Identifying factors associated with depression among men living with HIV/AIDS and undergoing antiretroviral therapy: a cross-sectional study in Heilongjiang, China

Factors Associated With Symptoms of Anxiety and Depression in People Living With HIV in Northeast Brazil

BACKGROUND

The diagnosis of HIV infection can cause mental disorders or exacerbate existing symptoms because of the stigma, psychological stress, and need for the self-management of the illness. The aim of this study was to determine the prevalence of anxiety and depression symptoms in people with HIV and to identify the associated factors.

METHODS

This is a cross-sectional study. A sample of 385 people living with HIV (PLWH) was interviewed using the Sociodemographic, Epidemiological, and Clinical Form; the Beck Anxiety Inventory; the Beck Depression Inventory; and Pittsburgh Sleep Quality Index. Univariate and multivariate logistic regression analysis were performed. The odds ratio and 95% confidence interval were calculated.

RESULTS

The prevalence of anxiety was 27.1% and depression was 39.8%. Being female (P = 0.0227), antiretroviral therapy (ART) for 8 years or less (P = 0.0042), and having depression (P < 0.0001) were associated with the occurrence of anxiety. Having a detectable viral load (P = 0.0476), not exercising regularly (P = 0.0070), and having sleep disorders (P = 0.0001) and anxiety (P < 0.0001) were associated with depression. Retired and on leave or sick pay were, respectively, 2.67 and 3.90 times more likely to have depression than those who were employed.

CONCLUSIONS

A considerable percentage of PLWH have anxiety and depression symptoms. Being female, less than 8 years of ART, and depression are associated with anxiety, while detectable viral load, not practicing physical exercise, having sleep disorders, anxiety, and being retired or on leave or sick pay are associated with depression. The study showed important data for health interventions by members of the multidisciplinary team for PLWH.

Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia

Depression is the most frequently detected and preventable mental illness among people with human immunodeficiency syndrome, with rates two to four times higher than in the general population. Currently, depression is estimated to affect 350 million people worldwide. To assess the prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Adama Hospital Medical College, Adama, Central Ethiopia. An institutional-based cross-sectional study was conducted from April 01 to September 30, 2021, at Adama Hospital Medical College, Adama, Ethiopia. A total of 420 individuals were selected using a systematic random sampling technique. After informed consent was obtained from each study participant, data were collected through face-to-face interviews, observations, and document reviews. Subsequently, the data were entered into EPI-Info Version 7 and analyzed by Statistical Package for the Social Sciences version 21. Variables with p-values less than 0.25 in the univariable logistic regression analysis were subsequently included in the multivariable logistic regression analysis to account for potential confounding factors. The association was measured using adjusted odds ratio (AOR) with a 95% confidence interval (CI), and variables with p-values less than 0.05 were considered statistically significant. The prevalence of depression was 52.4% (95% CI 47.6-57.1). Factors significantly associated with depression among HIV-positive patients on antiretroviral therapy included employment status [AOR = 0.22(95% CI 0.13-0.36)], the patient's most CD4 count [AOR = 6.99 (95% CI 2.81-17.38)], duration of months on antiretroviral therapy [AOR = 5.05 (95% CI 2.38-10.74)] and presence of chronic non-communicable diseases [AOR = 7.90 (95% CI 4.21-14.85)]. The highest proportion of HIV-positive patients taking antiretroviral drugs exhibited depression. Employment was identified as a preventive factor, whereas having a low CD4 count, recently initiating antiretroviral therapy, and having chronic non-communicable diseases were associated with increased odds of depression among HIV-positive patients on antiretroviral therapy. There need to strengthen mental health screening and treat depression among HIV-positive patients, particularly by targeting identified factors.

The relationship between social support and depression among HIV-positive men who have sex with men in China: the chain mediating role of psychological flexibility and hope

Introduction

HIV and mental health problems are a global syndemic. One key issue is that the significant mental health problems among people vulnerable to acquiring or living with HIV have not been fully addressed. Access to social support has been one of the biggest challenges for HIV-positive men who have sex with men (HIV+ MSM). Lower social support has been linked to more severe depression symptoms. However, the mechanisms underlying the association between social support and depression in HIV+ MSM are unclear. Two possible mediators include hope and psychological flexibility. This study aimed to examine the relationship between social support and depression in HIV+ MSM and to explore the single mediating effects of hope and psychological flexibility and the chain mediating effect of these two variables on this relationship.

Methods

A convenience sample was used to recruit participants from the designated HIV/AIDS hospital in Changsha city, Hunan Province of China. A total of 290 HIV+ MSM completed questionnaires.

Results

Our findings showed that hope mediated the relationship between social support and depression in HIV+ MSM. Furthermore, the chain mediation model confirmed a direct negative association between social support and depression, but this relationship was largely mediated by the chain effects of hope and psychological flexibility.

Conclusions

Integrating hope and psychological flexibility into interventions may provide better mental health support for HIV+ MSM and improve their wellbeing and quality of life.

