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Yotebieng M, Zotova N, Bernard C, Goodrich S, Awoh AR, Watnick D, Nsonde DM, Moungang EFT, Noumedem JLN, Mbongo’o GCN, Minga A, Seydi M, Gandou P, Kwobah EK, Atwoli L, Jaquet A, Wools-Kaloustian K, Anastos K. Accuracy of nine-item Patient Health Questionnaire against psychiatric diagnosis for depression among people with HIV. AIDS 2024; 38:1765-1773. [PMID: 38905494 PMCID: PMC11356670 DOI: 10.1097/qad.0000000000003963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH). DESIGN Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d'Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days. RESULTS Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d'Ivoire, 98 (12.6%) in Kenya, and 103 (13.2%) in Senegal. The area under the curve for PHQ-9 score was generally high ranging from 0.935 [95% confidence interval (CI): 0.893, 0.977] in Cote d'Ivoire to 0.768 (95% CI: 0.589, 0.947) in Congo. However, for the common cut-off score ≥10, sensitivity was low: 50% or lower in Cameroon, Congo and Senegal, 66.7% in Kenya and 70.6% in Cote d'Ivoire. But negative predictive values (NPV) were high: 98.9% (95% CI: 96.9%, 99.8%) in Cameroon, 96.1 (95% CI: 91.1, 98.7) in Cote d'Ivoire, 96.3% (95% CI: 89.7%, 99.2%) in Kenya, 95.7% (95% CI: 90.2%, 98.6%) in Congo, and 89.0% (95% CI: 81.2%, 94.4%) in Senegal. INTERPRETATION Across all countries, PHQ-9 score ≥10 performed very poorly (low sensitivity) as a tool to identify psychiatrist diagnosed depression. However, the observed high NPV suggests it can be used to rule out depression.
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Affiliation(s)
- Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Natalia Zotova
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charlotte Bernard
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Dana Watnick
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Guy Calvin Nko’o Mbongo’o
- Department of Psychiatry, Jamot Hospital, Yaoundé
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Albert Minga
- Centre médical de suivi des donneurs de sang (CNTSCI), Abidjan, Côte d’Ivoire
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
| | - Paul Gandou
- Centre de Traitement Ambulatoire, Brazzaville, Republic of Congo
| | | | - Lukoye Atwoli
- Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret
- Department of Internal Medicine, Medical College East Africa, the Aga Khan University
- Brain and Mind Institute, the Aga Khan University, Nairobi, Kenya
| | - Antoine Jaquet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Njuguna IN, King'e M, Moraa H, Kumar M, Benki-Nugent S, Wagner AD, McGrath CJ, Dorsey S, Ndegwa S, Onyango A, Wamalwa D, John-Stewart G. Cohort profile: longitudinal and population comparison of children who are HIV-exposed uninfected and children who are HIV unexposed in Kenya (HOPE study). BMJ Open 2024; 14:e081975. [PMID: 38844397 PMCID: PMC11163661 DOI: 10.1136/bmjopen-2023-081975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
PURPOSE Globally, the number of children/adolescents exposed to HIV but uninfected (HIV-exposed uninfected, HEU) is growing. The HEU outcomes: population-evaluation and screening strategies study was designed to provide population-level evidence of the impact of HIV and recent antiretroviral therapy regimen exposure on neurodevelopmental, hearing and mental health outcomes from infancy to adolescence. PARTICIPANTS The study includes a prospective mother-infant cohort and cross-sectional child/youth-caregiver cohorts conducted in Kenya.Between 2021 and 2022, the study enrolled 2000 mother-infant pairs (1000 HEU and 1000 HIV-unexposed uninfected (HUU)) for longitudinal follow-up. Infants were eligible if they were aged 4-10 weeks and healthy. Mothers were eligible if their HIV status was known and were ≥18 years. Study visits are 6 monthly until the child reaches age 3 years.Cross-sectional cohorts spanning ages 3-18 years started enrolment in 2022. Target enrolment is 4400 children/youth (4000 HEU and 400 HUU). Children and youth are eligible if they are HIV negative, maternal HIV status and timing of diagnosis is known, and caregivers are ≥18 years.Data on infant/child/youth growth, neurodevelopment, mental health, morbidity and hearing are collected at enrolment using standardised tools. Dry blood spots samples are collected for telomere length assessment at baseline and yearly for the longitudinal cohort. Growth z-scores, neurodevelopmental scores, telomere length and prevalence of developmental and hearing problems will be compared between HEU/HUU populations. FINDINGS TO DATE Full cohort enrolment for the longitudinal cohort is complete and participants are in follow-up. At 1 year of age, comparing HEU to HUU neurodevelopment using the Malawi developmental assessment tool, we found that HEU infants had higher language scores and comparable scores in fine motor, gross motor and social scores. The cross-sectional cohort has enrolled over 2000 participants and recruitment is ongoing. FUTURE PLANS Longitudinal cohort follow-up and enrolment to the cross-sectional study will be completed in June 2024.
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Affiliation(s)
- Irene N Njuguna
- Department of Medical Research, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Maureen King'e
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Helen Moraa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Manasi Kumar
- Grossman School of Medicine, New York University, New York City, New York, USA
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Sarah Benki-Nugent
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anjuli Dawn Wagner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Shannon Dorsey
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Serah Ndegwa
- Departnment of Surgery, University of Nairobi, Nairobi, Kenya
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Deaprtment of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Dawson-Rose C, Weiser SD. Resilient Mothering: An Application of Transitions Theory From Pregnancy to Motherhood Among Women Living With HIV in Western Kenya. ANS Adv Nurs Sci 2024; 47:E20-E39. [PMID: 36656116 PMCID: PMC10354209 DOI: 10.1097/ans.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Efficacious strategies can now prevent the transmission of HIV from mother to child. However, transmission rates remain unacceptably high, especially in sub-Saharan Africa. Understanding women's perinatal transitions can inform interventions to support adherence to preventive strategies. Therefore, we applied Transitions Theory in a longitudinal qualitative study to explore perinatal transitions among women living with HIV in western Kenya. We conducted in-depth interviews with 30 women living with HIV at 3 key time points and, using our findings, described the theory's concepts in terms of participants' experiences. We then proposed theory-based interventions that could support smooth transition processes and positive outcomes.
