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Di Gennaro F, Papagni R, Segala FV, Pellegrino C, Panico GG, Frallonardo L, Diella L, Belati A, Santoro CR, Brindicci G, Balena F, Bavaro DF, Montalbò D, Guido G, Calluso L, Di Tullio M, Sgambati M, Fiordelisi D, De Gennaro N, Saracino A. Stigma and mental health among people living with HIV across the COVID-19 pandemic: a cross-sectional study. BMC Infect Dis 2024; 24:423. [PMID: 38649892 PMCID: PMC11034033 DOI: 10.1186/s12879-024-09315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Mental health (MH) is extremely relevant when referring to people living with a chronic disease, such as people living with HIV (PLWH). In fact - although life expectancy and quality have increased since the advent of antiretroviral therapy (ART) - PLWH carry a high incidence of mental disorders, and this burden has been exacerbated during the COVID-19 pandemic. In this scenario, UNAIDS has set new objectives for 2025, such as the linkage of at least 90% of PLWH to people-centered, context-specific MH services. Aim of this study was to determine the prevalence of MD in PLWH followed at the Clinic of Infectious Diseases of the University of Bari, Italy. METHODS From January 10th to September 10th, 2022, all PLWH patients accessing our outpatient clinic were offered the following standardized tools: HAM-A for anxiety, BDI-II for depression, PC-PTSD-5 for post-traumatic stress disorder, CAGE-AID for alcohol-drug abuse. Factors associated with testing positive to the four MD were explored with a multivariable logistic regression model. RESULTS 578 out of 1110 HIV-patients agreed to receive MH screening, with 141 (24.4%) people resulting positive to at least one MH disorder. HAM-A was positive in 15.8% (n = 91), BDI-II in 18% (n = 104), PC-PTSD-5 in 5% (n = 29) and CAGE in 6.1% (n = 35). The multivariable logistic regression showed a higher probability of being diagnosed with anxiety, depression and post-traumatic stress disorder for PLWH who reported severe stigma, social isolation, psychological deterioration during the COVID-19 pandemic and for those receiving a dolutegravir (DTG)-based regimen. Moreover, history of drug use (OR 1.13; [95% CE 1.06-4.35]), family stigma (2.42 [1.65-3.94]) and social isolation (2.72 [1.55;4.84]) were found to be associated to higher risk for substance use disorder. CONCLUSIONS In this study, stigma was a strong predictor for being diagnosed of a MH disorder among PLWH. Also, the possible role of dolutegravir as a risk factor for the onset of MH disorders should be considered in clinical practice, and MH of patients receiving DTG-containing regimens should be constantly monitored.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy.
| | - Carmen Pellegrino
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Gianfranco Giorgio Panico
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Alessandra Belati
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Carmen Rita Santoro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Flavia Balena
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Domenico Montalbò
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | | | | | - Margherita Sgambati
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari 'Aldo Moro', Bari, Italy
| | - Deborah Fiordelisi
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Nicolò De Gennaro
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Disases, Department of Precision and Regenerative Medicine and Jonian Area - (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
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Ciccacci F, Ismael F, Chume V, Ruth L, Mbula P, Orlando S, Majid NA, Marazzi MC. Enhancing retention in care in HIV-infected adolescents during COVID-19 in Mozambique: results from the DREAM program. Int J Adolesc Med Health 2023; 35:227-231. [PMID: 36708359 DOI: 10.1515/ijamh-2022-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Around 1,7 million adolescents aged 10-19 years worldwide are infected with HIV, 84% of them living in Sub-Saharan Africa. Mozambique is one of the countries with the highest prevalence of HIV in the world. According to UNAIDS, HIV services for adolescents should be tailored and specifically designed for them. METHODS We aimed to evaluate a package of activities to enhance the retention of HIV-infected adolescent in Mozambique. We retrospectively reviewed routine data from 7 health centers involved in 26 months, from March 2020 to May 2022. A package of tailored interventions was implemented in all the sites. We reviewed activity data from the included centers. RESULTS The median number of patients per center was 343 (IQR: 289-466) at the beginning of the period and 395 (IQR: 322-453) at the end. The median overall retention in care and rate of lost to follow-up at the beginning and the end of the period were respectively: 94.2% (IQR 91.9-97.3%) to 99.0% (IQR 96.8-99.5%), 1.5% (IQR 1-3.2%) to 0% (IQR 0.0-0.3%). The total number of deaths increased reaching a plateau after September 2021. All the indicators improved after the beginning of the intervention, also during COVID-19 pandemic. CONCLUSIONS Our data support the idea that enhancing retention in care for HIV positive adolescents need tailored interventions, based on deep rooting in the specific social context. Tailored intervention can resist external shock such as COVID-19.
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Affiliation(s)
- Fausto Ciccacci
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Flavio Ismael
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Veronica Chume
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Lina Ruth
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Pedro Mbula
- DREAM program, Community of Sant'Egidio, Beira, Mozambique
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Torvergata, Rome, Italy
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Knight L, Schatz E. Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11473. [PMID: 36141746 PMCID: PMC9517460 DOI: 10.3390/ijerph191811473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants' disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH's health outcomes.
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Affiliation(s)
- Lucia Knight
- Division of Social & Behavioural Sciences, School of Public Health, University of Cape Town, Rondebosch, Cape Town 7701, South Africa
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA
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