Determinants of Depressive Symptoms in People Living with HIV: Findings from a Population-Based Study with a Gender Perspective

Depressive symptoms are common among people living with HIV (PLWH). The aim of this study was to identify the determinants of depressive symptoms in PLWH in Spain. A total of 1060 PLWH participated in this cross-sectional study and completed the Patient Health Questionnaire-9. The odds ratios for the presence of depressive symptoms were analyzed in a multivariable logistic regression model, including sociodemographic data, comorbidities, health-related behaviors, and social-environment-related variables. We found an overall prevalence of depressive symptoms of 21.42%; by subgroup, namely men, women, and transgender persons, prevalence was 18.13%, 32.81%, and 37.14%, respectively. Moreover, social isolation (OR = 1.05 [CI, 1.02-1.08]) and poor physical and mental quality of life (OR = 1.06 [CI, 1.02-1.09] and OR = 1.13 [CI, 1.09-1.17], respectively) were associated with depressive symptoms. As protective factors, we identified serodisclosure to more people (vs. none; OR = 0.39 [CI, 0.17-0.87]), satisfaction with social roles (OR = 0.86 [CI, 0.79-0.94]), better cognitive function (OR = 0.92 [CI, 0.89-0.95]), and sexualized drug use once in a lifetime (OR = 0.52 [CI, 0.29-0.93]). This study showed a high prevalence of depressive symptoms in PLWH, especially among women and transgender people. The association between psychosocial variables and depressive symptoms highlights the multidimensionality of the problem and identifies areas for intervention. This study found that the management of mental health issues is an area that needs to be improved and tailored to specific groups, with the aim of enhancing the well-being of PLWH.

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

ABSTRACT

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

Risk factors for depressive symptoms by age group among human immunodeficiency virus-infected adults in Korea

We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Validity of the patient health questionnaires (phq-2 and phq-9) for screening depression among human immunodeficiency virus patients in Lahore, Pakistan

BACKGROUND

Many human immunodeficiency virus (HIV) infected patients suffer from depr-ession, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments.

AIM

To determine the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis, and the sensitivity and specificity of the PHQ-2 in HIV infected patients.

METHODS

A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed.

RESULTS

The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998).

CONCLUSION

Good psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population.

Application of machine learning algorithms in predicting HIV infection among men who have sex with men: Model development and validation

Background

Continuously growing of HIV incidence among men who have sex with men (MSM), as well as the low rate of HIV testing of MSM in China, demonstrates a need for innovative strategies to improve the implementation of HIV prevention. The use of machine learning algorithms is an increasing tendency in disease diagnosis prediction. We aimed to develop and validate machine learning models in predicting HIV infection among MSM that can identify individuals at increased risk of HIV acquisition for transmission-reduction interventions.

Methods

We extracted data from MSM sentinel surveillance in Zhejiang province from 2018 to 2020. Univariate logistic regression was used to select significant variables in 2018-2019 data (P < 0.05). After data processing and feature selection, we divided the model development data into two groups by stratified random sampling: training data (70%) and testing data (30%). The Synthetic Minority Oversampling Technique (SMOTE) was applied to solve the problem of unbalanced data. The evaluation metrics of model performance were comprised of accuracy, precision, recall, F-measure, and the area under the receiver operating characteristic curve (AUC). Then, we explored three commonly-used machine learning algorithms to compare with logistic regression (LR), including decision tree (DT), support vector machines (SVM), and random forest (RF). Finally, the four models were validated prospectively with 2020 data from Zhejiang province.

Results

A total of 6,346 MSM were included in model development data, 372 of whom were diagnosed with HIV. In feature selection, 12 variables were selected as model predicting indicators. Compared with LR, the algorithms of DT, SVM, and RF improved the classification prediction performance in SMOTE-processed data, with the AUC of 0.778, 0.856, 0.887, and 0.942, respectively. RF was the best-performing algorithm (accuracy = 0.871, precision = 0.960, recall = 0.775, F-measure = 0.858, and AUC = 0.942). And the RF model still performed well on prospective validation (AUC = 0.846).

Conclusion

Machine learning models are substantially better than conventional LR model and RF should be considered in prediction tools of HIV infection in Chinese MSM. Further studies are needed to optimize and promote these algorithms and evaluate their impact on HIV prevention of MSM.

Prevalence of depression and associated factors among people living with HIV/AIDS in public hospitals of Southeast Ethiopia

BACKGROUND

Depression is the most frequent mental health condition among human immune deficiency virus or acquired immune deficiency syndrome (HIV/AIDS) patients. It has been related to negative health outcomes. This could lead to hospitalization and an increase in medical expenses. This study aimed to assess the prevalence of depression and associated factors among HIV/AIDS patients in public hospitals Bale Zone, Southeast Ethiopia.

METHODS

A hospital-based cross-sectional study design was randomly employed among 554 study participants. A systematic random sampling technique was used to select the study subjects. A structured Patients Health Questionnaires- 9 was used to measure the depression status of HIV/AIDS patients. Data were collected using a pretested interviewer administered structured questionnaire as well as review of patients medical charts or records. Descriptive statistics were computed. Multivariable logistic regression analyses were conducted identify factors associated with the prevalence of depression. Adjusted odds ratio (AOR), along with a 95% confidence interval (CI), was used to estimate the strength of the association. A p-value of < 0.05 was considered statistically significant.