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Affiliation(s)
- Emily L. Tuthill
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | - Ann E. Maltby
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | | | - Eliud Akama
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi Kenya
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco
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Nelson A, Lebelo K, Cassidy T, Duran LT, Mantangana N, Mdani L, Malabi N, Solomon S, Buchanan K, Hacking D, Bhardwaj V, de Azevedo V, Patel-Abrahams S, Harley B, Hofmeyr C, Schmitz K, Myer L. Postnatal clubs: Implementation of a differentiated and integrated model of care for mothers living with HIV and their HIV-exposed uninfected babies in Cape Town, South Africa. PLoS One 2023; 18:e0286906. [PMID: 37922301 PMCID: PMC10624264 DOI: 10.1371/journal.pone.0286906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/25/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Despite the overall reduction in the HIV mother-to-child transmission (MTCT) rate in South Africa, poor adherence and retention in care during breastfeeding contribute to this period being a major driver of MTCT in South Africa. To improve this retention, postnatal clubs were created as an integrated, differentiated model of care providing psychosocial support and comprehensive care for the mother-infant pairs (MIP), including HIV and under-5-child services. We describe the implementation of these facility-based clubs and examine its health outcomes in a peri-urban primary health care setting in Cape Town, South Africa. METHODS In this prospective cohort study, conducted between June 2016 and December 2019, MIPs were recruited into postnatal clubs between 6 weeks and 6 months of age and followed-up until 18 months of age. Outcomes including maternal Viral Load (VL), and children's HIV testing were compared to a historical control group. Children's immunizations and maternal sexual and reproductive health outcomes are also described. RESULTS During the implementation of the postnatal club study period, 484 MIP were recruited with 84% overall attendance, 95% overall viral load suppression, and 98% overall uptake of HIV infant testing. Compared to historical controls, the club infant rapid test uptake was 1.6 times higher (95% CI: 1.4-1.9) at 9 months and 2.0 times higher at 18 months (95% CI: 1.6-2.6). Through 12 months and between 12-18 months, maternal VL monitoring was higher in the club group compared to the historical control by 1.5 times (95% CI: 1.3-1.6) and 2.6 times (95% CI: 2.1-3.2), respectively, with similar maternal VL suppression. Of 105 infants attending the 12 months visit, 99% were fully vaccinated by one year. CONCLUSION MIP in the postnatal clubs showed better PMTCT outcomes than historical controls with high levels of retention in care. Other outcomes such as immunisation results suggest that integration of services, such as in the postnatal club, is feasible and beneficial for MIPs.
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Affiliation(s)
- Aurelie Nelson
- Médecins Sans Frontières, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Keitu Lebelo
- Médecins Sans Frontières, Cape Town, South Africa
| | - Tali Cassidy
- Médecins Sans Frontières, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | | | | | | | | | | | - Beth Harley
- City of Cape Town Health Department, Cape Town, South Africa
| | - Clare Hofmeyr
- Mothers2mothers, Cape Town, South Africa
- J-PAL Africa, University of Cape Town, Cape Town, South Africa
| | | | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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Lain MG, Chicumbe S, Cantarutti A, Porcu G, Cardoso L, Cotugno N, Palma P, Pahwa R, Pallikkuth S, Rinaldi S, Vaz P, Pahwa S. Caregivers' psychosocial assessment for identifying HIV-infected infants at risk of poor treatment adherence: an exploratory study in southern Mozambique. AIDS Care 2023; 35:53-62. [PMID: 36169018 PMCID: PMC10071299 DOI: 10.1080/09540121.2022.2125159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
Psychosocial support (PSS) to caregivers of HIV-infected infants on antiretroviral treatment (ART) is crucial to ensure ART adherence and sustained long-term viral suppression in children. A specific approach including tools to monitor and understand adherence behavior and risk factors that prevent optimal treatment compliance are urgently needed. This qualitative exploratory study, conducted in southern Mozambique, monitored the infants' viral response trajectories during 18 months follow-up, as a measure of adherence, reviewed the caregiver's PSS session notes and the answers to a study questionnaire, to analyze whether the standard PSS checklist applied to infants' caregivers can identify barriers influencing their adherence. Only 9 of 31 infants had sustained virologic response. Reported factors affecting adherence were: difficulties in drugs administration, shared responsibility to administer treatment; disclosure of child's HIV status to family members but lack of engagement; mother's ART interruption and poor viral response. In conclusion, we found that the standard PSS approach alone, applied to caregivers, was lacking focus on many relevant matters that were identified by the study questionnaire. A comprehensive patient-centered PSS package of care, including an adherence risk factor monitoring tool, tailored to caregivers and their children must be developed.
