FoP) and antiretroviral therapy (ART) adherence and the moderating role of social support in the FoP-depression/anxiety-ART adherence relationship in persons with HIV/AIDS (PWHA). 202 PWHA completed self-report measures. Simple mediation and moderated mediation analyses were performed. FoP was directly and negatively associated with ART adherence, and the mediating role of depression in this relationship was significant. Indirect effect of FoP mediated by anxiety on ART adherence was not significant. The moderating effect of social support was significant in the FoP-depression pathway, while the indirect effect of FoP on ART adherence mediated by depression was greatest at a higher level of social support and lower level of FoP. The results suggest the relevance of high FoP and depression-mediated FoP in ART adherence and social support may attenuate the negative impact of FoP.

Nocturnal systolic blood pressure dipping among people living with HIV and people without HIV: a cross-sectional study in Rural Uganda

Background

In this study, we investigated sleep quality, depression and stress symptoms as hypothesized factors affecting the association between HIV status and nocturnal blood pressure dipping status in rural Uganda.

Methods

Individuals living with HIV (PLHIV) and people without HIV (PwoHIV) underwent 24-hour ambulatory blood pressure monitoring (ABPM) and classified as extreme dippers, dippers and non-dippers based on a percentage nocturnal drop in mean systolic and diastolic blood pressure. Ordinal logistic regression models were used to assess the effect of different exposure variables (HIV status, sleep quality and other covariates) on the outcome (dipping status).

Results

The median age was 45 years (IQR: 35-54) and 80% of the participants were female. 24% of PwoHIV and 16% of PLHIV were overweight, 10% of HIV negative and 3% of the HIV positive individuals were obese. Depression was prevalent in both PLHIV and PwoHIV. Additionally, poor sleep quality was more prevalent in PLHIV compared to PwoHIV (70% versus 58%, P= 0.046). The study found that 53% of participants had normal dipping, while 35.1% were non-dippers, with non-dipping being more prevalent in PwoHIV individuals (34.9% vs 29.7%, P<0.001). PLHIV had 3.6 times the odds of being extreme dippers compared to PwoHIV (OR 3.64, 95% CI: 1.40 - 9.44).

Conclusion

This study identified high proportions of non-dipping BP profiles among both PLHIV and PwoHIV. However, the odds of being extreme dippers were higher among PLHIV compared to PwoHIV. Further research is needed to understand the underlying mechanisms contributing to extreme dipping patterns in PLHIV.

Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study

INTRODUCTION

There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan.

METHODS

We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June-November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used.

RESULTS

Participants' median age was 40.0 (IQR: 34-47) with 40.9% (n = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22-9.11, p < 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20-8.92, p < 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15-14.21, p < 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31-45.7, p < 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24-140.33, p < 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36-80.84, p < 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81-0.96, p < 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13-0.40, p < 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76-12.24, p < 0.005) and lower ASES score (β = -0.31, 95% CI: -0.45 to 0.16, p < 0.005). Those who had at least mild depression (β = -0.21, 95% CI: -0.35 to -0.07, p < 0.005); moderate anxiety (β = -0.21, 95% CI: -0.34 to -0.07, p < 0.005) and PTSD (β = -0.19, 95% CI: -0.33 to -0.05, p < 0.005) symptoms had lower ASES scores.

CONCLUSIONS

Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness were associated with poorer ART adherence and worse adherence self-efficacy. It is crucial to assess and treat mental illness and provide support for PLWH with worsened cognition to enhance ART adherence.

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research

Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings.

Association of Alcohol Use with COVID-19 Infection and Hospitalization Among People Living with HIV in the United States, 2020

Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use.

Brain function abnormalities and neuroinflammation in people living with HIV-associated anxiety disorders

Background

People living with HIV (PLWH) exhibits an increased susceptibility to anxiety disorders, concomitant with heightened vulnerability to aberrant immune activation and inflammatory responses, and endocrine dysfunction. There exists a dearth of scholarly investigations pertaining to the neurological, immune, and endocrine dimensions of HIV-associated anxiety disorders.

Method

This study aimed to compare a group of 16 individuals diagnosed with HIV-associated anxiety disorders (HIV ANXs) according to the Diagnostic and statistical manual of mental disorders (5th ed.), with a HIV individual control group (HIV control) of 49 PLWH without mental disorders. Muti-modal magnetic resonance was employed to assess the brain function and structure of both groups. Seed-based functional connectivity (FC) was used to assess the regional intrinsic brain activity and the influence of regional disturbances on FC with other brain regions. Peripheral blood cytokines and chemokines concentrations were measured using liquid chip and ELISA.

Results

Amplitude of low-frequency fluctuations in the right inferior temporal gyrus (ITG) was increased. There is a significant decreased regional homogeneity in HIV ANXs in the right superior occipital gyrus (SOG). The right ITG and the right SOG were separately set as the seed brain region of interest (ROI 1 and ROI 2) to be analyzed the FC. FC decreased in HIV ANXs between ROI1 and the right middle occipital gyrus, the right SOG, FC between ROI2 and left ITG increased in HIV ANXs. No significant structural difference was found between two groups. Pro-inflammatory chemokines showed higher levels in the HIV ANXs. Pro-inflammatory cytokines, neurotrophic factors, and endocrine factors were significantly correlated with alterations in brain function.

Conclusion

This study suggests that patients with HIV-associated anxiety disorders may exhibit abnormalities in neurologic, immune, and endocrine functioning. Consequently, it is imperative to implement additional screening and intervention measures for anxiety disorders among PLWH.

The experiences of individuals living with HIV in Ireland attending out-patient physiotherapy

People living with HIV (PLWH) are living longer and are becoming increasingly susceptible to multi-morbidity resulting in disability. Physiotherapy is an important component in the care of PLWH, increasing functional capacity and quality of life. However, few PLWH access physiotherapy services due to a lack of specialised services, relapses in medical conditions and financial barriers. This study aimed to gather feedback from PLWH in a tertiary infection centre in Ireland attending out-patient physiotherapy on their experiences of physiotherapy. Eleven PLWH completed a semi-structured feedback survey focusing on their expectations and experiences of physiotherapy. Participants reported an overall positive experience of physiotherapy especially in terms of improving movement, confidence, physical activity level and sense of control. In addition, participants highlighted the importance of a physiotherapist with specialist knowledge of HIV. Barriers to participation in physiotherapy included potential relapses in other medical conditions, lack of time due to work and lack of flexibility or availability of physiotherapy appointments. This study highlights the important role of physiotherapy in the care of PLWH, several potential barriers to participation in physiotherapy for PLWH and the importance of the participation of PLWH in the co-design of services.