RESULTS

The prevalence of depression among the study participants was found to be 44.9% (95% CI: 40.79%, 49.1%). Perceived HIV related stigma is the single most dominant predictor of depression [(AOR = 8.2, 95% CI: (4.96, 13.68)], low income level [(AOR = 3.1, 95% CI: (1.59, 6.22)] Experiencing any form of a side effect of highly active anti-retroviral therapy (HAART) [(AOR = 1.5, 95% CI: (1.04, 2.56)], having normal BMI [(AOR = 0.49, 95% CI: (0.29, 0.8)] being HIV patients at WHO clinical stage II [(AOR = 0.44, 95% CI: (0.22, 0.9)], were significantly associated with prevalence of depression.

CONCLUSION

The study revealed that the prevalence of depression among people living with HIV in the study settings was high, almost two out of every five HIV patients were depressed. Low income level, side effect to HAART, and having HIV related stigma were more likely to suffer from depression.

Chinese version of the auditory verbal learning test: normative study and clinical applications in Chinese-speaking population in Shijiazhuang city

OBJECTIVE

The purposes were to establish standardized values for the Auditory Verbal Learning Test (AVLT) in the communities of Shijiazhuang city (China), with particular focus on the influences of age, education and sex, and to detect the discriminant validity data of the AVLT in patients with acute ischemic stroke (AIS).

METHODS

406 Chinese-speaking subjects (age: 50-84 years old) from Shijiazhuang city, were brought into this study. Using linear regression analyses, standardized values were developed for three variables of interest, including scores on short-term memory (sum of AVLT trials 1-3), delayed recall (AVLT trial 4), and an index representing recognition memory corrected for false-positive identifications (AVLT trial 5). 177 patients with AIS were included to probe the discriminant validity of the AVLT.

RESULTS

The linear regression analysis showed statistically significant effect of age and sex on all trials of the AVLT. Years of education contributed significantly to trial 1-3 and trial 4 but not trial 5. Based on the results obtained, trail 1-3 and trail 4 of AVLT norms were stratified by age (3 strata), education (2 strata), and sex (2 strata). Trail 5 norms were stratified by age (3 strata) and sex (2 strata). Moreover, AIS groups performed significantly worse on most AVLT trials than matched cognitively healthy controls.

CONCLUSIONS

Normative data stratified by age, education and sex for the Chinese-speaking community-residents in Shijiazhuang was presented for use in research and clinical settings. The AVLT measures adequately differentiated between the cognitive performance (especially memory decline) of healthy adults and patients with AIS.

Prevalence of Sleep Disorders and Associated Factors in People Living With HIV in the Ceará, Brazil: A Cross-sectional Study

ABSTRACT

The aim of this study was to determine the prevalence of sleep disorders and associated factors in people living with HIV (PLWH). This was a cross-sectional study with a sample of 385 participants followed-up on an outpatient basis in Fortaleza, Ceará, Brazil. Interviews were conducted using the Sociodemographic, Epidemiological and Clinical Form for PLWH and the Pittsburgh Sleep Quality Index. Descriptive statistics and univariate and multivariate logistic regression analysis were performed, and the odds ratio (OR) and 95% confidence interval (95% CI) were calculated, considering p < .05 as statistically significant. The prevalence of sleep disorders was 43.38%. Having children (p = .0054; OR = 1.91; 95% CI = 1.21-3.01), less than 8 years of education (p = .0013; OR = 2.11; 95% CI = 1.34-3.34), and not engaging in regular physical exercise (p = .0001; OR = 2.61; 95% CI = 1.61-4.23) were factors associated with the occurrence of sleep disorders. It was concluded that almost half of the sample had sleep disorders, especially those with children, low level education, and sedentary habits. These data point to the need for increased guidance on sleep hygiene, in addition to the practice of regular physical exercise for this population.

Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review

Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.

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.

Associations between antiretroviral therapy-related experiences and mental health status among people living with HIV in China: a prospective observational cohort study

BACKGROUND

Mental health problems (e.g., depression and anxiety) are among the most commonly reported comorbidities of HIV. Antiretroviral therapy (ART) coverage has increased sharply. The purposes of this prospective cohort study were to investigate the ART-related experiences and whether they were associated with mental health problems among a sample of people living with HIV undergoing ART in China.

METHODS

The participants were 400 people living with HIV who had started ART for the first time in Guangzhou city. They were followed-up 1-year after ART initiation. Probable depression and moderate/severe anxiety were measured at baseline and Month 12, while experiences related to ART (e.g., side effects and regained self-confidence) were measured at Month 6. Univariate and multivariate logistic regressions were used to explore the associations between baseline characteristics, ART-related experiences and mental health status.

RESULTS

Among the 300 participants (75.0%) who completed all three surveys, a significant decline in prevalence of probable depression (23.0% at baseline vs. 14.0% at Month 12, P = 0.002) and moderate/severe anxiety (14.7% at baseline vs. 8.7% at Month 12, P = 0.023) was observed during the follow-up period. After adjustment for mental health status and potential confounders at baseline, a number of ART-related experiences at Month 6 were associated with probable depression and/or moderate/severe anxiety measured at Month 12. Improved physical health, relationships with sexual partners, and self-confidence were associated with decreased mental health issues, while the side effects of ART, AIDS-related symptoms, and inconvenience in daily life due to ART use were associated with increased mental health issues.

