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Kabunga A, Namata H, Kigongo E, Musinguzi M, Tumwesigye R, Auma AG, Nabaziwa J, Shikanga EM, Okalo P, Nalwoga V, Udho S. Exploring Effective Approaches: Integrating Mental Health Services into HIV Clinics in Northern Uganda. HIV AIDS (Auckl) 2024; 16:165-174. [PMID: 38706528 PMCID: PMC11069383 DOI: 10.2147/hiv.s459461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024] Open
Abstract
Background Integrating mental health services into HIV clinics is recognized as a promising strategy. However, the literature reveals gaps, particularly in the unique context of Northern Uganda, where factors such as historical conflict, stigma, and limited resources pose potential barriers. Material and Methods This qualitative study, conducted between October and November 2023, employed a phenomenological design. The study involved primary healthcare facilities across diverse urban and rural settings, focusing on healthcare providers, village health teams, and service users. A purposive sampling approach ensured diverse demographics and perspectives. In-depth interviews and focus group discussions were conducted, with healthcare providers and service users participating individually, and village health teams engaged in group discussions. Thematic analysis was employed during data analysis. Results Findings revealed a predominance of females among healthcare providers (18 of 30) and service users (16 of 25), as well as in VHTs. Average ages were 33.4 (healthcare providers), 38.5 (service users), and 35.1 (VHTs). Most healthcare providers (15) held diplomas, while 12 service users and 4 VHTs had certificates. The majority of healthcare providers (n=20) and 4 VHTs had 6-10 years of experience. Thematic analysis highlighted three key themes: benefits of integrated mental health services, implementation challenges, and the role of community engagement and cultural sensitivity. Conclusion This study contributes valuable insights into the integration of mental health services into HIV clinics in Northern Uganda. The perceived benefits, challenges, and importance of cultural sensitivity and community engagement should guide future interventions, fostering a holistic approach that enhances the overall well-being of individuals living with HIV/AIDS in the region. Policymakers can use this information to advocate for resource allocation, training programs, and policy changes that support the integration of mental health services into HIV clinics in a way that addresses the identified challenges.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, Lira City, Uganda
| | - Halimah Namata
- Department of Mental Health, Makerere University, Lira City, Uganda
| | - Eustes Kigongo
- Department of Environmental Health and Disease Control, Lira University, Lira City, Uganda
| | - Marvin Musinguzi
- Department of Community Health, Lira University, Lira City, Uganda
| | - Raymond Tumwesigye
- Department of Critical Nursing, Mbarara University of Science and Technology, Mbarara City, Uganda
| | | | - Jannat Nabaziwa
- Department of Community Health, Lira University, Lira City, Uganda
| | - Enos Mwirotsi Shikanga
- Department of Education Psychology, Moi University, Eldoret City, Kenya
- Department of Psychiatry, Gulu University, Gulu City, Uganda
| | - Ponsiano Okalo
- Department of Psychiatry, Lira University, Lira City, Uganda
| | - Viola Nalwoga
- Department of Psychiatry, Lira University, Lira City, Uganda
| | - Samson Udho
- Department of Midwifery, Lira University, Lira City, Uganda
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Grimes KEL, Ebasone PV, Dzudie A, Nash D, Wainberg ML, Pence BW, Barrington C, Pefura E, Yotebieng M, Anastos K, Nsame D, Ajeh R, Nyenti A, Parcesepe AM. Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives. BMC Health Serv Res 2024; 24:519. [PMID: 38658992 PMCID: PMC11044447 DOI: 10.1186/s12913-024-10775-w] [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: 05/31/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.