Symptomatology and Quality of Life of Older People With HIV and Comorbid Chronic Obstructive Pulmonary Diseases From an HIV Clinic in Birmingham, Alabama

ABSTRACT

Psychological symptomatology and quality of life (QoL) have been studied in older people with HIV (PWH) and those with chronic obstructive pulmonary disease (COPD), respectively, but there is a dearth of studies in older PWH with COPD. Our study compared depressive symptoms, anxiety, and QoL between older PWH with and without COPD using data from an HIV clinic in Birmingham, Alabama, from January 2018 to February 2020. Data on depressive symptoms (Patient Health Questionnaire-9), anxiety (Patient Health Questionnaire-5 Anxiety), and QoL (EuroQoL-5 Dimension) were analyzed. Among 690 PWH aged 50 years or older, 102 individuals (14.8%) had COPD. Significant differences were found between the two groups in depressive symptoms and components of QoL (e.g., mobility, self-care, usual activities, and pain/discomfort), but not in anxiety and general health. Experiencing COPD may worsen depressive symptomatology and QoL in older PWH, highlighting the need for tailored health care and research for this population.

People who living with HIV/AIDS also have a high prevalence of anxiety disorders: a systematic review and meta-analysis

Background

An estimated 301 million people worldwide suffer from anxiety disorders. People living with HIV/AIDS (PLWHA) are particularly prone to anxiety disorders that could interfere with the important developmental process in an individual's development and ultimately result in a wide range of negative mental, physical, and psychosocial consequences, as well as poor quality of life in those population groups. Early intervention for anxiety disorders can reverse some of the physical damage caused by anxiety. However, based on systematic reviews and meta-analyses, the specific prevalence of anxiety disorders in PLWHA remains unknown.

Method

We conducted a literature search on PubMed, Embase, and Web of Science up to 22 October 2022. A random-effects meta-analysis was used to pool prevalence rates from the included studies. Sensitivity and subgroup analyses were performed to identify the possible sources of heterogeneity and to compare the prevalence estimates across groups. The Joanna Briggs Institute's Quality Assessment Checklist was used to assess the quality of the included studies. Cochran's Q and I2 tests were used to assess the between-study heterogeneity.

Results

Ten studies with a total of 238,570 cases were included for the final analysis. Results showed that 15.5% of HIV/AIDS patients had anxiety disorders. The prevalence was higher in females (20.8%) than males (20.7%). The mean age of PLWHA with anxiety disorders was 46.58 ± 11.15 years in these included studies. The subgroup analyses showed significant higher prevalence in non-heterosexual (32.1%).

Conclusion

We attempted to quantify literature that could allow for stronger inferences to be made regarding the significantly higher prevalence of anxiety disorders in PLWHA, a finding that suggests the imperativeness of intervention strategies to alleviate suffering and reduce the probable negative ramifications.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023442219, identifier CRD42023442219.

The association of depression and anxiety symptoms to three different types of activities of daily living in persons with and without HIV

Mood disorders are highly prevalent in people living with HIV (PLWH) and represent a potential contributor to functional impairment in activities of daily living. We aimed to determine if (1) Anxiety and depression symptoms were independently associated with impairments in basic self-care, role functioning, and social functioning and (2) PLWH differentially experienced impairments due to mood symptoms compared to those without HIV. Data for this study were obtained from 150 individuals (87 PLWH, 61% male, mean age = 44) via a cross-sectional study on alcohol and HIV-associated brain dysfunction. The Beck Anxiety Inventory (BAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess anxiety and depressive symptoms. Higher anxiety symptoms were associated with role functioning impairment, while higher depressive and anxiety symptoms were each associated with social functioning impairment. As depressive symptoms increased, PLWH were 3x more likely to have impairments in role functioning compared to those without HIV. HIV status did not interact with mood symptoms to affect basic self-care or social functioning. Overall, mood symptoms are associated with different types of functional impairment, and improved management of mood symptoms could lead to improved role and social functioning.

Effect of a brief psychological intervention for common mental disorders on HIV viral suppression: A non-randomised controlled study of the Friendship Bench in Zimbabwe

BACKGROUND

For people living with co-morbid HIV and common mental disorders (CMD), it is not known whether a brief psychological intervention for CMD can improve HIV viral suppression.

METHODS

We conducted a prospective cohort study in eight primary care clinics in Harare, Zimbabwe, enrolling adults with co-morbid HIV and CMD. Six clinics provided the Friendship Bench (FB), a brief psychological intervention for CMD based on problem-solving therapy, delivered by lay counsellors. Two clinics provided enhanced usual care (EUC). The primary outcome was viral non-suppression after six months (viral load ≥400 copies/mL). Data were analysed using a difference-in-difference approach with linear regression of cluster-level proportions, adjusted for baseline viral non-suppression (aDiD). The secondary outcome was presence of CMD measured by the Shona Symptom Questionnaire.

RESULTS

In FB clinics, 407/500 (81.4%) participants had viral load results at baseline and endline: 58 (14.3%) had viral non-suppression at baseline and 41 (10.1%) at endline. In EUC clinics, 172/200 (86.0%) had viral load results at baseline and endline: 22 (12.8%) were non-suppressed at baseline and 26 (15.1%) at endline (aDiD = -7.3%; 95%CI 14.7% to -0.01%; p = 0.05). Of the 499 participants virally suppressed at baseline, the FB group had lower prevalence of non-suppression at endline compared to the EUC group (2.9% vs 9.3%; p = 0.002). There was no evidence of a difference in endline viral non-suppression by group among the 80 participants with non-suppression at baseline (53.5% vs 54.6%; p = 0.93). The FB group was less likely to screen positive for CMD at endline than the EUC group (aDiD = -21.6%; 95%CI -36.5% to -6.7%; p = 0.008).

CONCLUSION

People living with co-morbid HIV and CMD may benefit from receiving a low-cost mental health intervention to enhance viral suppression, especially if they are already virally suppressed. Research is needed to understand if additional adherence counselling could further improve viral suppression.

The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: A modeling study

BACKGROUND

Estimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective of our study was to forecast the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the United States (US) through 2030.