CONCLUSIONS

ART-related experiences were associated with mental health problems, tailored mental health promotion interventions targeting these experiences are needed.

Prevalence of Depressive Symptoms and Its Associated Factors among People Living with HIV Attending Public Hospitals of Nekemte Town, Western Ethiopia, 2021

Background

Depressive symptoms are the most common mental illness among people living with HIV/AIDS. Depressive symptoms impact negatively on the course of HIV infection and can lead to suicide and increased risk of mortality when it is a severe form. Although depressive symptoms are common among HIV/AIDS patients, only a few studies have been conducted in Ethiopia and no study, particularly at Nekemte town public hospitals. Therefore, this study was aimed at assessing the prevalence and risk factors for depressive symptoms among people living with HIV/AIDS attending Nekemte town public hospitals, Western Ethiopia. Methods. An institution-based cross-sectional study design was conducted on 425 HIV/AIDS patients at Nekemte town public hospitals, from March 30 to May 30, 2019. Data were collected through interviews and patient document reviews. The nine-item Patient Health Questionnaire (PHQ-9) was used to collect information concerning depressive symptoms and was defined by a PHQ-9 score ≥ 5. HIV stigma and discrimination scales were used to measure stigma. Social support was described by a sum score of the Oslo3 social support scale (OSS-3). The collected data was entered into EpiData Windows version 4.1 and then exported to Statistical Package for the Social Sciences (SPSS) Windows version 24.0 for analysis. All variables found to be significant at the bivariable level (p value < 0.25) were entered into a multivariable logistic regression model. p values of <0.05 and 95% confidence level were used to determine statistical significance.

Results

Out of the total of 384 study participants who participated in the study, 165 (42.96%) had depressive symptoms. Self-reported sleeping problems (AOR = 7.04, 95% CI: 3.23, 15.33), CD4 level of <200 (AOR = 5.45, 95% CI: 2.06, 14.42), poor social support (AOR = 2.79, 95% CI: 1.17, 6.67), and perceived stigma (AOR = 9.11, 95% CI: 1.17, 17.33) were significantly associated with depressive symptoms among HIV/AIDS patients at Nekemte town public hospitals.

Conclusion

The level of depressive symptoms among HIV/AIDS patients in this study was high. Self-reported sleeping problems, CD4 level, social support, and perceived stigma were found to be significantly associated with depressive symptoms among HIV patients. Health care professionals should have to strengthen the linkage of mental health with antiretroviral therapy (ART) clinic to early detect and treat depressive symptoms.

Analysis on the trend of AIDS incidence in Zhejiang, China based on the age-period-cohort model (2004-2018)

Objective

To predict the trend of AIDS in specific age groups and to determine the objective population for AIDS screening, this study explored the three transmission routes and characterized each patient group using the APC model based on the whole, local, and immigrant populations in Zhejiang, China.

Methods

The data recruited in this paper was obtained from the national Comprehensive AIDS Prevention and Control Information System - Antiviral Therapy Management database and the Chinese Disease Prevention and Control Information System and the Statistical Yearbook of Zhejiang, China. An APC model was used to estimate the impact of age, period, and cohort on the incidence of AIDS, as well as to predict the AIDS incidence in specific age groups based on different sexes with different transmission routes.

Results

The AIDS incidence peaked in males aged 20–35 years; the incidence of males was higher than that of females due to the impact of period; obvious cohort effect was observed among the immigrants. In the whole and local populations, the incidences of males in all age groups and females in both the 35-year-old group and the whole age group were predicted to increase sharply in 5 years. In the immigrant population, the AIDS incidences in both sexes in all age groups were expected to increase significantly in 5 years. Under the influence of period, the incidence of AIDS via homosexual transmission in the whole population and the local population increased and remained stable after 2015. At the same time, the incidence of AIDS transmitted by homosexual and heterosexual routes in the immigrants also showed an increasing trend.

Conclusions

The results elucidate that there are sex differences in AIDS incidence, and the incidence of AIDS through various transmission routes in all groups is predicted to exhibit an upward trend in the 5 years to come. Effective intervention strategies should be developed and implemented by the public health departments in Zhejiang to control the epidemic of AIDS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11050-x.

Relationship of psychological discomforts of stress, depression, and anxiety to sleep quality in HIV/AIDS patients

HIV/AIDS remains a chronic disease that is ubiquitous in the community. People with HIV/AIDS can experience psychological problems because of the influence of internal and external stress. This study aimed to determine the relationship of psychological discomforts of stress, depression, and anxiety to sleep quality in HIV/AIDS patients. This study employed a descriptive-correlational research design with a cross-sectional approach and consecutive sampling technique. The Depression Anxiety Stress Scale-21 and Pittsburgh Sleep Quality Index were used as research instruments on 110 respondents. This study found that there was a significant relationship between psychological discomforts of stress, depression, and anxiety and sleep quality in patients with HIV/AIDS (p<α=0.05). The results of this study indicate the importance of health services, especially those of HIV/AIDS polyclinics, to be more concerned with the psychological discomfort experienced by patients to improve the sleep quality of patients with HIV/AIDS.