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Affiliation(s)
- Kathryn E L Grimes
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | | | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Moitra M, Gonese G, Mukherjee M, White B, Young D, Collins PY. "A labor of love": Integrating mental health and HIV care: Lessons from a multicountry mental health learning network. Glob Ment Health (Camb) 2024; 11:e17. [PMID: 38390248 PMCID: PMC10882173 DOI: 10.1017/gmh.2024.6] [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: 08/15/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
Mental health conditions among people living with HIV (PLWH) are important to address as they adversely affect quality of life, impede adherence to HIV treatment and increase mortality. Planning for integrating mental health care in resource-limited HIV care settings requires substantial effort. Learning networks are a useful way to exchange knowledge between countries about best and current practices in planning mental health care for PLWH. This paper describes the launch of a mental health learning network within a global health implementing center and the lessons learned across participating members from six countries: the United States, Jamaica, Trinidad and Tobago, Zimbabwe, Malawi and India. Lessons learned from the learning network sessions spanned four broad domains: (i) the need for routine and integrated mental health data collection, (ii) developing standardized protocols to implement mental health care, (iii) adequate training and supervision of health care staff and (iv) prioritization of mental health care integration by program funders. We find that time and resource constraints can be barriers to shared leadership and sustainability of learning networks. Prioritizing learning networks as an important component of integrated HIV and mental health care programs is one of the potential strategies to ensure long-term continuity.
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Affiliation(s)
- Modhurima Moitra
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Gloria Gonese
- Zimbabwe Technical Assistance Training and Education Center for Health, Harare, Zimbabwe
| | | | - Belinda White
- International Training and Education Center for Health, Port of Spain, Trinidad and Tobago
| | - Dorraine Young
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | - Pamela Y Collins
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lancaster KE, Stockton M, Remch M, Wester CW, Nash D, Brazier E, Adedimeji A, Finlayson R, Freeman A, Hogan B, Kasozi C, Kwobah EK, Kulzer JL, Merati T, Tine J, Poda A, Succi R, Twizere C, Tlali M, Groote PV, Edelman EJ, Parcesepe AM. Availability of substance use screening and treatment within HIV clinical sites across seven geographic regions within the IeDEA consortium. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104309. [PMID: 38228025 PMCID: PMC10939808 DOI: 10.1016/j.drugpo.2023.104309] [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: 08/16/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, the extent to which alcohol use disorder (AUD) and other substance use disorders (SUD) services have been integrated within HIV clinical settings is limited. We describe AUD/SUD screening and treatment availability in HIV clinical sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS In 2020, 223 IeDEA HIV clinical sites from 41 countries across seven geographic regions completed a survey on capacity and practices related to management of AUD/ SUD. Sites provided information on AUD and other SUD screening and treatment practices. RESULTS Sites were from low-income countries (23%), lower-middle-income countries (38%), upper-middle income countries (17%) and high-income counties (23%). AUD and SUD screening using validated instruments were reported at 32% (n=71 located in 12 countries) and 12% (n=27 located in 6 countries) of the 223 sites from 41 countries, respectively. The North American region had the highest proportion of clinics that reported AUD screening (76%), followed by East Africa (46%); none of the sites in West or Central Africa reported AUD screening. 31% (n=69) reported both AUD screening and counseling, brief intervention, psychotherapy, or Screening, Brief Intervention, and Referral to Treatment; 8% (n=18) reported AUD screening and detox hospitalization; and 10% (n=24) reported both AUD screening and medication. While the proportion of clinics providing treatment for SUD was lower than those treating AUD, the prevalence estimates of treatment availability were similar. CONCLUSIONS Availability of screening and treatment for AUD/SUD in HIV care settings is limited, leaving a substantial gap for integration into ongoing HIV care. A critical understanding is needed of the multilevel implementation factors or feasible implementation strategies for integrating screening and treatment of AUD/SUD into HIV care settings, particularly for resource-constrained regions.