METHODS AND FINDINGS

Using the PEARL model-an agent-based simulation of PWH who have initiated ART in the US-the prevalence of anxiety, depression, stage ≥3 chronic kidney disease (CKD), dyslipidemia, diabetes, hypertension, cancer, end-stage liver disease (ESLD), myocardial infarction (MI), and multimorbidity (≥2 mental or physical comorbidities, other than HIV) were forecasted through 2030. Simulations were informed by the US CDC HIV surveillance data of new HIV diagnosis and the longitudinal North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data on risk of comorbidities from 2009 to 2017. The simulated population represented 15 subgroups of PWH including Hispanic, non-Hispanic White (White), and non-Hispanic Black/African American (Black/AA) men who have sex with men (MSM), men and women with history of injection drug use and heterosexual men and women. Simulations were replicated for 200 runs and forecasted outcomes are presented as median values (95% uncertainty ranges are presented in the Supporting information). In 2020, PEARL forecasted a median population of 670,000 individuals receiving ART in the US, of whom 9% men and 4% women with history of injection drug use, 60% MSM, 8% heterosexual men, and 19% heterosexual women. Additionally, 44% were Black/AA, 32% White, and 23% Hispanic. Along with a gradual rise in population size of PWH receiving ART-reaching 908,000 individuals by 2030-PEARL forecasted a surge in prevalence of most comorbidities to 2030. Depression and/or anxiety was high and increased from 60% in 2020 to 64% in 2030. Hypertension decreased while dyslipidemia, diabetes, CKD, and MI increased. There was little change in prevalence of cancer and ESLD. The forecasted multimorbidity among PWH receiving ART increased from 63% in 2020 to 70% in 2030. There was heterogeneity in trends across subgroups. Among Black women with history of injection drug use in 2030 (oldest demographic subgroup with median age of 66 year), dyslipidemia, CKD, hypertension, diabetes, anxiety, and depression were most prevalent, with 92% experiencing multimorbidity. Among Black MSM in 2030 (youngest demographic subgroup with median age of 42 year), depression and CKD were highly prevalent, with 57% experiencing multimorbidity. These results are limited by the assumption that trends in new HIV diagnoses, mortality, and comorbidity risk observed in 2009 to 2017 will persist through 2030; influences occurring outside this period are not accounted for in the forecasts.

CONCLUSIONS

The PEARL forecasts suggest a continued rise in comorbidity and multimorbidity prevalence to 2030, marked by heterogeneities across race/ethnicity, gender, and HIV acquisition risk subgroups. HIV clinicians must stay current on the ever-changing comorbidities-specific guidelines to provide guideline-recommended care. HIV clinical directors should ensure linkages to subspecialty care within the clinic or by referral. HIV policy decision-makers must allocate resources and support extended clinical capacity to meet the healthcare needs of people aging with HIV.

Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review

BACKGROUND

Antiretroviral therapy has transformed HIV from a progressive and often fatal infection to a chronic disease. Currently, people living with HIV (PLHIV) have near-normal life expectancy; however, they face accelerated ageing and a rise in non-AIDS-defining HIV-associated conditions. Comorbidities increase the number of prescribed drugs and, therefore, the risk of polypharmacy and prescribing potentially inappropriate medications (PIMs). Still, there are no specific tools to identify PIMs in older PLHIV, which opens a pathway to investigate the particularities in the prescription of medication in this population.

METHODS

We conducted a scoping review in 5 electronic databases for studies reporting the use of tools to identify PIMs in older PLHIV. No language or date restrictions were applied. To complete the search, abstracts published in the most relevant HIV Conferences and Events in their editions from 2010 to 2022 were screened.

RESULTS

Of 50,193 records returned (13,701 of the databases and 36,492 of the Congresses), 39 studies met the inclusion criteria. Most studies were single-centre and conducted in Europe. Twenty-eight studies were cross-sectional, and most researchers used explicit criteria, mainly Beers and STOPP-START criteria, to identify PIMs.

CONCLUSIONS

Potentially inappropriate prescribing is frequent among older PLHIV. Explicit conventional tools to identify PIMs in older populations may need to be adapted to tackle the needs of PLHIV. Implicit tools may be more valid, although their use is more time-consuming, and standardization is complex.

Association Between Age of Anal Sex Debut and Adult Health Behaviors Among Sexual Minoritized Men Living with HIV

Earlier age of anal sex debut (ASD) has been linked with contemporary and long-term health outcomes, including vulnerability to HIV acquisition. The goal of this study was to utilize a life course approach to examine associations between earlier ASD and recent health behaviors among sexual minoritized men (SMM) living with HIV. A total of 1156 U.S. SMM living with HIV recruited from social and sexual networking apps and websites completed online surveys as part of a longitudinal eHealth intervention. Data from baseline surveys were analyzed to determine associations between age of ASD and adult health outcomes, including mental health, HIV viral load, and substance use. The median age of ASD among these participants was 17 years old, consistent with other work. Earlier ASD was significantly associated with a greater likelihood of past 2-week anxiety (AOR = 1.45, 95% CI 1.07-1.97) and past 3-month opioid use (AOR = 1.60, 95% CI 1.13-2.26); no significant associations were found for recent depression, HIV viral load, or stimulant use. Earlier ASD may function as an important proxy measure for deleterious health outcomes in adulthood, particularly recent anxiety and opioid use. Expansion of comprehensive and affirming sexual health education is critical to early engagement of individuals with a higher risk of HIV acquisition, with plausible downstream health benefits lasting into adulthood among SMM living with HIV.

HIV-related Stigma and Discrimination in Health Care and Health-related Quality of Life among People Living with HIV in England and Wales: A Latent Class Analysis

Though life expectancy of people living with HIV (PLHIV) is now comparable to that of HIV-negative persons, their health-related quality of life (HRQoL) lags behind. Lower HRQoL among PLHIV may vary meaningfully, shaped in part by social factors, including stigma. Using data from Positive Voices, a national cross-sectional probability survey of adults ≥ 18 years living with HIV and accessing HIV care services in England and Wales (N = 4,422), we conducted latent class analysis on responses to a HRQoL measure (problems with mobility, usual activities, self-care, pain/discomfort, anxiety/depression) to identify HRQoL patterns, followed by multinomial logistic regression to examine relationships between HRQoL classes and a 4-item measure of HIV-related stigma and discrimination in health care. Four classes emerged: All Problems (18% prevalence); Pain and Distress (18%); Pain and Mobility (9%); No Problems (55%). Scale scores of HIV-related stigma and discrimination in health care were positively, significantly associated with membership in the All Problems (adjusted odds ratio [aOR] = 2.05; 95% confidence interval [CI] = 1.85, 2.28), Pain and Distress (aOR = 1.56; CI = 1.41, 1.73), and Pain and Mobility classes (aOR = 1.33; CI = 1.16, 1.52) compared to the No Problems class. A similar trend was observed for individual stigma and discrimination items. HRQoL among PLHIV in England and Wales varies and may be underpinned or exacerbated by HIV-related stigma and discrimination in health care. Ensuring stigma-mitigation interventions reach all health care systems/providers and emotional support services reach all PLHIV may improve HRQoL for PLHIV.

Neuropsychiatric predictors of cognitive functioning over a one-year follow-up period in HIV

BACKGROUND

Neuropsychiatric symptoms (NPS) and cognitive impairment are highly prevalent among persons with HIV (PWH). We examined the effect of the most common NPS, depression and anxiety, on cognitive change among PWH and compared these associations to those among persons without HIV (PWoH).