Effect of Stress Management Training on Stigma and Social Phobia in HIV-Positive Women

The purpose of this study was to investigate the effect of stress management training on stigma and social phobia among HIV-positive women. This quasi-experimental pre- and posttest study was performed on a single group of 55 HIV-positive females Hamadan city, Iran, in 2018. The samples were taken through a convenience sampling method and the data collection tool were Berger HIV Stigma and Connor Social Phobia Scale. The mean scores of the stigma were 119.98 ± 21.15 and 94.78 ± 16.34 and social phobia were 24 ± 17.4 and 11.2 ± 9.68 before and after the intervention, respectively. The results of the paired sample t test indicated a significant difference in the stigma and social phobia mean scores before and after the intervention in HIV-positive women (P < .05). The results of the study revealed that stigma and social phobia are big challenges for HIV-positive women since these people are always judged by others and are subjected to labeling and rejection.

Prevalence and associated factors of depressive symptoms among people living with HIV on antiretroviral therapy in Jakarta, Indonesia

OBJECTIVE

We aimed to investigate the prevalence of depressive symptoms among people living with HIV (PLHIV) on antiretroviral therapy (ART) in a large HIV treatment facility in Jakarta, Indonesia, and to assess associated factors.

METHODS

The Indonesian version of Beck Depression Inventory-II was used to assess depressive symptoms of 346 participants visiting the HIV Integrated Clinic Cipto Mangunkusumo hospital between June and November 2018.

RESULTS

Depressive symptoms (BDI-II score ≥14) were exhibited by 50.9% of participants, with prevalences of mild, moderate and severe depression of 30.4%, 15.6% and 4.9%, respectively. Poisson regression with robust variance analysis indicated that having lower income (aPR = 1.38, 95% CI 1.12-1.63), duration of ART for 1-5 years (aPR = 1.25, 95% CI 1.01-1.54) and same-sex partnership (aPR = 1.27, 95% CI 1.02-1.58) were positively associated with depressive symptoms. Age, sex and history of using intravenous drugs, and ART-based regimen were not associated with depressive symptoms.

CONCLUSIONS

Depressive symptoms were common among our population despite long-term ART use and were associated with having low-income, ART for 1-5 years and same-sex partnership.

Discriminatory Behavior among People Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome against Adherence to Antiretroviral Treatment

BACKGROUND: Globally, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a serious health issue, as the number of sufferers increases from year to year. As there are many HIV/AIDS cases, antiretroviral treatment (ART) regimens’ success is determined by the high adherence of people living with HIV/AIDS (PLWHA) undergoing a treatment regimen. PLWHA adherence in undergoing ART regimens can be influenced by discriminatory behavior toward them. AIM: This study aims to identify discriminatory behavior in PLWHA toward adherence to ART in Yogyakarta. METHODS: This research used a qualitative method with a phenomenology approach. The collection of data was carried out through interviews and observation. Participants totaling seven people were determined by purposive sampling. The data validity employed source triangulation and checked the data back to the participants. Analysis of data was by comparing among categories, marking, and describing descriptively. RESULTS: The results showed that PLWHA got discriminatory behavior around them during ARV treatment, which came from the attitude of health workers and unpleasant experiences from the environment, but this discriminatory behavior did not affect PLWHA adherence to ARV treatment. CONCLUSION: Discriminatory behavior from health workers and the environment around PLWHA did not affect PLWHA adherence during ARV treatment.

A Noninvasive Prediction Model for Hepatitis B Virus Disease in Patients with HIV: Based on the Population of Jiangsu, China

Objective

To establish a machine learning model for identifying patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through two sexual transmission routes in Jiangsu, China.

Methods

A total of 14197 HIV cases transmitted by homosexual and heterosexual routes were recruited. After data processing, 12469 cases (HIV and HBV, 1033; HIV, 11436) were left for further analysis, including 7849 cases with homosexual transmission and 4620 cases with heterosexual transmission. Univariate logistic regression was used to select variables with significant P value and odds ratio for multivariable analysis. In homosexual transmission and heterosexual transmission groups, 10 and 6 variables were selected, respectively. For identifying HIV individuals coinfected with HBV, a machine learning model was constructed with four algorithms, including Decision Tree, Random Forest, AdaBoost with decision tree (AdaBoost), and extreme gradient boosting decision tree (XGBoost). The detective value of each variable was calculated using the optimal machine learning algorithm.

Results

AdaBoost algorithm showed the highest efficiency in both transmission groups (homosexual transmission group: accuracy = 0.928, precision = 0.915, recall = 0.944, F − 1 = 0.930, and AUC = 0.96; heterosexual transmission group: accuracy = 0.892, precision = 0.881, recall = 0.905, F − 1 = 0.893, and AUC = 0.98). Calculated by AdaBoost algorithm, the detective value of PLA was the highest in homosexual transmission group, followed by CR, AST, HB, ALT, TBIL, leucocyte, age, marital status, and treatment condition; in the heterosexual transmission group, the detective value of PLA was the highest (consistent with the condition in the homosexual group), followed by ALT, AST, TBIL, leucocyte, and symptom severity.

Conclusions

The univariate logistics regression combined with the AdaBoost algorithm could accurately screen the risk factors of HBV in HIV coinfection without invasive testing. Further studies are needed to evaluate the utility and feasibility of this model in various settings.