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Affiliation(s)
| | - Melissa Stockton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Remch
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Denis Nash
- City University of New York (CUNY), New York, NY, USA
| | - Ellen Brazier
- City University of New York (CUNY), New York, NY, USA
| | | | | | - Aimee Freeman
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Breanna Hogan
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Judiacel Tine
- Centre Hospitalier National Universitaire de Fann, Dakar, Senagal
| | - Armel Poda
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Regina Succi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Christelle Twizere
- Centre National de Référence en Matière de VIH/SIDA au Burundi, Bujumbura, Burundi
| | - Mpho Tlali
- University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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Regan M, Muhihi A, Saleh A, Duggan CP, Ulenga N, Alwy Al-Beity FM, Aboud S, Fawzi WW, Manji KP, Sudfeld CR. Antenatal depression and adverse birth outcomes among pregnant women living with HIV in Dar es Salaam, Tanzania. J Affect Disord 2023; 339:82-88. [PMID: 37437720 PMCID: PMC10538406 DOI: 10.1016/j.jad.2023.07.047] [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: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Women who experience antenatal depression may be at increased risk of adverse birth outcomes. Few studies have examined this association among women living with HIV (WHIV). METHODS We conducted a prospective cohort study of 2298 pregnant WHIV on antiretroviral therapy (ART) in Dar es Salaam, Tanzania, who were participants in a randomized trial of vitamin D3 supplementation. Depressive symptoms were assessed at 12-27 weeks gestation using the Hopkins Symptoms Checklist (HSCL-25). Generalized estimating equations to account for twins were used to assess the relative risks of adverse birth outcomes. RESULTS Approximately 67 % of the women in our study population reported symptoms consistent with depression. We observed a 4.0 % prevalence of stillbirth and a 25.1 % prevalence of preterm birth. We found that low social support, higher education, and more recent initiation of ART were associated with a greater risk of antenatal depression. There was no association of antenatal depression with risk of fetal loss, stillbirth, low birth weight, birth weight, preterm birth, gestational age at delivery, or small-for-gestational age. LIMITATIONS Depression was self-reported and only collected at one timepoint in pregnancy. Our findings may not be generalizable to all WHIV. CONCLUSIONS Our findings illustrate the high risk of both depression and adverse birth outcomes among WHIV and underscore the need for interventions to improve their mental health and the health of their infants; however, the relationship between depression and birth outcomes remains unclear. Further research on this topic is merited, particularly examining the chronicity and timing of depression in pregnancy.
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Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Arvin Saleh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M Alwy Al-Beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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Parcesepe AM, Stockton M, Remch M, Wester CW, Bernard C, Ross J, Haas AD, Ajeh R, Althoff KN, Enane L, Pape W, Minga A, Kwobah E, Tlali M, Tanuma J, Nsonde D, Freeman A, Duda SN, Nash D, Lancaster K. Availability of screening and treatment for common mental disorders in HIV clinic settings: data from the global International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium, 2016-2017 and 2020. J Int AIDS Soc 2023; 26:e26147. [PMID: 37535703 PMCID: PMC10399924 DOI: 10.1002/jia2.26147] [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: 12/07/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020. METHODS In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys. RESULTS Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048). CONCLUSIONS Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- University of North Carolina at Chapel HillCarolina Population CenterChapel HillNorth CarolinaUSA
| | | | - Molly Remch
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - C. William Wester
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Charlotte Bernard
- University of BordeauxNational Institute for Health and Medical ResearchResearch Institute for Sustainable DevelopmentBordeaux Population Health Research CentreBordeauxFrance
| | - Jeremy Ross
- TREAT Asia/amfARThe Foundation for AIDS ResearchBangkokThailand
| | - Andreas D. Haas
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland
| | - Rogers Ajeh
- Clinical Research Education and Networking ConsultancyYaoundeCameroon
| | - Keri N. Althoff
- Johns Hopkins UniversityBloomberg School of Public HealthBaltimoreMarylandUSA
| | - Leslie Enane
- Department of PediatricsThe Ryan White Center for Pediatric Infectious Disease and Global HealthIndiana University School of MedicineIndianapolisIndianaUSA
| | - William Pape
- Groupe Haitien d''Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO)Port au PrinceHaiti
| | - Albert Minga
- Centre Medical de Suivi de Donneurs de Sang/CNTS/PRIMO‐CIAbidjanCote D''Ivoire
| | - Edith Kwobah
- Department of Mental HealthMoi Teaching and Referral HospitalEldoretKenya
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research (CIDER)School of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Junko Tanuma
