Depression, social support, and stigma as predictors of quality of life over time: results from an Asha-based HIV/AIDS intervention in India

Can social support mediate stigma and perceived stress in people live with human immunodeficiency virus?

Stigma has heavily impacted People Living with HIV (PLWH). Limited studies report on how social support affects HIV-related stigma and perceived stress, especially in Myanmar. During first seven months of 2020, a random sample of 248 eligible PLWH were contacted from a private, closed Facebook group with more than 18,000 Myanmar people, where 90% of the members were PLWH. Variables collected included demographics data, perceived stress, social support, and HIV stigma. After controlling for the effects of demographic variables, the path from HIV stigma to perceived stress (direct effect β = 0.40) and though the mediation of social support was significant (indirect effect β = 0.014). However, the mediating effect of social support was non-significant between HIV stigma and perceived stress. This exploratory study shows that social support did not have the expected effect of decreasing perceived stress in PLWH in Myanmar. Interventions to reduce HIV stigma to decrease perceived stress should consider other strategies, e.g., spirituality-based practice, to reduce perceived stress in Myanmar PLWH.

Community-Based Intervention Targeting Depressive Symptomatology in Indian Women: An Exploration of Its Efficacy in a Non-Specialized Healthcare Setting

Depressive symptomatology casts a more adverse impact on the well-being of women in countries with unfavourable societal norms. The prevalence of depressive symptomatology in Indian women and the treatment gap in case of mental health issues are alarming and thus may require interventions at a community level. The present study tested the efficacy of a psychosocial community-based intervention in managing depressive symptomatology and associated factors like rumination, reappraisal, psychological resilience, and self-efficacy using a pre-test post-test control group design. A total of 114 (M_age=23.03, SD = 5.29) and 37 (M_age=24.89, SD = 6.44) adult females were there in the experimental and the control group, respectively. A series of ANOVAs showed that participants' scores on depressive symptomatology and associated vulnerabilities and defences improved as compared to the baseline and the control group. The findings support the use of psychosocial community-based intervention in a non-specialized healthcare setting to manage depressive symptomatology, associated vulnerability and defences.

Burden of HIV-related stigma and associated factors among women living with depression accessing PMTCT services in Dar es Salaam, Tanzania

HIV-related stigma represents a potent risk factor for a range of poor health outcomes, including mental health symptoms, treatment non-adherence, and substance use. Understanding the role of HIV-related stigma in promoting healthcare outcomes is critical for vulnerable populations, such as pregnant women living with HIV, in contexts with continued high rates of HIV and associated stigma, such as sub-Saharan Africa. The current study examined a range of risk and protective factors for HIV-related stigma with 742 pregnant women (M age = 29.6 years) living with depression and HIV accessing prevention of mother-to-child transmission of HIV (PMTCT) services in Dar es Salaam, Tanzania. Risk factors included depressive symptoms, ART non-adherence, intimate partner violence, food insecurity, and alcohol problems. Protective factors included disclosure of HIV status, social support, an appreciative relationship with their partner, hope, and self-efficacy. Findings highlight key psychosocial and behavioral determinants of HIV-related stigma for pregnant women living with HIV in Tanzania, and can inform perinatal care programming and interventions to optimize mental health and adherence outcomes.

Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV

PURPOSE OF THE REVIEW

By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches.

RECENT FINDINGS

After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms.

CONCLUSION

Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.

Longitudinal trajectory of the association between quality of life and depression among people living with HIV in China: a mixed effects model

ABSTRACTAlthough depression has been associated with low QOL, limited research has quantified the change of depression to improvement of QOL among naïve PLHIV using ART in Shanghai, China. This study examined the association between depression symptoms and QOL among Chinese PLWH in a six-month longitudinal study. Data were collected from 111 people living with HIV at baseline, 3rd month and 6^th month after initiating ART, using the WHOQOL-HIV BREF and the Center for Epidemiologic Studies Depression Scale (CES-D), and analyzed using a mixed effects model. QOL is improved after initiating ART, while the symptoms of depression did not decrease significantly. The depression symptoms were strong and negatively associated with QOL and all domains of QOL, and the strength of this association decreased over time in the six months follow-up. ART had different impacts on depression symptoms and QOL. Besides, depression symptoms were strong and negatively associated with QOL among PLHIV over time. Mental health practitioners and nurses should consider the ART and time factors when designed interventions to improve QOL by targeting depression symptoms. Interventions designed to improve QOL and depression symptoms should be developed targeting both ART and self-management among PLHIV.