Sleep, Prospective Memory, and Immune Status among People Living with HIV

Background: Persons living with HIV (PLWH) frequently report sleep complaints, but objective measurements are still lacking regarding sleep continuity, total sleep time per 24 h, and the links with both prospective memory performance and HIV infection parameters. Methods: PLWH (n = 96) and control (n = 96) groups (balanced for gender and age) were monitored by 24h-actigraphy for at least seven consecutive days. The prospective memory performance was assessed through a naturalistic, activity-based task performed twice a day on the actigraph. Results: PLWH had greater sleep latency and worse sleep continuity (higher fragmentation index) for night-time sleep and longest daytime nap (mean duration of the longest nap). Comparable results were reported for the prospective memory task; better performance scores were associated with several sleep parameters in controls but not in PLWH. Finally, within the PLWH group, being a long sleeper per 24 h (total sleep time > 8 h including more and long daytime naps) was associated with a greater severity of the disease (lower CD4 nadir and more frequent history of AIDS-defining events). Conclusions: These findings indicate that PLWH have more fragmented sleep and that the severity of HIV infection is associated with increased sleep duration.

A Systematic Review and Meta-Analysis on Depression and Associated Factors among Adult HIV/AIDS-Positive Patients Attending ART Clinics of Ethiopia: 2021

INTRODUCTION

Depression is the most common mental health problem in people living with the human immune virus. It ranges from 11% to 63% in low- and middle-income countries. Depression was high in people living with HIV/AIDS in developing countries, especially in the Ethiopian context. Even though depression has negative consequences on HIV-positive patients, the care given for depression in resource-limited countries like Ethiopia is below the standard in their HIV care programs.

METHOD

International databases (Google Scholar, PubMed, Hinari, Embase, and Scopus) and Ethiopian university repository online have been covered in this review. Data were extracted using Microsoft Excel and analyzed by using the Stata version 14 software program. We detected the heterogeneity between studies using the I ² test. We checked publication bias using a funnel plot test.

RESULTS

The overall pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was 36.3% (95% CI: 28.4%, 44.2%) based on the random effect analysis. Adult HIV/AIDS patients having CD4count < 200(AOR = 5.1; 95% CI: 2.89, 8.99), widowed marital status (AOR = 3.7; 95% CI: 2.394, 5.789), medication nonadherence (AOR = 2.3; 95% CI: 1.63, 3.15), poor social support (2.986) (95% CI: 2.139, 4.169), perceived social stigma (2.938) (2.305, 3.743), opportunistic infections (3.010) (2.182, 4.151), and adverse drug reactions (4.013) (1.971, 8.167) were significantly associated with depression among adult HIV/AIDS patients on antiretroviral therapy, in Ethiopia. Conclusion and Recommendation. The pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was higher than the general population and is alarming for the government to take special consideration for HIV-positive patients. Depression assessment for all HIV-positive patients and integrating with mental health should be incorporated to ensure early detection, prevention, and treatment. Community-based and longitudinal study designs mainly focusing on the incidence and determinants of depression among adult HIV/AIDS patients should be done in the future.

Perceived discrimination and mental health symptoms among persons living with HIV in China: the mediating role of social isolation and loneliness

Perceived discrimination is significantly associated with mental health symptoms among persons living with HIV (PLWH). However, little is known about the factors mediating this relationship. We aimed to examine the mediating role of social isolation and loneliness in the association between perceived discrimination and mental health symptoms among PLWH. A multicenter (Shanghai, Kunming, Nanning, Hengyang, and Changning in China) cross-sectional study was conducted in 2017. Data from 883 PLWH were used for statistical analysis. Perceived discrimination, mental health symptoms, loneliness and social isolation were assessed through self-report questionnaires. Structural equation modeling (SEM) showed a satisfactory model fit (CMIN/DF = 2.676, GFI = 0.998, CFI = 0.997, NFI = 0.995, TLI = 0.985, RMSEA = 0.044 [0.000, 0.090]) and a significant total indirect effect (β = 0.058, SE = 0.009, Z = 6.444, p < 0.01). Both loneliness (β = 0.042, SE = 0.008, Z = -5.250, p < 0.01) and social isolation (β = 0.016, SE = 0.004, Z = -4.000, p < 0.01) were determined to be significant mediators of the association between perceived discrimination and mental health symptoms. Interventions that combat loneliness and social isolation may help ameliorate the adverse consequences of perceived discrimination on mental health.

Clock-drawing test: Normative data of three quantitative scoring methods for Chinese-speaking adults in Shijiazhuang City and clinical utility in patients with acute ischemic stroke

OBJECTIVE

The clock-drawing test (CDT) is a widely used screening tool for detecting cognitive decline. However, normative data for Chinese individuals are scarce. Our study aimed to provide standardized values for the three quantitative CDT scoring methods that were tailored for Chinese-speaking adults in Shijiazhuang City and explore the discriminant validity of the CDT scores in patients with acute ischemic stroke.