METHODS

Participants included 168 PWH and 91 PWoH who completed baseline self-report measures of depression (Beck Depression Inventory-II) and anxiety (Profile of Mood States [POMS] - Tension-anxiety subscale) and completed a comprehensive neurocognitive evaluation at baseline and at 1-year follow-up. Demographically-corrected scores from 15 neurocognitive tests were used to calculate global and domain-specific T-scores. Linear mixed-effects models examined the effect of depression and anxiety and their interaction with HIV-serostatus and time on global T-scores.

RESULTS

There were significant depression-by-HIV and anxiety-by-HIV interactions on global T-scores such that, among PWH only, greater depressive and anxiety symptoms at baseline related to worse global T-scores across visits. Non-significant interactions with time suggest stability in these relationships across visits. Follow-up analyses examining cognitive domains revealed that both the depression-by-HIV and the anxiety-by-HIV interactions were driven by learning and recall.

LIMITATIONS

Follow-up was limited to one-year and there were fewer PWoH than PWH, creating a differential in statistical power.

CONCLUSION

Findings suggest that anxiety and depression have stronger links to worse cognitive functioning in PWH than PWoH, particularly learning and memory, and that these associations seem to persist for at least one-year.

Associations between mental health challenges, sexual activity, alcohol consumption, use of other psychoactive substances and use of COVID-19 preventive measures during the first wave of the COVID-19 pandemic by adults in Nigeria

BACKGROUND

The aims of this study were to assess: 1) the associations among sexual activity, alcohol consumption, use of other psychoactive substances and mental health during the COVID-19 pandemic; and 2) the associations between COVID-19 preventive measures, alcohol consumption and use of psychoactive substances.

METHODS

This was a secondary analysis of data collected from adults in Nigeria between July and December 2020. The variables extracted included change in sexual activity, alcohol consumption and use of other psychoactive substances, COVID-19 preventive behaviors (wearing face masks, washing hands, physical distancing), anxiety, depression, post-traumatic stress disorder (PTSD) and sociodemographic variables (age, sex, education, HIV status, employment status). Multivariable logistic regressions were conducted. A model was run to regress depression, anxiety, PTSD, increased alcohol consumption, and increased use of other psychoactive substances, on increased sexual activity. In separate models, anxiety, depression, and PTSD were regressed on increased alcohol consumption and on increased use of other psychoactive substances. Finally, three models were constructed to determine the associations between increased alcohol consumption and increased use of other psychoactive substances on three separate COVID-19 preventive behaviors. All models were adjusted for sociodemographic variables.

RESULTS

Increased alcohol consumption (AOR:2.19) and increased use of other psychoactive substances (AOR: 3.71) were significantly associated with higher odds of increased sexual activity. Depression was associated with significantly higher odds of increased alcohol consumption (AOR:1.71) and increased use of other psychoactive substances (AOR:3.21). Increased alcohol consumption was associated with significantly lower odds of physical distancing (AOR:0.59).

CONCLUSION

There was a complex inter-relationship between mental health, sexual health, increased use of psychoactive substances. The consumption of alcohol also affected compliance with physical distancing. Further studies are needed to understand the observed relationships.

'She showed me a new path, a way forward': exploring how navigation influences mental health among Guatemalan gay and bisexual men living with HIV

Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

HIV associated psychiatric comorbidity among attendees at a tertiary hospital, North-Eastern Nigeria

Background

There are a wide range of neuropsychiatric conditions associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These mental disorders may be unrecognised yet their presence can significantly affect outcome.

Aim

This study aimed to determine psychiatric comorbidity associated with HIV and AIDS.

Setting

The HIV clinic of a tertiary hospital in North-Eastern Nigeria.

Methods

A cross-sectional descriptive study consecutively recruiting 328 adult persons living with HIV. The Mini International Neuropsychiatric Interview and a sociodemographic questionnaire were administered to the participants.

Results

Two-thirds of the respondents were females. The mean age (±s.d.) was 42 years (±11.24). Majority of the participants had World Health Organization stage 1 HIV disease. The prevalence of psychiatry comorbidity among our respondents was 82.9%. Social phobia was the leading disorder (69.8%). Others were mixed depression anxiety disorder (49.4%) and post-traumatic stress disorder (36.6%). Current psychosis was 27.7%, while major depressive disorder was 12.2%. Psychiatric comorbidity was significantly associated with male gender, religion, ethnicity, marital status and being unemployed with p < 0.01. Human immunodeficiency virus stage was related to panic disorder with p < 0.01, while viral load was significantly associated with depressive disorder with p = 0.001.

Conclusion

Majority of our HIV patients attending the clinic have undetected psychiatric morbidity. Clinicians need to be aware of the features of major psychiatric disorders and refer appropriately for improved overall outcome.

Contribution

This study contributes to the body of work on unrecognised psychiatric comorbidity in people living with HIV and AIDS, especially in North-Eastern Nigeria, identifying issues which are relevant to clinical practice and buttressing the need for integration of mental healthcare services into HIV treatment and prevention services.

Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial

OBJECTIVE

Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART).

MATERIALS AND METHODS

This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale.

RESULTS

Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes.

CONCLUSIONS

Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS.

TRIAL REGISTRATION

Thai clinical trial registry (i.e. TCTR =  TCTR20210702002 ).

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

Importance

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

Objective

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

Design, Setting, and Participants

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

Intervention

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

Trial Registration

ClinicalTrials.gov Identifier: NCT03704805.

Characteristics of mental health interventions in a cohort of Italian PLWH over the last five years: impact of HIV disease and outbreak of COVID-19 pandemic

Evidence accumulated during past years confirm that people living with HIV (PLWH) still have to deal with comorbidities and chronic complications that can increase physical and psychological issues and can affect daily functioning, quality of life and mental health. Moreover, during the COVID-19 pandemic PLWH proved to be a population at increased risk of psychological distress. We explored the ongoing issues and the characteristics of the mental health interventions for which a cohort of Italian PLWH interacted with a psychologist over the past five years. We analysed a dataset that included 61 PLWH who underwent a psychological intervention between 2018 and 2022. We compared different frequencies in characteristics of mental health interventions according to different demographic and clinical variables, psychopathological symptoms and time of the request for intervention. We showed that psychopathological symptoms most frequently reported by patients were anxiety (55.7%), and depression (49.2%). Furthermore, we reported that most our patients undertook occasional psychological support meetings (31%), sought an intervention after the outbreak of the COVID-19 pandemic (62.3%) and complained about disclosure issues (48.5%). Disclosure issues were mainly reported by younger PLWH (p = 0.002) with a shorter disease (p = 0.031) and treatment history (p = 0.032), and higher interpersonal sensitivity (p = 0.042). It seems fundamental to integrate psychological interventions into the care of PLWH, to give particular attention to PLWH with risky demographic, clinical and mental health factors and to pay special attention to emergency conditions (such as the COVID-19 pandemic) and the most widespread issues to create ad hoc interventions.