- Division of the AIDS Medical Information of AIDS Clinical CareNational Center for Global Health and MedicineTokyoJapan
| | | | - Aimee Freeman
- Johns Hopkins UniversityBloomberg School of Public HealthBaltimoreMarylandUSA
| | - Stephany N. Duda
- Department of Biomedical InformaticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Denis Nash
- City University of New YorkInstitute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | | | - the IeDEA Consortium
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Goldstein D, Salvatore M, Ferris R, Phelps BR, Minior T. Integrating global HIV services with primary health care: a key step in sustainable HIV epidemic control. Lancet Glob Health 2023; 11:e1120-e1124. [PMID: 37349037 DOI: 10.1016/s2214-109x(23)00156-0] [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: 11/14/2022] [Revised: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 06/24/2023]
Abstract
Ending the HIV epidemic relies in part on integrating stand-alone HIV programming with primary health-care platforms to improve population-level health and ensure sustainability. Integration of HIV and primary health care services in sub-Saharan Africa improves both outcomes. Existing models support both integrating primary health care services into existing HIV services, and incorporating HIV services into primary health care platforms, with optimal programming based on local contexts and local epidemic factors. Person-centred differentiated service delivery, community-based interventions, and a well supported health workforce form the backbone of successful integration. Strategic financing to optimise HIV and primary health care integration requires well-coordinated partnerships with host governments, private sector companies, multilateral stakeholders, development banks, and non-government organisations. Programme success will require increased flexibility of international donors' implementation guidance as well as involvement of local communities and civil society organisations. As we seek to end the HIV epidemic by 2030 amidst a constrained global economic climate, integration of HIV programming with primary health care offers an avenue of opportunity and hope.
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Affiliation(s)
- Deborah Goldstein
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA.
| | | | - Robert Ferris
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Benjamin Ryan Phelps
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Thomas Minior
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
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Bhardwaj A, Comins CA, Guddera V, Mcingana M, Young K, Phetlhu R, Mulumba N, Mishra S, Hausler H, Baral S, Schwartz S. Prevalence of depression, syndemic factors and their impact on viral suppression among female sex workers living with HIV in eThekwini, South Africa. BMC Womens Health 2023; 23:232. [PMID: 37147708 PMCID: PMC10161481 DOI: 10.1186/s12905-023-02392-2] [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: 08/31/2022] [Accepted: 04/24/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Over half of female sex workers (FSW) in South Africa are living with HIV and clinical depression has been frequently documented among FSW. Data characterizing structural determinants of depression and the role of syndemic theory, synergistically interacting disease states, on viral suppression among FSW in South Africa are limited. METHODS Between July 2018-March 2020, non-pregnant, cisgender women (≥ 18 years), reporting sex work as their primary income source, and diagnosed with HIV for ≥ 6 months were enrolled into the Siyaphambili trial in eThekwini, South Africa. Using baseline data, robust Poisson regression models were used to assess correlates of depression and associations between depression and syndemic factors on viral suppression. RESULTS Of 1,384 participants, 459 (33%) screened positive for depression, defined as a score of ≥ 10 on the PHQ-9. Physical and sexual violence, drug use, alcohol use, anticipated stigma and internalized stigma were univariately associated with depression (all p's < 0.05) and included the multivariate model. In the multivariate regression, prevalence of depression was higher among participants experiencing sexual violence (PR = 1.47 95% CI:1.24,1.73), physical violence 5 times or more in < 6 months (PR = 1.38 95% CI:1.07, 1.80), using illicit drugs in the last month (PR = 1.23 95%:CI 1.04, 1.48), and reporting higher levels of internalized stigma (PR = 1.11, 95% CI:1.04,1.18). Depression in the absence of the Substance Abuse, Violence and AIDS SAVA syndemic factors was associated with increased prevalence of unsuppressed viral load (aPR 1.24; 95% CI:1.08,1.43), and the SAVA substance use and violence syndemic was associated with an increase in unsuppressed viral load among non-depressed FSW (aPR 1.13; 95% CI:1.01, 1.26). Compared to those experiencing neither factors, those jointly experiencing depression and the SAVA syndemics were at increased risk for unsuppressed viral load (aPR 1.15; 95% CI:1.02,1.28). CONCLUSION Substance use, violence, and stigma were all associated with depression. Depression and syndemic factors (substance use + violence) were related to unsuppressed viral load; we did not observe higher unsuppressed viral load amongst those experiencing both depression and syndemic factors. Our findings point to the need to understand the unmet mental health needs of FSW living with HIV. TRIAL REGISTRATION Clinical Trial Number: NCT03500172.