METHODS

We conducted the CDT among 418 healthy individuals aged between 35 and 84 years. The CDT was administered and scored by five raters using the method derived from the Montreal Cognitive Assessment (MoCA), Rouleau's, and Babins' scoring systems. The influence of age, education, and sex on the performance in the CDT was analyzed. Furthermore, 336 patients with acute ischemic stroke were enrolled to explore the discriminant validity of CDT scores.

RESULTS

In all three scoring systems, CDT scores were significantly correlated with age and years of education but not with sex. Normative data stratified for age and years of education were established. Interrater and intersystem reliability were high in our study. CDT total scores and subscores showed significant differences between stroke patients and healthy individuals.

CONCLUSIONS

Our study provides CDT normative data using three quantitative scoring methods for Chinese-speaking adults in Shijiazhuang City. Age and education level were the key factors that affected the CDT scores. CDT total scores and subscores provided good discriminant validity for patients with acute ischemic stroke.

Prevalence and factors associated with depression among adult HIV patients attending ART clinics: a cross-sectional study in Western Bhutan

Depression is highly prevalent among people living with human immunodeficiency virus across the globe. Data regarding prevalence and factors associated with depression among HIV-infected individuals in Bhutan remained unknown. Therefore, a cross-sectional study was undertaken among 103 adult (≥18 years) HIV patients attending anti-retroviral therapy clinics located at four different hospitals in Western Bhutan. Depression was assessed using the translated and validated Bhutanese version of centre for epidemiologic studies depression scale-revised. The overall response rate of our participants was 73.6%. Age of our participants ranged from 23 to 79 (mean = 40.29, standard deviation ± 11.22) years. The overall prevalence of depression among our participants was 27.2% (95% confidence interval [CI]: 19.4-35.9). Multivariate binary logistic regression analysis showed that females (adjusted odds ratio (AOR) = 3.96, 95% CI: 1.37-11.41) and the poor perceived family support (AOR = 3.31, 95% CI: 1.20-9.10) were significantly associated with depression. Divorced, low income, drinking alcohol and CD₄ <200 cells/mm³ had no associations with depression. We recommend mental health interventions to be integrated into routine HIV care in Bhutan for proper management of depression.

Unmet needs of symptom management and associated factors among the HIV-positive population in Shanghai, China: A cross-sectional study

BACKGROUND

People living with HIV/AIDS (PLWHA) are a vulnerable group who experience multiple physiological and psychological symptoms. A better understanding of unmet symptom management needs will allow researchers to design interventions that are more reflective of deficits in care and more effective at improving patient care. Few studies have focused on unmet needs for symptom management in PLWHA particularly in China. Factors influencing Chinese PLWHA symptom management needs are rarely discussed.

AIM

The purpose of this study was to investigate the unmet needs for symptom management of PLWHA and how their symptom burden, HIV perceived stigma, and self-management capacity contributes to HIV-related self-management practices in Shanghai, China.

DESIGN

Study participants were recruited from the outpatient and inpatient HIV/AIDS wards in an infectious hospital in Shanghai, China. Self-administered questionnaires were implemented and medical charts were reviewed.

RESULTS

A total of 367 participants was recruited from April to September 2017. The results show that 53.1% (195 of 367) of participants presented at least one unmet symptom management need and that symptom burden, as well as perceived stigma, reduced self-management capacity, and no employment significantly affected unmet symptom management needs.

CONCLUSION

The findings indicate that there is room for improvement in symptom management for Chinese PLWHA. Culturally appropriate interventions focusing on improving symptom burden, decreasing HIV perceived stigma, and enhancing self-management capacity can enhance symptom management in this population.

Clock-drawing test in vascular mild cognitive impairment: Validity of quantitative and qualitative analyses

INTRODUCTION

The clock-drawing test (CDT) has been used as a screening tool to identify cognitive deficit in patients with dementia. However, it has not been extensively evaluated for categorizing patients with vascular mild cognitive impairment (vMCI). This study aimed to examine the discrimination of vMCI using various CDT scoring methods.

METHOD

A total of 120 vMCI patients and 119 normal control (NC) subjects were tested using three CDT quantitative scoring systems: the one from the Montreal Cognitive Assessment (MoCA) (CDT3) and the systems of Rouleau (CDT10) and Babins (CDT18). We used a revised scoring method to evaluate the effectiveness in differentiating vMCI patients from NC subjects, which combined the CDT10 quantitative score and three qualitative errors with a significantly higher prevalence in vMCI group (called hereinafter CDTcomb, including CDTcomb13 and CDTcomb16 based on different weights of the three error types). The sensitivity and specificity of the CDT methods were determined by the receiver operating characteristic (ROC) curve. The results of the scoring systems were compared with those of the Mini-Mental State Examination (MMSE).

RESULTS

The results of the ROC analyses with the CDT3, CDT10, and CDT18 systems produced a sensitivity of 71.1%, 81.8%, and 60.3%, and a specificity of 66.12%, 58.68%, and 73.55%, respectively, for the diagnosis of vMCI. Compared with the separate MMSE score, the combination of MMSE with the CDT3, CDT10 and CDT18 scores did not increase the sensitivity and specificity. When three qualitative errors were incorporated into the CDT10 quantitative score, CDTcomb13 and CDTcomb16 provided a sensitivity of 87.6% and 86.78%, and a specificity of 74.79% and 80.67%, respectively, in differentiating vMCI patients from the NC group.