Translation, Adaption, and Psychometric Testing of the Myanmar Version of the Medical Outcomes Study Social Support Survey for People Living With HIV/AIDS

Introduction: Valid and reliable instruments are crucial for measuring perceived social support among people living with HIV (PLHIV). We aimed to investigate the psychometric properties of the English version of the 19-item Medical Outcomes Study Social Support Survey (MOS-SSS) adapted for PLHIV in Myanmar. Methods: Based on a standard cross-cultural procedure, we adapted the MOS-SSS and formed a Myanmar version of the scale (MOS-SSS-M), and then tested its validity and reliability. A sample of 250 eligible PLHIV was collected from a closed Facebook group that included more than 10,000 Myanmars, most of whom were PLHIV. Results: The MOS-SSS-M achieved a Cronbach's α of 0.82-0.95. Confirmatory factor analysis revealed an acceptable fit index for the four-factor structure. Construct validity was demonstrated by significant association with self-reported HIV stigma and stress levels, and further confirmed by the findings of Rasch analysis. Conclusion: The MOS-SSS-M with a four-factor structure can be used to measure the level and categories of perceived social support among PLHIV in Myanmar.

The association between the use of efavirenz and the occurrence of depressive disorders among HIV-treated patients: An application of Bayesian cox regression

OBJECTIVES: Efavirenz therapy plays an important role in controlling the progression of HIV/AIDS. However, efavirenz often causes short-term side effects for the central nervous system, and it remained controversial as to whether efavirenz leads to depression or even suicidal attempt when applied for a longer period of time. The purpose of this study is to determine the association between the use of efavirenz and depressive disorders. METHODS: This study explored the use of efavirenz on HIV-infected patients using National Health Insurance Research Database (NHIRD) in Taiwan by Bayesian survival analysis and investigated whether the use of efavirenz has the risk of depressive disorders. To reduce the dependence of statistical modeling assumptions, this study applied propensity score matching to research data. RESULTS: Based on the result of this study, it can be found that the use of efavirenz (HR = 1.009, 95% CI=–0.505 0.554), gender (HR = 0.324, 95% CI = –2.544 0.381) were not significantly associated with the occurrence of depressive disorders, whereas age of HIV diagnosis (HR = 1.021, 95% CI = 0.011 0.055) was significantly associated with the occurrence of depressive disorders. This study concludes that the use of efavirenz does not in-crease the risk of depressive disorders among HIV-treated patients. CONCLUSIONS: For the care of HIV-infected patients (especially the older ones), the psychological harm from society, such as lack of social support, social stigma or unemployment is higher than the harm of medicine.

Systematic review of interventions to reduce mental health stigma in India

BACKGROUND

Stigma is a barrier for help-seeking, mental health service access, and contributes to the mental health treatment gap. Because the mental health treatment gap is greatest in low- and middle-income countries, it is vital to identify effective strategies to reduce stigma in these settings. To date, there has been a lack of synthesis of findings from interventions to reduce stigma related to mental disorders within India.

METHOD

A systematic review was conducted to provide an overview of the characteristics and effectiveness of stigma reduction interventions studies in India. PubMed, Embase and PsycINFO databases were searched for literature published up to 30th June 2020.

RESULTS

From a total of 1,984 articles identified, only 9 were eligible for final inclusion, published between 1990-2020. No study was found from North, North-East, Central or East India. Most stigma-reduction interventions were multi-level, that is, using a combination of intra-personal, inter-personal and community level strategies to target changes in outcomes of individuals, environments and community groups. Three studies focused on health and stigma-related changes at the organisational/institutional level. No interventions focused on the governmental/structural level. There were only two randomised controlled trials, and two studies focused on all three stigma components of knowledge, attitudes and behaviour. Most interventions were delivered to community members. None focused on mental health professionals as intervention delivery target.

CONCLUSION

There is a need for the development of comprehensive, culturally acceptable evidence-based interventions that act at multiple levels, and involve a mixture of various stigma reducing strategies with multiple target groups.

A retrospective analysis of the care cascades for non-communicable disease and mental health among people living with HIV at a tertiary-care centre in Malaysia: opportunities to identify gaps and optimize care

INTRODUCTION

The rapidly growing epidemic of non-communicable diseases (NCDs) including mental health among aging people living with HIV (PLWH) has put a significant strain on the provision of health services in many HIV clinics globally. We constructed care cascades for specific NCDs and mental health among PLWH attending our centre to identify potential areas for programmatic improvement.

METHODS

This was a follow-up study of participants recruited in the Malaysian HIV & Aging study (MHIVA) from 2014 to 2016 at the University Malaya Medical Centre (n = 336). PLWH on suppressive antiretroviral therapy (ART) for a minimum of 12 months were invited to participate. At study entry, all participants underwent screening for diabetes (DM), hypertension (HTN) and dyslipidaemia; and completed assessments using the depression, anxiety and stress scale (DASS-21). Screening results were recorded in medical charts and clinical management provided as per standard of care. A subsequent review of medical records was performed at 24 months following study completion among participants who remained on active follow-up. Treatment pathways for NCD treatment and psychiatric referrals were assessed based on local practice guidelines to construct the care cascade.