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Affiliation(s)
| | - Sergio Chicumbe
- Health System and Policy Cluster, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Anna Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Loide Cardoso
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
| | - Nicola Cotugno
- Bambino Gesù Children’s Hospital IRCCS, Department of Pediatrics, Research Unit of Clinical Immunology and Vaccinology, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Paolo Palma
- Bambino Gesù Children’s Hospital IRCCS, Department of Pediatrics, Research Unit of Clinical Immunology and Vaccinology, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Rajendra Pahwa
- Department of Microbiology and Immunology, Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Suresh Pallikkuth
- Department of Microbiology and Immunology, Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stefano Rinaldi
- Department of Microbiology and Immunology, Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paula Vaz
- Fundação Ariel Glaser contra o SIDA Pediátrico, Maputo, Mozambique
| | - Savita Pahwa
- Department of Microbiology and Immunology, Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, USA
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Kulisewa K, Dussault JM, Gaynes BN, Hosseinipour MC, Go VF, Kutengule A, LeMasters K, Meltzer-Brody S, Midiani D, Mphonda SM, Udedi M, Pence BW, Bengtson AM. The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis. BMC Psychiatry 2022; 22:833. [PMID: 36581849 PMCID: PMC9798611 DOI: 10.1186/s12888-022-04476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics. METHODS We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi. We conducted in-depth interviews with the first 4-5 women presenting with PND per site (n = 24 total) from July to August 2018. PND classification was based on a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS). We conducted 10 additional in-depth interviews with HIV and mental health providers at the 5 clinics. RESULTS Most participants endorsed the feasibility of integrated PND screening, as they believed that PND had potential for significant morbidity. Among providers, identified barriers to screening were negative staff attitudes toward additional work, inadequate staffing numbers and time constraints. Suggested solutions to barriers were health worker training, supervision, and a brief screening tool. Patient-centered counselling strategies were favored over medication by WLHIV as the acceptable treatment of choice, with providers supporting the role of medication to be restricted to severe depression. Providers identified nurses as the most suitable health workers to deliver task-shifted interventions and emphasized further training as a requirement to ensure successful task shifting. CONCLUSION Improving PND in a simple, task-shifted intervention is essential for supporting mental health among women with PND and HIV. Our results suggest that an effective PND intervention for this population should include a brief, streamlined PND screening questionnaire and individualized counselling for those who have PND, with supplemental support groups and depression medication readily available. These study results support the development of a PND intervention to address the gap in treatment of PND and HIV among WLHIV in Malawi.
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Affiliation(s)
- Kazione Kulisewa
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Faculty of Medicine, Private Bag 360, Blantyre, Malawi
| | - Josée M Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bradley N Gaynes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- UNC-Project Malawi, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela M Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
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Chorwe-Sungani G, Wella K, Mapulanga P, Nyirongo D, Pindani M. Systematic review on the prevalence of perinatal depression in Malawi. S Afr J Psychiatr 2022; 28:1859. [PMCID: PMC9634823 DOI: 10.4102/sajpsychiatry.v28i0.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Genesis Chorwe-Sungani
- Department of Mental Health, School of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kondwani Wella
- Kamuzu University of Health Sciences Library, Lilongwe, Malawi
| | | | - Ditress Nyirongo
- Department of Mental Health, School of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mercy Pindani
- Department of Mental Health, School of Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Stanton AM, O'Cleirigh C, Knight L, Davey DLJ, Myer L, Joska JA, Mayer KH, Bekker L, Psaros C. The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities. J Int AIDS Soc 2022; 25:e26026. [PMID: 36251124 PMCID: PMC9575939 DOI: 10.1002/jia2.26026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA,Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA
| | - Conall O'Cleirigh
- Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Lucia Knight
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Dvora L. Joseph Davey
- School of Public HealthUniversity of Cape TownCape TownSouth Africa,Division of Infectious Diseases, Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Landon Myer
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Kenneth H. Mayer
- Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA,HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa,Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | | - Christina Psaros
- Massachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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Chorwe-Sungani G, Mwagomba M, Chirwa E, Jere D, Chipps J. Acceptability and feasibility of a screening protocol for antenatal depression (SPADe) in Blantyre District, Malawi. BMC Psychiatry 2022; 22:544. [PMID: 35953774 PMCID: PMC9371629 DOI: 10.1186/s12888-022-04195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression is one of the most common perinatal mental health problems that affect pregnant women. Antenatal depression can adversely affect the well-being of the pregnant woman and her foetus. Depression is rarely detected by midwives due to the unavailability of relevant screening instruments in Malawi. A Screening Protocol for Antenatal Depression (SPADe) was developed and recommended for possible use to screen for depression in antenatal clinics in the country. The acceptability and feasibility of using the SPADe protocol to screen for depression has not been established. The aim of this study was to assess the acceptability and feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre district. METHODS This study used a quantitative survey design to collect data among 60 midwives in three antenatal clinics in primary care settings. All inclusive sampling of all 60 midwives were used. The Structured Assessment of FEasibility and Ottawa Acceptability of Decision Rules Instruments were used to collect the data. Descriptive statistics and Chi square tests were used to analyse the data. RESULTS This study found that it was feasible to implement SPADe and the following enablers for screening depression had the highest ratings: the SPADe is applicable to pregnant women (M = 3.9, sd = 0.4); the intended goal of the SPADe matches the prioritised goals of Malawi Ministry of Health (M = 3.9, sd = 0.5); and the SPADe is likely to be effective (M = 3.8, sd = 0.6). On the other hand, barriers for implementing the SPADe were: the need for specific training to deliver the SPADe (M = 3.7, sd = 0.7); ongoing support and supervision (M = 3.5, sd = 0.8); and additional resources (M = 3.0, sd = 0.9). This study also found that the implementation of the SPADe was acceptable to respondents. The overall mean score for respondents on acceptability of screening antenatal depression using SPADe was found to be high (M = 4.6, sd = 0.6). However the differences in the respondents' mean scores on acceptability of screening for depression in antenatal clinics using SPADe in relation to their demographic characteristics were not significant (p > .05). CONCLUSION This study suggests that midwives feel that it is feasible and acceptable for them to implement the SPADe in antenatal clinics with ongoing training, support and clinical supervision.