Sociodemographic and Clinical Characteristics Associated With Recent Incarceration Among People With HIV, United States, 2015-2017

OBJECTIVES

We examined sociodemographic, clinical, and behavioral factors associated with previous incarceration among people with diagnosed HIV to inform HIV care efforts for this population.

METHODS

We used 2015-2017 data from a cross-sectional, nationally representative sample of US adults with diagnosed HIV (N = 11 739). We computed weighted percentages and 95% CIs to compare the characteristics of people with HIV incarcerated in the past 12 months (ie, recently) with people with HIV not recently incarcerated. We used adjusted prevalence ratios (aPRs) with predicted marginal means to examine associations between selected factors and incarceration status.

RESULTS

Adults with HIV who were recently incarcerated, when compared with those who were not, were more likely to be aged 18-29 years (prevalence ratio [PR] = 2.51), non-Hispanic Black (PR = 1.39), less educated (

CONCLUSIONS

Among people with HIV, recent incarceration was associated with increased health risks and worse health outcomes. Pre- and postrelease linkage-to-care interventions and reentry services might improve the health of recently incarcerated people with HIV.

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Key Words

• HIV
• correctional health
• incarceration
• justice-involved people

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MESH Headings

• Adult
• Humans
• Cross-Sectional Studies
• HIV Infections/epidemiology
• Prisoners
• United States/epidemiology
• Unsafe Sex
• Adolescent
• Young Adult
• Black or African American

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Grants Collapse

Affiliation(s)

Jovanni V. Reyes Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
Ranell L. Myles Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
Qingwei Luo Strategic Innovative Solutions, LLC, Clearwater, FL, USA
Linda Beer Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
Deron C. Burton Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

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Characterizing the Development of Research Landscapes in Substance Use and HIV/AIDS During 1990 to 2021

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions.

App-Delivered Mindfulness Training to Reduce Anxiety in People with HIV Who Smoke: A One-Armed Feasibility Trial

INTRODUCTION

People with HIV (PWH) who smoke have reported that managing anxiety is a barrier to making a quit attempt and maintaining abstinence post-quit. This study examined the feasibility and acceptability of an app-based mindfulness intervention, Unwinding Anxiety, to reduce anxiety prior to a quit attempt in PWH who were not planning to quit in the next 30 days.

METHODS

Sixteen PWH (mean age 51.5 [SD = 13.2]; mean cigarettes per day 11.4 [SD = 5.4]) were enrolled and followed for eight weeks. A smartphone-based app with 30 modules designed to reduce anxiety was introduced at baseline; participants were encouraged to complete one module daily for four weeks. Symptoms of anxiety and readiness to quit smoking were measured at baseline and weeks 4 and 8. The mean number of modules completed, session attendance, and number of study completers were examined. Generalized estimating equations (GEE) were used to examine changes in self-reported anxiety and readiness to quit at baseline, week 4, and week 8. A brief qualitative interview was conducted at week 4 to explore the acceptability of the app.

RESULTS

Feasibility was high, with 93% of participants completing the study. The mean number of study sessions completed was 2.7 (SD = 0.59), and the mean number of modules completed was 16.0 (SD 16.8). Anxiety was high at baseline (M = 14.4, SD = 3.9), but lower at week 4 (b = -5.5; CI: [-9.4, -1.7]; p = 0.004) and week 8 (b = -5.1; CI: [-8.8, -1.3]; p = 0.008), and stable between weeks 4 and 8 (b = 0.48; CI: [-2.0, 3.0]; p = 0.706). Readiness to quit significantly increased from baseline M = 5.5 (SD = 1.6) to week 4 (b = 0.56; CI: [0.20, 0.91]; p = 0.002) but was not significantly different from baseline at week 8 (b = 0.34; CI: [-0.30, 1.0]; p = 0.30). Ad-hoc moderation analyses found that anxiety had a small significantly positive association with readiness to quit at baseline (main effect: b = 0.10; SE = 0.03; p < 0.001) and significantly attenuated the increase in readiness to quit observed at week 4 (anxiety by week 4 interaction: b = -0.08; SE = 0.03; p = 0.009).

CONCLUSIONS

App-based mindfulness training appears to be feasible and acceptable for PWH who smoke and report baseline anxiety. At week 4, anxiety was reduced and readiness to quit was increased, perhaps a key time point for a smoking cessation attempt.

HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia

HIV stigma is associated with negative physical and mental health outcomes. Intersectional stigma among persons living with HIV (PLHIV) results from interrelated, synergistic impacts of experiencing multiple stigma forms. Its relation with mental health outcomes is still an emerging area of study in this key population. This study aimed to evaluate associations of intersectional stigma, defined as endorsing high levels of HIV and substance use stigmas, with depressive and anxiety symptoms in a cohort of 111 PLHIV who inject drugs in St. Petersburg, Russia. Over a third of participants (37%) reported experiencing intersectional stigma (i.e., both stigma scores above the median). In adjusted analysis, lower Patient Health Questionnaire depression scale (PHQ-9) scores (beta (β=-4.31, 95% CI: -7.11 - -1.51, p = 0.003) and Generalized Anxiety Disorders Scale (GAD-7) scores (β=-3.64, 95% CI: -5.57 - -1.71, p < 0.001) were associated with having low scores for both HIV and substance use stigmas. Lower PHQ-9 scores (β=-3.46, 95% CI: -5.72 - -1.19, p = 0.003) and GAD-7 scores (β=-3.06, 95% CI: -4.62 - -1.50, p < 0.001) were also associated with high stigma on either HIV or substance use stigma scales. Controlling for demographics, depressive symptoms approximately linearly increased from both forms of stigma low to experiencing either form of stigma high to experiencing intersectional stigma, while levels of anxiety symptoms were comparable among participants with both types of stigma low and one stigma high. Participants who experienced intersectional stigma reported the greatest severity of both depressive and anxiety symptoms, as compared to individuals who endorsed low stigma scores (i.e., low stigma on both HIV and substance use stigma scales) or high scores of only one form of stigma. This suggests that intersectional stigma in this population of PLHIV who inject drugs in Russia is linked with worsened mental health outcomes, exceeding the effects of experiencing one form of stigma alone. Interventions to help people cope with intersectional stigma need to consider affective symptoms and tailor coping strategies to address impacts of multiple forms of mental health distress.