CONCLUSION

Our findings suggest that the combination of CDT quantitative score with qualitative observations of the clock-drawing errors can provide a better discrimination between vMCI patients and cognitively normal subjects.

Food insecurity and the risk of depression in people living with HIV/AIDS: a systematic review and meta-analysis

BACKGROUND

The link between food insecurity and depression in people living with HIV/AIDS (PLWHA) has been explored in numerous studies; however, the existing evidence is inconclusive due to inconsistent results. Therefore, the objective of this systematic review and meta-analysis is to examine the relationship between food insecurity and depression in PLWHA.

METHODS

We systematically searched PubMed, EMBASE, and Scopus to identify relevant studies. A random-effect model was used for conducting the meta-analysis. We assessed the risk of publication bias by funnel plot and Egger's regression asymmetry test.

RESULTS

In this review, seven studies were included in the final analysis. Our meta-analysis revealed that food insecurity significantly increased the risk of depression in PLWHA [RR 2.28 (95% CI 1.56-3.32)]. This association remained significant after adjusting for the confounding effects of drug use [RR 1.63 (95% CI 1.27-2.10)], social support [RR 2.21 (95% CI 1.18-4.16)] as well as ART drugs [RR 1.96 (95% CI 1.17-3.28)]. Our subgroup and sensitivity confirmed the robustness of the main analysis.

CONCLUSION

This systematic review and meta-analysis suggest a significant association between food insecurity and increased risk of depression PLWHA. Therefore, early screening and management of food insecurity in PLWHA seem to be necessary.

Perceived benefits and costs of disclosing HIV diagnosis to family members among people living with HIV in Southern China: an application of a decision-making framework

ABSTRACT People living with HIV (PLWH) would decide whether to disclose their HIV serostatus to others based on the weight of perceived benefits and costs for the disclosure. Using cross-sectional data from 1254 PLWH in Guangxi, China, the study aimed to examine a framework of disclosure decision-making in the context of disclosure to family members (parents and siblings) through exploring the associations between disclosure and perceived benefits and costs of disclosure at individual and interpersonal levels. Univariate and multivariate regression analyses showed that HIV disclosure was associated with perceived benefits at both individual level (stress relief and social support) and interpersonal level (educating others and promoting family stability), but was not associated with perceived costs at either individual level (stigma and confidentiality breaching) or interpersonal level (family conflicts and concerns). Our findings suggest that perceived benefits rather than costs are associated with disclosure to family and play an important role in disclosure decision-making. These results may refine and expand the existing framework on decision-making of HIV disclosure focusing on PLWH's weight of individual benefits and costs. Future interventions highlighting the benefits for their family and other members of their social network may be an effective strategy to promote HIV disclosure to family members.

Depression and its associated factors among HIV/AIDS patients attending ART clinics at Gimbi General hospital, West Ethiopia, 2018

OBJECTIVE

The aim of this study was to assess the prevalence and factors associated with depression among people living with HIV/AIDS attending Gimbi General hospital, West Ethiopia. Institutional based cross-sectional study was conducted on 404 HIV/AIDS patients, from March 01 to March 30, 2018. Multivariable logistic regression was used to determine factors associated with depression. Possible association and statistical significance were measured using odds ratio at 95% confidence interval and P-value less than 0.05.

RESULTS

A total of 393 HIV/AIDS patients were included in this study. Out of this, 41.7% had depression. Perceived social stigma (AOR = 6.98, 95% CI 3.07, 15.86), opportunistic infection (AOR = 9.38, 95% CI 4.21, 20.89), adverse drug reaction (AOR = 3.73, 95% CI 1.58, 8.81), absence of family/social support (AOR = 9.97, 95% CI 3.57, 27.86), and presence of other chronic diseases (AOR = 6.14, 95% CI 1.66, 22.68) were significantly associated with depression. The level of depression among HIV/AIDS patient in this study was high. The clinician should early recognize and treat drug side effects, early detect and manage opportunistic infection and other chronic diseases, and give health information about the disease for the community to reduce social stigma.

Prevalence and correlates of depression among caregivers of children living with HIV in Ghana: findings from the Sankofa pediatric disclosure study

Prior studies show an association between caregiver depression and child health outcomes. There has been little examination of depression among caregivers of HIV-infected children in sub-Saharan countries where pediatric HIV is concentrated. Using baseline data collected in the pediatric HIV disclosure intervention trial, Sankofa, we examined the prevalence and factors associated with depression among caregivers (N = 446) of children infected with HIV in Ghana. Data were analyzed with descriptive and regression analyses. The mean age of the caregivers was 42.2 ± 10.4 years. Eighty percent of the caregivers were female and 59% were HIV-infected. Twenty-eight percent (n = 126) of the caregivers were found to have mild to severe depression. In the adjusted model, factors significantly associated with caregiver depression included: HIV-positive caregiver status (P = 0.04), low income (P = 0.02), lower social support, (P = 0.01), lower HIV knowledge, (P = 0.01), worse HIV illness perceptions (P≤0.001), and greater perceived HIV stigma (P≤0.001). Although we found a high prevalence of depression among our study participants, several of the risks factors identified are modifiable and amenable to interventions that are locally available and affordable.