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Affiliation(s)
| | - Modesta Mwagomba
- District Nursing Officer, Blantyre District Health and Social Office, Chipatala Avenue, Blantyre, Malawi
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, School of Maternal Neonatal and Reproductive Health, P/Bag 360, Blantyre, Malawi
| | - Diana Jere
- Kamuzu University of Health Sciences, School of Nursing, P/Bag 360, Blantyre, Malawi
| | - Jennifer Chipps
- University of the Western Cape, School of Nursing, Private Bag X17, Bellville, 7535, South Africa
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Bhushan NL, Stockton MA, Harrington BJ, DiPrete BL, Maliwichi M, Jumbe AN, Kulisewa K, Chagomerana MB, Pence BW, Gaynes BN, Hosseinipour MC. Probable perinatal depression and social support among women enrolled in Malawi's Option B+ Program: A longitudinal analysis. J Affect Disord 2022; 306:200-207. [PMID: 35314248 PMCID: PMC9681029 DOI: 10.1016/j.jad.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/19/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malawi's PMTCT Option B+ program has expanded the reach of ART services among pregnant and breastfeeding women, but retention in lifelong HIV care remains challenging. Given that depression can undermine retention, it is important to understand how depression changes over the perinatal period, varies across treatment and retention groups, and could be buffered by social support. METHODS Data are from an observational study conducted among women enrolled in Malawi's PMTCT Option B+ program. We used multilevel generalized linear models to estimate the odds of probable depression by time, treatment and retention group, and social support. Probable depression was assessed with the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9. RESULTS Of 468 women, 15% reported probable depression at antenatal enrollment and prevalence differed across newly diagnosed individuals, second line therapy users, and previous defaulters (18%, 21%, 5%, p = 0.001). Odds of probable perinatal depression decreased over time (OR per month: 0.87, 95% CI: 0.82-0.92) but were higher among those newly diagnosed (OR: 3.25, 95% CI: 1.59-6.65) and on second line therapy (OR: 3.39, 95% CI: 1.44-7.99) as compared to previous defaulters. Odds of probable postpartum depression were lower for participants with high social support (OR: 0.19, 95% CI: 0.09-0.39). LIMITATIONS Lack of diagnostic psychiatric evaluation precludes actual diagnosis of depression. CONCLUSIONS Probable depression varied across the perinatal period and across treatment and retention groups. Social support was protective for postpartum depression among all participants. Depression screening and provision of social support should be considered in PMTCT programs.
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Affiliation(s)
- Nivedita L. Bhushan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Bethany L. DiPrete
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Brian W. Pence
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Mina C. Hosseinipour
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,UNC Project, Lilongwe, Malawi
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Rochat TJ, Dube S, Herbst K, Hoegfeldt CA, Redinger S, Khoza T, Bland RM, Richter L, Linsell L, Desmond C, Yousafzai AK, Craske M, Juszczak E, Abas M, Edwards T, Ekers D, Stein A. An evaluation of a combined psychological and parenting intervention for HIV-positive women depressed in the perinatal period, to enhance child development and reduce maternal depression: study protocol for the Insika Yomama cluster randomised controlled trial. Trials 2021; 22:914. [PMID: 34903257 PMCID: PMC8666837 DOI: 10.1186/s13063-021-05672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The combination of poverty, HIV and depression in the perinatal period represents a major public health challenge in many Southern African countries. In some areas, up to a third of HIV-positive women experience perinatal depression. Perinatal depression is associated with negative effects on parenting and key domains of child development including cognitive, behavioural and growth, especially in socio-economically disadvantaged communities. Several studies have documented the benefits of psychological interventions for perinatal depression in low- and middle-income countries, but none have evaluated an integrated psychological and parenting intervention for HIV-positive women using task-sharing. This randomised controlled trial aims to evaluate the effect of a home-based intervention, combining a psychological treatment for depression and a parenting programme for perinatally depressed HIV-positive women. METHODS This study is a cluster randomised controlled trial, consisting of 48-60 geospatial clusters. A total of 528 pregnant HIV-positive women aged ≥ 16 years who meet the criteria for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥ 9)) are recruited from antenatal clinics in rural KwaZulu-Natal, South Africa. The geospatial clusters are randomised on an allocation ratio of 1:1 to either the intervention or Enhanced Standard of Care (ESoC). The intervention group receives 10 home-based counselling sessions by a lay counsellor (4 antenatal and 6 postnatal sessions) and a booster session at 16 months. The intervention combines behavioural activation for depression with a parenting programme, adapted from the UNICEF/WHO Care for Child Development programme. The ESoC group receives two antenatal and two postnatal counselling support and advice telephone calls. In addition, measures have been taken to enhance the routine standard of care. The co-primary outcomes are child cognitive development at 24 months assessed on the cognitive subscale of the Bayley Scales of Infant Development-Third Edition and maternal depression at 12 months measured by the EPDS. ANALYSIS The primary analysis will be a modified intention-to-treat analysis. The primary outcomes will be analysed using mixed-effects linear regression. DISCUSSION If this treatment is successful, policymakers could use this model of mental healthcare delivered by lay counsellors within HIV treatment programmes to provide more comprehensive services for families affected by HIV. TRIAL REGISTRATION ISRCTN registry # 11284870 (14/11/2017) and SANCTR DOH-27-102020-9097 (17/11/2017).