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22-1.96], substance use disorders (aRR 1.53, 95% CI 1.19-1.97), serious mental disorders (aRR 1.30, 95% CI 1.09-1.54), and depression (aRR 1.19, 95% CI 1.10-1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15-19 years), and young adults (20-24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes-particularly of adolescents and young adults-and supports strengthening mental health services in HIV treatment programmes.

Exploring core mental health symptoms among persons living with HIV: A network analysis

CONTEXT

Persons living with HIV (PLWH) commonly experience mental health symptoms. However, little is known about the core mental health symptoms and their relationships.

OBJECTIVE

This study aimed to evaluate the prevalence of various mental health symptoms and to explore their relationships in symptom networks among PLWH.

METHODS

From April to July 2022, we recruited 518 participants through convenience sampling in Beijing, China, for this cross-sectional study. Forty mental health symptoms, including six dimensions (somatization symptoms, negative affect, cognitive function, interpersonal communication, cognitive processes, and social adaptation), were assessed through paper-based or online questionnaires. Network analysis was performed in Python 3.6.0 to explore the core mental health symptoms and describe the relationships among symptoms and clusters.

RESULTS

Of the 40 mental health symptoms, the most common symptoms were fatigue (71.2%), trouble remembering things (65.6%), and uncertainty about the future (64.0%). In the single symptom network, sadness was the most central symptom across the three centrality indices (r_S = 0.59, r_C = 0.61, r_B = 0.06), followed by feeling discouraged about the future (r_S = 0.51, r_C = 0.57, r_B = 0.04) and feelings of worthlessness (r_S = 0.54, r_C = 0.53, r_B = 0.05). In the symptom cluster network, negative affect was the most central symptom cluster across the three centrality indices (r_S = 1, r_C = 1, r_B = 0.43).

CONCLUSION

Our study provides a new perspective on the role of each mental health symptom among PLWH. To alleviate the mental health symptoms of PLWH to the greatest extent possible and comprehensively improve their mental health, we suggest that psychological professionals pay more attention to pessimistic mood and cognitive processes in PLWH. Interventions that apply positive psychology skills and cognitive behavioral therapy may be necessary components for the mental health care of PLWH.

Age and Mental Health Symptoms Among Chinese Persons With HIV: The Mediating and Moderating Role of Perceived Discrimination

ABSTRACT

The association between age and mental health symptoms among persons with HIV (PWH) is inconsistent, and little is known about the mediators and moderators of this association. This study aimed to examine the association between age and mental health symptoms, as well as the mediators and moderators of perceived discrimination. Data were from 1,304 PWH who completed a cross-sectional survey in five areas of China. Multiple linear regressions showed that younger age was significantly associated with more severe mental health symptoms and that perceived discrimination moderated this relationship. The Sobel test showed that perceived discrimination also mediated the association between age and mental health symptoms. Our study indicates that perceived discrimination shapes the association between age and mental health symptoms among PWH and highlights the importance of designing age-tailored mental health intervention strategies for perceived discrimination among young PWH. Interventions addressing discrimination are necessary to help improve mental health, especially for young PWH.

How food support improves mental health among people living with HIV: A qualitative study

BACKGROUND

Food insecurity is associated with poor mental health among people living with HIV (PLHIV). This qualitative study explored the mental health experiences of PLHIV participating in a medically appropriate food support program.

METHODS

Semi-structured interviews were conducted post-intervention (n = 34). Interview topics included changes, or lack thereof, in mental health and reasons for changes. Interviews were audio-recorded, transcribed, and double-coded. Salient themes were identified using an inductive-deductive method.

RESULTS

Positive changes in mental health self-reported by PLHIV included improved mood and reduced stress, worry, and anxiety. Participants attributed these changes to: 1) increased access to sufficient and nutritious foods, 2) increased social support, 3) reduced financial hardship, 4) increased sense of control and self-esteem, and 5) reduced functional barriers to eating.

CONCLUSIONS

Medically appropriate food support may improve mental health for some PLHIV. Further work is needed to understand and prevent possible adverse consequences on mental health after programs end.

Anxiety and Associated Factors Among Clients on Highly Active Antiretroviral Therapy (HAART) in Public Hospitals of Southern Ethiopia: A Multi-Center Cross-Sectional Study

Background

Anxiety is an unpleasant feeling of fear, apprehension, and nervousness without any apparent stimulus. Anxiety is one of the co-morbidities that are often overlooked in treating patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Anxiety is worse among people with HIV/AIDS than the general population. Few studies have been conducted on prevalence of anxiety in people receiving antiretroviral treatment and limited evidence is available on its associated factors. Therefore, the objective of this study was to investigate the magnitude and associated factors of anxiety among clients on highly active antiretroviral therapy in public hospitals of Southern Ethiopia.

Methods

An institution-based cross-sectional study was conducted in public hospitals of Southern Ethiopia. Simple random sampling method was used to recruit study participants. Data collection was done by using a structured questionnaire regarding medical data related to HIV/AIDS. Seven items of the Hospital Anxiety and Depression Scale (HADS) were also used to measure the anxiety level. Oslo social support scale and perceived stigma scale were used to measure social support and stigma respectively. Bivariate and multivariate logistic regression analyses were computed with 95% CI to identify different explanatory variables. Significance was declared at p<0.05. Multi-collinearity was checked by variance inflation factors and Hosmer-Lemeshow test was used to check model fitness.

Results

Prevalence of anxiety among clients on HAART in selected public hospitals of Southern Ethiopia was found to be 25.6%. Females (AOR=3.24, 95% CI [1.32, 7.97]), being widowed (AOR=5.47, 95% CI [1.08, 29.72], monthly income 1425-2280 Ethiopian birr (AOR=7.29, 95% CI [2.55, 20.88]), comorbid conditions (AOR=5.47, 95% CI [1.92, 15.62]), perceived stigma (AOR=8.34, 95% CI [3.49, 19.91]) were factors associated with anxiety.

Conclusion

Approximately one-fourth of participants living with HIV/AIDS had anxiety. Being female, widowed, medium income, comorbid conditions, and perceived stigma were significantly associated with anxiety. This finding highlights the importance of mental health assessment, early detection and treatment of anxiety as an integral component of HIV/AIDS care.

Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation

OBJECTIVE

The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH.

METHOD

A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL).

RESULTS

Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities.

CONCLUSIONS

Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.

Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast

INTRODUCTION

Empirical research on the burden and determinants of common mental disorders (CMDs), especially depression and anxiety, among older adults living with HIV (OALWH) in sub-Saharan Africa is inadequate. To bridge the gap in Kenya we: (1) determined the prevalence of CMDs among OALWH on routine HIV care compared to HIV-negative peers; (2) investigated HIV status as an independent predictor of CMDs in older adults; and (3) investigated CMD determinants.