RESULTS

A total of 329 participants (median age = 43 years, 83% male, 100% on ART) completed follow-up at 24 months. The prevalence of diabetes was 13%, dyslipidaemia 88% and hypertension 44%, whereas 23% presented with severe/extremely severe symptoms of depression, anxiety and/or stress. More than 50% of participants with dyslipidaemia and hypertension were not diagnosed until study screening, whereas over 80% with prevalent psychiatric symptoms were not previously recognized clinically. Suboptimal control of fasting lipids, sugar and blood pressure were found in the majority of participants despite optimal HIV treatment outcomes maintained over this same period. Only 32% of participants with severe/extremely severe mental health symptoms received psychiatric referrals and 83% of these attended their psychiatry clinic appointments.

CONCLUSIONS

Systematic screening must be introduced to identify NCDs and mental health issues among PLWH followed by proper linkage and referrals for management of screen-positive cases. Assessment of factors associated with attrition at each step of the care cascade is critically needed to improve health outcomes in our aging patients.

Sex Differences in People Aging With HIV

BACKGROUND

To evaluate differences between older women and men with HIV regarding HIV variables, comorbidity, physical function, and quality of life (QOL).

SETTING

The Modena HIV clinic.

METHODS

Prospective cohort study. Cross-sectional analysis. Patients >50 years were included, stratified by sex. We recorded sociodemographic data, comorbidities, variables related to HIV infection, frailty, data on body composition, physical function, physical activity, and QOL.

RESULTS

We evaluated 1126 older adults with HIV, of which 284 (25.2%) were women. Median age was 55 (IQR 6) years. There were significant differences between women and men in the median current CD4 T-cell and the mean CD4/CD8 ratio. There were differences regarding alcohol consumption, cardiovascular (CV) disease, hypertension, diabetes mellitus, and renal failure. Sarcopenia and slower gait speed were found more prevalent among men, but without significant differences. Significant differences were found regarding lower extremity strength measured by the chair stand test and in the short physical performance battery score. Short physical performance battery <9 was detected for 11.1% women vs. 5.6% men (P = 0.002). EQ5D5L score was 0.87 in women vs. 0.89 in men (P = 0.002).

CONCLUSIONS

In our cohort, older women represented one in 4 of the total patients. Despite the fact that women have better immunological recovery measured by CD4 T-cell count and CD4/CD8 ratio, and fewer CV disease and CV risk factors than men, their physical function and their QOL are worse. Therefore, older HIV-infected women have special characteristics, and the assessment of physical function in this group seems to be crucial.

Effects of Exercise on Memory Interference in Neuropsychiatric Disorders

There are several mechanisms that cause memory impairment, including motivated forgetting, active forgetting, natural decay, and memory interference. Interference occurs when one is attempting to recall something specific, but there is conflicting information making it more difficult to recall the target stimuli. In laboratory settings, it is common to measure memory interference with paired associate tasks-usually utilizing the AB-CD, AB-AC, AB-ABr, or AB-DE AC-FG method. Memory impairments are frequent among those with neuropsychiatric disorders such as depression, schizophrenia, and multiple sclerosis. The memory effects of each condition differ, but are all related to alterations in brain physiology and general memory deterioration. Exercise, or physical activity, has been demonstrated to attenuate memory interference in some cases, but the mechanisms are still being determined. Further research is needed on memory interference, in regard to exercise and neuropsychiatric disorders.

"They Kept Away": Social Isolation of Cisgender Women Living with HIV in Hyderabad, India

Social isolation of cisgender women living with HIV has been recognized as a barrier to early detection of the virus, disclosure of HIV status to partners, and access to healthcare and social work services. The goal of this study is to explore how social isolation and depression affect cisgender women living with HIV in Hyderabad, India. Sixteen cisgender women living with HIV were asked to complete in-depth interviews regarding their experiences with HIV stigma and depression. All interviews were digitally audio-recorded in Hindi or Telugu, then translated, transcribed, and analyzed using thematic content analysis by two to three coders. Three main themes emerged from the qualitative interviews among these cisgender women living with HIV: (1) "They kept away": Experiences with social isolation; (2) "I thought people would think badly about me": Perceived experiences of discrimination; and (3) "I will live till I die": Suicidality, resilience, and gaining hope. Our findings reinforce the need for emphasis on culturally appropriate interventions for depression for cisgender women living with HIV in India, including greater access to mental health resources, greater availability of trained counselors that share the same gender and are native speakers of Hindi or Telugu, and increased family and community support for socially isolated individuals.

Sustained Effect of a Community-based Behavioral and Nutrition Intervention on HIV-related Outcomes Among Women Living With HIV in Rural India: A Quasi-experimental Trial

BACKGROUND

Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression.

SETTING

WLH were recruited from primary health centers in rural India.

METHOD

A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time.

FINDINGS

Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = -0.18, 95% CI: -1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains.

CONCLUSIONS

A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.