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Affiliation(s)
- Tamsen J. Rochat
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Samukelisiwe Dube
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
| | | | - Stephanie Redinger
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Thandeka Khoza
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruth Margret Bland
- Institute of Health and Wellbeing and Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chris Desmond
- Priceless, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Ed Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Taygen Edwards
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - David Ekers
- Tees Esk and Wear Valleys NHS FT, Darlington, UK
| | - Alan Stein
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Chorwe-Sungani G, Mwagomba M, Kulisewa K, Chirwa E, Jere D, Chipps J. Protocol for assessing feasibility, acceptability and fidelity of screening for antenatal depression (FAFSAD) by midwives in Blantyre District, Malawi. Pilot Feasibility Stud 2021; 7:32. [PMID: 33494838 PMCID: PMC7836563 DOI: 10.1186/s40814-021-00775-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/18/2021] [Indexed: 12/21/2022] Open
Abstract
Background Depression is often underdiagnosed by treating health professionals. This is a situation in Malawi where there is no routine screening of depression at antenatal clinics. Recently, a Screening Protocol for Antenatal Depression (SPADe) that can be used by midwives to screen for antenatal depression was developed in Blantyre District. SPADe proposes multistage screening of antenatal depression by midwives which may enable early detection and treatment of pregnant women with depression. Proper treatment of antenatal depression can assist in achieving Sustainable Development Goals (SDGs). However, utilisation of SPADe in clinical practice to screening for depression in antenatal clinics has not been established yet. Therefore, the primary aim of this study is to assess feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. The secondary aim was to assess acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. Methods This will be a feasibility study which will consist of scientific investigations that will support movement of evidence-based, effective health care approach, SPADe, from the clinical knowledge base into routine use. This study will consist three phases: phase 1 will introduce SPADe in antenatal clinics in Blantyre District where screening of depression is almost none existent; phase 2 will implement screening of depression using SPADe in antenatal clinics in Blantyre District; and phase 3 will evaluate the screening of antenatal depression using SPADe to establish its feasibility, acceptability and fidelity in antenatal clinics in Blantyre District. Discussion This study will establish and document feasibility, acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. It is expected that midwives will develop more confidence in detecting and dealing with antenatal depression. Consequently, there will be increased numbers of pregnant women detected with depression by midwives and increased accessibility to mental health care by pregnant women in antenatal clinics. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00775-6.
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Affiliation(s)
- Genesis Chorwe-Sungani
- Kamuzu College of Nursing, University of Malawi, Chipatala Avenue, P. O. Box 415, Blantyre, Malawi.
| | - Modesta Mwagomba
- Blantyre District Health Office, Chipatala Avenue, P/Bag 66, Blantyre, Malawi
| | - Kazione Kulisewa
- College of Medicine, University of Malawi, Mahatma Ghandi Rd, P/Bag, 360, Blantyre, Malawi
| | - Ellen Chirwa
- Kamuzu College of Nursing, University of Malawi, Chipatala Avenue, P. O. Box 415, Blantyre, Malawi
| | - Diana Jere
- Kamuzu College of Nursing, University of Malawi, Chipatala Avenue, P. O. Box 415, Blantyre, Malawi
| | - Jennifer Chipps
- University of the Western Cape, Robert Sobukwe Rd, Bellville, Cape Town, 7535, South Africa
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Medeiros FBD, Faria ERD, Piccinini CA. Maternidade e HIV: Continuidade do Tratamento e Adesão em Mulheres após Parto. PSICO-USF 2021. [DOI: 10.1590/1413-82712021260105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O estudo examinou fatores sociodemográficos, clínicos e psicossociais que afetam a continuidade do tratamento e a adesão à medicação antirretroviral em mulheres nos primeiros três meses após o parto. Participaram 56 mulheres vivendo com HIV, com idades entre 18 e 43 anos, na sua grande maioria brancas e casadas. Foram utilizadas entrevistas sobre dados sociodemográficos e clínicos, exames laboratoriais e escalas psicológicas. Análises estatísticas revelaram que mais de um terço das participantes (37,5%) descontinuaram o próprio tratamento após o parto. A qualidade de vida e o apoio instrumental podem favorecer a continuidade do tratamento de HIV após o parto, e as condições de trabalho e a situação clínica dessas mulheres pode afetar a adesão após o parto. Tais resultados podem contribuir para o desenvolvimento de intervenções que favoreçam a continuidade do tratamento e adesão das mulheres no pós-parto.
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Gelaw MM, Zeleke EG, Asres MS, Reta MM. One-Third of Perinatal Women Living with HIV Had Perinatal Depression in Gondar Town Health Facilities, Northwest Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:887-895. [PMID: 33324114 PMCID: PMC7733382 DOI: 10.2147/hiv.s268686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
Background Depression is the most common co-morbidity among perinatal women living with HIV. It affects client’s adherence to care and treatment, which results in increased viral load; further exposing women to opportunistic infections that reduce quality-of-life. A cumulative effect of these may increase mother-to-child transmission of HIV. Methods An institution-based cross-sectional study was conducted among perinatal women living with HIV in Gondar town health facilities, Northwest Ethiopia from October 1–30, 2018. A single population proportion formula was used to calculate the sample size. The sample was stratified and proportionally allocated to each health facility. Participants were chosen from each stratum independently using a simple random sampling technique. A total of 422 study participants were selected. The World Health Organization (WHO) 20-item self-reported questionnaire (SRQ-20) was used to measure perinatal depression among women living with HIV. Perceived stigma was measured using HIV stigma scale. Women were interviewed at the PMTCT clinic during follow-up care, and clinical variables were extracted from client chart. Bi-variable and multivariable logistic regression models were used to identify factors associated with perinatal depression. Variables having an odds ratio with 95% confidence interval and a P-value less than 0.05 were taken as significant variables associated with perinatal depression. Results The prevalence of perinatal depression among women living with HIV was found to be 38.4% (95% CI=34.1–43.1%). Fair and poor ART drug adherence (AOR=5.44; 95% CI= 2.81–10.56%), the presence of comorbid illness (AOR=3.24; 95% CI: 1.83–5.75), being on second line ART (AOR=2.97; 95% CI=1.08–8.17), perceived stigma (AOR=3.61; 95% CI=2.11–6.17), and suicidal ideation (AOR=3.89; 95% CI=1.28–11.81) were factors associated with perinatal depression. Conclusion The prevalence of perinatal depression among women living with HIV was found to be high. Adherence counseling needs to be strengthened; preventing first line treatment failure has to be encouraged; greater emphasis has to be given for those women on second line ART. Early identification and management of co-morbidity has to be considered. HIV positive perinatal women need counseling to reduce HIV-related perceived stigma.