METHODS

In a cross-sectional study conducted between 2020 and 2021, the prevalence of CMDs and associated determinants were investigated at the Kenyan coast among 440 adults aged ≥50 years (257 OALWH). The Patient Health Questionnaire and Generalized Anxiety Disorder scale were administered alongside measures capturing biopsychosocial information. Logistic regression was used to examine the correlates of CMDs.

RESULTS

No significant differences were found in the prevalence of mild depressive symptoms, 23.8% versus 18.2% (p = 0.16) and mild anxiety symptoms, 11.7% versus 7.2% (p = 0.12) among OALWH compared to HIV-negative peers, respectively. HIV status was not independently predictive of CMDs. Among OALWH, higher perceived HIV-related stigma, ageism, increasing household HIV burden, loneliness, increasing functional disability, sleeping difficulties, chronic fatigue and advanced age (>70 years) were associated with elevated CMDs. Among HIV-negative older adults, loneliness, increased medication burden and sleeping difficulties were associated with elevated depressive symptoms. Easier access to HIV care was the only factor associated with lower CMDs among OALWH.

CONCLUSIONS

On the Kenyan coast, the burden of moderate and severe CMDs among older adults is low; however, both OALWH and their HIV-negative peers have a similar relatively high burden of mild depressive and anxiety symptoms. Our results also suggest that determinants of CMDs among OALWH in this setting are predominantly psychosocial factors. These results highlight the need for psychosocial interventions (at the family, community and clinical levels) to mitigate the risks of mild CMDs as they are known to be potentially debilitating.

Contemporary prevalence and predictors of anxiety among patients living with HIV/AIDS in Ghana

Objectives

To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana.

Design

The study employed a cross-sectional design.

Setting

The study was conducted in the outpatient HIV clinic of a tertiary hospital.

Participants

Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study.

Interventions

Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors.

Main outcome measure

Proportion of PLWHA who had HADS score of ≥8.

Results

Overall prevalence of anxiety was 61.0% (95%CI: 56.6 - 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 - 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 - 2.38) and depression (aOR: 13.62, 95%CI: 7.91 - 23.45) were independently associated with anxiety.

Conclusion

In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety.

Funding

This study was funded by a grant from the National Institutes of Health Fogarty International Center (R21 TW010479).

HIV and AIDS in Older Adults: Neuropsychiatric Changes

PURPOSE OF REVIEW

Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population.

RECENT FINDINGS

Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.

Psychiatric Problems in HIV Care

Psychiatric problems associated with HIV/AIDS are many, varied and often bidirectional and they are often neglected. Their presence compromises HIV care and prevention efforts. Unaddressed, they compromise treatment outcomes, increase HIV virus–resistant strains, leave pockets of potential HIV spread in the community and lead to poor quality of life and early death of Persons Living With HIV/AIDS. This chapter focuses on specific HIV-associated mental disorders and their management. However, the mental health problems of HIV/AIDS go beyond disorders to include social, family and community problems such as the problems faced by AIDS orphans, widowhood, family disruptions, multiple deaths, bereavements, poverty, stigma, caregiver burden, education and occupational difficulties etc. All these need to be addressed in holistic HIV care. This calls for more research and integration of mental healthcare in all HIV/AIDS treatment and prevention programs.

The prevalence of depression, anxiety and associated factors among adults with living human immunodeficiency virus in University Malaya Medical Centre

BACKGROUND

This study estimates prevalence of depression and anxiety among adults living with Human Immunodeficiency Virus (HIV) in University Malaya Medical Centre (UMMC) and determines its associated factors.

METHODS

This cross-sectional study was conducted between August 2020 and January 2021, in the Infectious Disease clinic and ward. One hundred ninety-one patients were recruited via convenience sampling. Patients' sociodemographic were obtained, followed by Depression, Anxiety, Stress Scale -21 (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and M.I.N.I. international neuropsychiatric interview (M.I.N.I.) The cut off DASS-21 point for depression is ≥5, for anxiety, ≥ 4. Mann-Whitney U and Chi square test were used to analyse the association between variables, and logistic regression to find predictability.

RESULTS

Of the 191 participants, 89.5% outpatient, mean age 40 years (SD 0.742), 91.1% male, 65.4% single, 71.2% working, 46.1% Malaysian Chinese, 59.8% non- heterosexual, mean 6 years of being HIV positive; mean CD4 count 449/μL; mean viral load 116,690 (median = 20). 85.9% were taking antiretroviral therapy. The prevalence of depression was 35.1% (n = 67); anxiety was 42.9% (n = 82). Regression analysis revealed anxiety and stress increased odds of depression by 3.8 times (p = .001) and 12 times (p < .001) respectively. Those 40 years old and younger had 2.3 times odds of anxiety (p = .048). Increased social support from friends increased odds of anxiety by 1.7 times (p = .018). Depression and stress increased odds of anxiety by 4.4 times (p = .001) and 3.7 times (p = .008) respectively.

CONCLUSIONS

Depression and anxiety among people with HIV is often under-recognised. Early identification and treatment of the mental illness is warranted. Screening with DASS-21 is useful to detect depression in patients with HIV.

Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions

Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.

HIV Symptom Clusters are Similar Using the Dimensions of Symptom Occurrence and Distress

CONTEXT

People living with HIV infection (PLWH) in the United States continue to experience a high symptom burden despite improvements in antiretroviral therapy.

OBJECTIVES

The purpose of this study was to determine if the number and types of symptom clusters differed based on whether symptom occurrence rates or distress ratings were used to create the clusters.

METHODS

Data from 2,000 patients with complete symptom occurrence rates and distress scores on the 20-item HIV Symptom Index from their first ambulatory clinic visit at one of six national HIV centers of excellence in the Center for AIDS Research Network of Integrated Clinical Systems were used in these analyses. Exploratory factor analysis was used to create the symptom clusters.

RESULTS

The same four symptom clusters (i.e., gastrointestinal, psychological, pain, body image) were identified using occurrence rates and distress ratings. For both dimensions of the symptom experience, the psychological, pain, and body image clusters each had the same symptoms. For the gastrointestinal cluster, four symptoms loaded on the occurrence dimension and six symptoms loaded on the distress dimension.

CONCLUSION

The number and types of symptom clusters were relatively similar across the occurrence and distress dimensions of the symptom experience. Symptom clusters in PLWH may provide insights into the development of targeted interventions for multiple co-occurring symptoms.

Factors Influencing Psychological Distress During the COVID-19 Pandemic in People Aging with HIV

Older adults living with HIV may be at increased risk of experiencing distress during the coronavirus disease 2019 (COVID-19) pandemic. We took advantage of a cohort study in older adults living with HIV in Canada (The Positive Brain Health Now [+BHN]) to study the psychological impact of the first wave of the COVID-19 pandemic. A longitudinal study was conducted in which participants in the +BHN study who had access to the internet and agreed to be contacted were queried on symptoms of psychological distress and its predictors each week between mid-April and the end of June 2020. Evolution of distress, measured with the Hospital Anxiety and Depression Scale (HADS), was modeled using Group Based Trajectory Analysis and logistic regression was used to identify factors predictive of psychological distress in the clinical range. The study was approved by the Research Ethics Board of the McGill University Health Center and all participants provided informed consent. The 77 +BHN participants who took part in this study were mostly men (92%) and on average 57.3 years of age. Over the study period, 32.5% experienced psychological distress in the clinical range at one or more weekly surveys. In the transition between the pre-COVID-19 and the COVID-19 periods, the HADS scores followed five distinct trajectories: (1) 39.5 % of the sample, with normal HADS scores in the several months preceding the pandemic, experienced an increase in HADS scores; (2) 30.6% of the sample had normal prepandemic HADS scores, remained stable; and (3) 29.9%, with prepandemic presence of distress, had a decrease in HADS scores. During the first wave of COVID-19, some attenuation in distress was seen over time. Feeling lonely and financial insecurity were associated with distress. Presence of psychological distress during the first wave of the COVID-19 pandemic was not universal among older adults with HIV, with as many as one third of the participants reporting an improvement in mental health. Distress was predicted by loneliness and financial insecurity.

The association between benzodiazepine use and greater risk of neurocognitive impairment is moderated by medical burden in people with HIV

Benzodiazepine use is linked to neurocognitive impairment (NCI) in the general population and people with HIV (PWH); however, this relationship may depend on age-related factors such as medical comorbidities, which occur at an elevated rate and manifest earlier in PWH. We retrospectively examined whether chronological age or medical burden, a clinical marker for aging, moderated the relationship between benzodiazepine use and NCI in PWH. Participants were 435 PWH on antiretroviral therapy who underwent neurocognitive and medical evaluations, including self-reported current benzodiazepine use. A medical burden index score (proportion of accumulated multisystem deficits) was calculated from 28 medical deficits. Demographically corrected cognitive deficit scores from 15 neuropsychological tests were used to calculate global and domain-specific NCI based on established cut-offs. Logistic regressions separately modeled global and domain-specific NCI as a function of benzodiazepine x age and benzodiazepine x medical burden interactions, adjusting for current affective symptoms and HIV disease characteristics. A statistically significant benzodiazepine x medical burden interaction (p = .006) revealed that current benzodiazepine use increased odds of global NCI only among those who had a high medical burden (index score > 0.3 as indicated by the Johnson–Neyman analysis), which was driven by the domains of processing speed, motor, and verbal fluency. No age x benzodiazepine interactive effects on NCI were present. Findings suggest that the relationship between BZD use and NCI among PWH is specific to those with greater medical burden, which may be a greater risk factor for BZD-related NCI than chronological age.

Patient and provider perspectives on self-administered electronic substance use and mental health screening in HIV primary care

Background

Substance use disorders, depression and anxiety disproportionately affect people with HIV (PWH) and lead to increased morbidity and mortality. Routine screening can help address these problems but is underutilized. This study sought to describe patient and provider perspectives on the acceptability and usefulness of systematic electronic, self-administered screening for tobacco, alcohol, other substance use, and mental health symptoms among patients in HIV primary care.

Methods

Screening used validated instruments delivered pre-appointment by both secure messaging and clinic-based tablets, with results integrated into the electronic health record (EHR). Qualitative analysis of semi-structured interviews with 9 HIV primary care providers and 12 patients in the 3 largest HIV primary care clinics in the Kaiser Permanente Northern California health system who participated in a clinical trial evaluating computerized screening and behavioral interventions was conducted. Interviews were audio-recorded and transcribed. A thematic approach was utilized for coding and analysis of interview data using a combination of deductive and inductive methods.

Results

Four key themes were identified: (1) perceived clinical benefit of systematic, electronic screening and EHR integration for providers and patients; (2) usefulness of having multiple methods of questionnaire completion; (3) importance of the patient–provider relationship to facilitate completion and accurate reporting; and (4) barriers, include privacy and confidentiality concerns about reporting sensitive information, particularly about substance use, and potential burden from repeated screenings.

Conclusions

Findings suggest that electronic, self-administered substance use and mental health screening is acceptable to patients and may have clinical utility to providers. While offering different methods of screening completion can capture a wider range of patients, a strong patient–provider relationship is a key factor in overcoming barriers and ensuring accurate patient responses. Further investigation into facilitators, barriers, and utility of electronic screening for PWH and other high-priority patient populations is indicated.

Trial registration ClinicalTrials.gov, NCT03217058. Registered 13 July 2017, https://clinicaltrials.gov/ct2/show/NCT03217058

Supplementary Information

The online version contains supplementary material available at 10.1186/s13722-022-00293-7.

Intimate Partner Violence Victimization and Mental Health Among Men Who Have Sex With Men Living With HIV in Guatemala

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by poor mental health compared to their heterosexual counterparts. One factor that may increase mental health problems among MSM is intimate partner violence (IPV) victimization. The objectives of this study are to (a) describe the prevalence of different forms of IPV victimization experienced by MSM living with HIV in Guatemala City and (b) examine the relationship between IPV victimization and mental health. We analyzed cross-sectional survey data from a cohort of MSM living with HIV in Guatemala City (n = 374) to describe the burden of IPV, including physical, sexual, and emotional IPV. We then examined relationships between lifetime IPV and each form of recent IPV (past 12 months) with self-reported anxiety and depression using multivariable logistic regression. Over a quarter (27.3%) of the participants screened positive for anxiety and nearly one fifth (17.9%) screened positive for depression. Over a quarter of the participants (28.6%) reported ever having experienced any IPV victimization and 8.8% reported having experienced any form of recent IPV. In multivariable analyses, participants who experienced any form of lifetime IPV had roughly twice the odds of experiencing anxiety (OR: 1.86; 95% CI = [1.03, 3.38]) and depression (OR: 2.02; 95% CI = [1.02, 3.99]) compared to those who had not. Participants who experienced recent emotional IPV had over seven times the odds of experiencing anxiety (OR: 7.23; 95% CI = [1.46, 38.85]) compared to those who had not. MSM living with HIV in Guatemala experience a high burden of anxiety, depression, and IPV victimization. Those participants who had experienced lifetime IPV and recent emotional IPV were significantly more likely to screen for anxiety and depression. To improve their mental health, HIV clinics and other health services should provide support for MSM who have experienced IPV victimization.