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Affiliation(s)
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institution of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw Asres
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
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LeMasters K, Dussault J, Barrington C, Bengtson A, Gaynes B, Go V, Hosseinipour MC, Kulisewa K, Kutengule A, Meltzer-Brody S, Midiani D, Mphonda S, Udedi M, Pence B. "Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi. PLoS One 2020; 15:e0227935. [PMID: 32502150 PMCID: PMC7274419 DOI: 10.1371/journal.pone.0227935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Perinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi. METHODS We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis. RESULTS Women experienced a double burden of physical and mental illness, expressed as pain in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support. CONCLUSIONS These findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - Josée Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Clare Barrington
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Angela Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Bradley Gaynes
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mina C. Hosseinipour
- UNC-Project Malawi, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | - Michael Udedi
- College of Medicine, University of Malawi, Lilongwe, Malawi
- Ministry of Health, Lilongwe, Malawi
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Velloza J, Njoroge J, Ngure K, Thuo N, Kiptinness C, Momanyi R, Ayub S, Gakuo S, Mugo N, Simoni J, Heffron R. Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya. BMC Psychiatry 2020; 20:31. [PMID: 31996166 PMCID: PMC6990517 DOI: 10.1186/s12888-020-2435-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women. METHODS We administered the Kiswahili or English PHQ-9 (based on preference) to 29 pregnant and postpartum women in Thika, Kenya. Following administration, we conducted cognitive interviews with a purposive sample of 20 women. We used analytic memos and data matrices to identify themes around scale acceptability, comprehension, and decision and response processes. RESULTS Most participants preferred to answer the PHQ-9 in Kiswahili (N = 15; 52%). Among the 20 interview participants, 12 (60%) had scores ≥5, indicating depressive symptoms. Overall, participants found the scale acceptable as an interviewer-administered tool. Participants reported few problems related to comprehension but had difficulty answering items not relevant to their lives (e.g., "watching television") and double-barreled items (e.g., "poor appetite or overeating"). They were hesitant to endorse items related to "duties as a wife and mother" and suicidal ideation. Most participants had difficulty distinguishing between response options of "several days" and "more than half the days". CONCLUSIONS We detected several problems related to PHQ-9 comprehension, decision processes, and response processes. We provide recommended changes to instructions and item wording to improve PHQ-9 validity among Kenyan women.
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Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, USA. .,Department of Epidemiology, University of Washington, Seattle, USA. .,International Clinical Research Center, University of Washington, Box 359927, 325 Ninth Avenue, Seattle, WA, 98104, USA.
| | - John Njoroge
- Partners in Health and Research Development, Nairobi, Kenya
| | - Kenneth Ngure
- 0000 0000 9146 7108grid.411943.aDepartment of Community Health Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nicholas Thuo
- Partners in Health and Research Development, Nairobi, Kenya
| | | | | | - Snaidah Ayub
- Partners in Health and Research Development, Nairobi, Kenya
| | - Stephen Gakuo
- Partners in Health and Research Development, Nairobi, Kenya
| | - Nelly Mugo
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, USA ,Partners in Health and Research Development, Nairobi, Kenya ,0000 0001 0155 5938grid.33058.3dCenter for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Simoni
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, USA ,0000000122986657grid.34477.33Department of Psychology, University of Washington, Seattle, USA
| | - Renee Heffron
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, USA ,0000000122986657grid.34477.33Department of Epidemiology, University of Washington, Seattle, USA
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Christodoulou J, Rotheram-Borus MJ, Bradley AK, Tomlinson M. Home Visiting and Antenatal Depression Affect the Quality of Mother and Child Interactions in South Africa. J Am Acad Child Adolesc Psychiatry 2019; 58:1165-1174. [PMID: 30926571 PMCID: PMC7316421 DOI: 10.1016/j.jaac.2019.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 01/28/2019] [Accepted: 03/19/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine whether maternal depressed mood at birth moderated the protective effect of a home-visiting intervention on the quality of caregiving for children growing up in a low- and middle-income country. METHOD Almost all pregnant mothers in 24 Cape Town neighborhoods were recruited into a cluster randomized controlled trial matched by neighborhoods to the Philani home-visiting condition (HVC) or the standard care condition (SC). At 3 years after birth, the quality of mother-child interactions between HVC and SC mothers with and without antenatal depressed mood was assessed in a representative subset by rating videotaped observations of mother-child interactions on 10 dimensions of caregiving. RESULTS As predicted, maternal depressed mood at birth moderated the effect of the HVC on the quality of mother-child interactions. Among nondepressed mothers, mothers and their children in the HVC scored significantly higher on 5 of the 10 dimensions of the maternal-child interaction scale than mothers in the SC: mothers exhibited more maternal sensitivity, talked more, had more harmonious interactions, and had children who paid more attention and exhibited more positive affect. However, being in the HVC did not significantly affect the mother-child interaction scores among mothers with depressed mood. Among HVC children, those with mothers with depressed mood showed significantly less positive affect and talked less with their mothers than children with nondepressed mothers. SC children with mothers with depressed mood were more responsive and paid attention to their mothers than children with nondepressed mothers. CONCLUSION Home visiting resulted in a better quality of caregiving for mothers without depressive symptoms. Future interventions need to specifically target maternal depression and positive mother-child interactions. CLINICAL TRIAL REGISTRATION INFORMATION Mentor Mothers: A Sustainable Family Intervention in South African Townships; https://clinicaltrials.gov; NCT00972699; Philani Home-based Nutrition Intervention Program; https://clinicaltrials.gov; NCT00995592.
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Affiliation(s)
| | | | - Alexandra K Bradley
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa; School of Nursing and Midwifery, Queens University, Belfast, UK
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Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania. PLoS One 2019; 14:e0224515. [PMID: 31671160 PMCID: PMC6822761 DOI: 10.1371/journal.pone.0224515] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mental health disorders in pregnant women living with HIV are associated with poor maternal and child outcomes, and undermine the global goals of prevention of mother-to-child transmission of HIV (PMTCT). This study aimed to determine prevalence of depression and anxiety and identify factors associated with these common mental health disorders among HIV-infeced pregnant women in Tanzania. METHODS We enrolled 200 pregnant women living with HIV from antenatal care clinics in the Kilimanjaro region. Women were eligible if they were in the second or third trimester of pregnancy and had been in PMTCT care for a minimum of one month. Data were collected via interviewer administered surveys. Participants self reported depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and anxiety symptoms (Brief Symptom Index, BSI). Multivariate logistic regression models examined factors associated with depression, anxiety, and comorbid depression and anxiety. RESULTS 25.0% of women met screening criteria for depression (EPDS ≥10). Depression was significantly associated with being single (aOR = 4.2, 95% CI = 1.1-15.5), food insecurity (aOR = 2.4, 95% CI = 1.0-6.4), and HIV shame (aOR = 1.2, 95% CI = 1.1-1.3). 23.5% of participants met screening criteria for anxiety (BSI ≥1.01). Anxiety was associated with being single (aOR = 3.6, 95%CI = 1.1-11.1), HIV shame (aOR = 1.1, 95% CI = 1.1-1.2) and lifetime experience of violence (aOR = 2.3, 95% CI = 1.0-5.1). 17.8% of the sample met screening criteria for both depression and anxiety. Comorbid depression and anxiety was associated with being single (aOR = 4.5, 95%CI = 1.0-19.1), HIV shame (aOR = 1.2, 95%CI = 1.1-1.3) and lifetime experience of violence (aOR = 3.4, 95% CI = 1.2-9.6). CONCLUSION Depression and anxiety symptomatology was common in this sample of pregnant women living with HIV, with a sizable number screening positive for comorbid depression and anxiety. In order to successfully engage women in PMTCT care and support their well-being, strategies to screen for mental health disorders and support women with mental illnesses are needed.
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Jones DL, Rodriguez VJ, Alcaide ML, Weiss SM, Peltzer K. The Use of Efavirenz During Pregnancy is Associated with Suicidal Ideation in Postpartum Women in Rural South Africa. AIDS Behav 2019; 23:126-131. [PMID: 29959721 DOI: 10.1007/s10461-018-2213-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Efavirenz is used for the management of HIV infection during pregnancy in South Africa (SA), but it is contraindicated in patients with history of depression due to possible suicidal ideation. This study compared suicidal ideation 12-months postpartum among women receiving and not receiving efavirenz in rural SA, where high rates of depression have been identified. Antenatal psychological intimate partner violence (IPV; AOR = 1.04), depression (AOR = 1.06) and detection of efavirenz in dried blood spot at 32 weeks predicted suicidal ideation 12-months postnatally (AOR = 2.29), controlling for antenatal stigma and physical IPV. Findings support using alternative agents for the management of HIV during pregnancy.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA.
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
- Ford Foundation Fellow, National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA
| | - Karl Peltzer
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
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Rodriguez VJ, Matseke G, Cook R, Bellinger S, Weiss SM, Alcaide ML, Peltzer K, Patton D, Lopez M, Jones DL. Infant Development and Pre- and Post-partum Depression in Rural South African HIV-Infected Women. AIDS Behav 2018; 22:1766-1774. [PMID: 28986652 DOI: 10.1007/s10461-017-1925-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV-exposed infants born to depressed women may be at risk for adverse developmental outcomes. Half of HIV-infected women in rural South Africa (SA) may suffer from pregnancy-related depression. This pilot study examined the impact of depression in HIV-infected women in rural SA on infant development. Mother-infant dyads (N = 69) were recruited in rural SA. Demographics, HIV disclosure, depression, male involvement, and alcohol use at baseline (18.35 ± 5.47 weeks gestation) were assessed. Male involvement, depression, infant HIV serostatus and development were assessed 12 months postnatally. Half of the women (age = 29 ± 5) reported depression prenatally and one-third reported depression postnatally. In multivariable logistic regression, not cohabiting with their male partner, nondisclosure of HIV status, and postnatal depression predicted cognitive delay; decreased prenatal male involvement predicted delayed gross motor development (ps < 0.05). Assessing pregnancy-related depression among HIV-infected women and infant development and increasing male involvement may reduce negative developmental outcomes among HIV-exposed or infected infants.
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Peltzer K, Rodriguez VJ, Jones D. Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa. SAHARA J 2017; 13:60-7. [PMID: 27250738 PMCID: PMC4955403 DOI: 10.1080/17290376.2016.1189847] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to assess the prevalence of depressed symptoms and associated factors in prenatal HIV-positive women in primary care facilities in rural South Africa. In a cross-sectional study, 663 HIV-positive prenatal women in 12 community health centres in Mpumalanga province, South Africa, were recruited by systematic sampling (every consecutive patient after HIV post-test counselling). Results indicate that overall, 48.7% [95% CI: 44.8, 52.6] of women during the prenatal period reported depressed mood (scores of ≥ 13 on the Edinburgh Postnatal Depression Scale 10). In multivariate analysis, not being employed, unplanned pregnancy, not having an HIV-positive child, poor antiretroviral therapy adherence, non-condom use at last sex, and intimate partner violence were associated with depressive symptoms. Potential risk factors among HIV-infected prenatal women were identified which could be utilized in interventions. Routine screening for depression may be integrated into prenatal care settings.
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Affiliation(s)
- Karl Peltzer
- a PhD, is a distinguished Research Fellow in HIV/AIDS/STIs and TB (HAST) Research Programme , Human Sciences Research Council , Pretoria , South Africa.,b is a Professor at the ASEAN Institute for Health Development , Mahidol University , Salaya , Thailand.,c is a Research Associate in the Department of Research & Innovation , University of Limpopo , Sovenga , South Africa
| | - Violeta J Rodriguez
- d MSEd, is a Research Associate in Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , USA
| | - Deborah Jones
- e PhD, is a Professor in Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , USA
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Tuthill EL, Pellowski JA, Young SL, Butler LM. Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding. AIDS Behav 2017; 21:1691-1698. [PMID: 27752868 DOI: 10.1007/s10461-016-1557-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28-42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.
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Affiliation(s)
- Emily L Tuthill
- UCSF School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA, 94143-0608, USA.
| | - Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sera L Young
- Department of Anthropology, Institute for Policy Research Northwestern University, Evanston, IL, USA
| | - Lisa M Butler
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, USA
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Yotebieng KA, Fokong K, Yotebieng M. Depression, retention in care, and uptake of PMTCT service in Kinshasa, the Democratic Republic of Congo: a prospective cohort. AIDS Care 2016; 29:285-289. [PMID: 27819151 DOI: 10.1080/09540121.2016.1255708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is a clear need for effective strategies to address the factors that affect retention, or lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and (1) LTFU or (2) uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly diagnosed HIV-infected women in Kinshasa, DRC.
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Affiliation(s)
- Kelly A Yotebieng
- a Department of Anthropology , The Ohio State University , Columbus , OH , USA
| | - Kunuwo Fokong
- b Division of Epidemiology , The Ohio State University, College of Public Health , Columbus , OH , USA
| | - Marcel Yotebieng
- b Division of Epidemiology , The Ohio State University, College of Public Health , Columbus , OH , USA
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Narasimhan M, Loutfy M, Khosla R, Bras M. Sexual and reproductive health and human rights of women living with HIV. J Int AIDS Soc 2015; 18:20834. [PMID: 28326129 PMCID: PMC4813610 DOI: 10.7448/ias.18.6.20834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Orza L, Bewley S, Logie CH, Crone ET, Moroz S, Strachan S, Vazquez M, Welbourn A. How does living with HIV impact on women's mental health? Voices from a global survey. J Int AIDS Soc 2015; 18:20289. [PMID: 26643460 PMCID: PMC4672402 DOI: 10.7448/ias.18.6.20289] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/05/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Women living with HIV experience a disproportionate burden of mental health issues. To date, global guidelines contain insufficient guidance on mental health support, particularly regarding perinatal care. The aim of this article is to describe the extent and impact of mental health issues as experienced by women living with HIV on their sexual and reproductive health and human rights (SRH&HR). METHODS A global, mixed-methods, user-led and designed survey on SRH&HR of women living with HIV was conducted using snowball sampling, containing an optional section exploring mental health issues. Statistical quantitative data analysis included descriptive statistics, correlation and multiple linear regression analysis for the mental health responses. Thematic analysis of open free-text responses was performed for qualitative data. RESULTS A total of 832 respondents from 94 countries participated in the online survey with 489 responses to the optional mental health section. Of the respondents, 82% reported depression symptoms and 78% rejection. One-fifth reported mental health issues before HIV diagnosis. Respondents reported experiencing a 3.5-fold higher number of mental health issues after diagnosis (8.71 vs 2.48, t[488]=23.00, p<0.001). Nearly half (n=224; 45.8%) had multiple socially disadvantaged identities (SDIs). The number of SDIs was positively correlated with experiencing mental health issues (p<0.05). Women described how mental health issues affected their ability to enjoy their right to sexual and reproductive health and to access services. These included depression, rejection and social exclusion, sleep problems, intersectional stigma, challenges with sexual and intimate relationships, substance use and sexual risk, reproductive health barriers and human rights (HR) violations. Respondents recommended that policymakers and clinicians provide psychological support and counselling, funding for peer support and interventions to challenge gender-based violence and to promote HR. CONCLUSIONS Interventions addressing intersecting stigmas and any especial impacts of diagnosis during pregnancy are required to ensure women's SRH&HR. Global policy guidelines regarding women living with HIV must incorporate mental health considerations.
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Affiliation(s)
- Luisa Orza
- ATHENA Network, London, UK
- Salamander Trust, London, UK
| | - Susan Bewley
- Women's Health Academic Centre, King's College London, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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