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Affiliation(s)
- Anvita Bhardwaj
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Carly A Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | | | | | - Rene Phetlhu
- TB HIV Care, Café Town, South Africa
- University of Western Cape, Café Town, South Africa
| | | | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, ON, USA
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, USA
- Institute of Medical Science and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, USA
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Hammett WH, Muanido A, Cumbe VFJ, Mukunta C, Manaca N, Hicks L, Dorsey S, Fabian KE, Wagenaar BH. Demonstration project of a lay counselor delivered trans-diagnostic mental health intervention for newly diagnosed HIV patients in Mozambique. AIDS Care 2023; 35:1-6. [PMID: 35348399 PMCID: PMC9519808 DOI: 10.1080/09540121.2022.2039356] [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: 01/07/2021] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
ABSTRACTCommon mental disorders (CMDs) are associated with poor HIV outcomes in low- and middle-income countries. The present study implemented a psychological therapy delivered in routine HIV care and examined its effects on HIV outcomes in Mozambique. The Common Elements Treatment Approach (CETA) was integrated into routine HIV care in Sofala, Mozambique for all newly-diagnosed HIV+ patients with CMD symptoms. HIV treatment initiation and retention were compared to overall facility averages (those enrolled in CETA + those not enrolled). Of 250 patients screened, 59% (n = 148 met the criteria for CETA enrollment, and 92.6 (n = 137) enrolled in CETA. After four CETA visits, CMD symptoms decreased >50% and suicidal ideation decreased 100%. Patients enrolling in CETA had an antiretroviral therapy initiation rate of 97.1%, one-month retention of 69.2%, and three-month retention of 82.4%. Patients in the comparison group had one-month retention of 66.0% and three-month retention of 68.0%. CETA may be a promising approach to reduce symptoms of CMDs and improve HIV care cascade outcomes in areas with high HIV prevalence.
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Affiliation(s)
- Wilson H Hammett
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
| | | | - Vasco FJ Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | | | - Nelia Manaca
- Health Alliance International, Beira, Mozambique
| | | | - Shannon Dorsey
- University of Washington, Department of Psychology and Behavioral Sciences, Seattle, Washington
| | - Katrin E Fabian
- University of Washington, Department of Global Health, Seattle, Washington
| | - Bradley H. Wagenaar
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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10
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Qambayot MA, Naidoo S. Provision of HIV services to psychiatric inpatients in Botswana: Challenges and recommendations. S Afr J Psychiatr 2023; 29:1990. [PMID: 36876029 PMCID: PMC9982490 DOI: 10.4102/sajpsychiatry.v29i0.1990] [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: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 03/06/2023] Open
Abstract
Background The high prevalence of HIV among psychiatric inpatients is well-documented, yet little is known about the provision of HIV services for these patients. Aim This qualitative study aimed to explore and understand healthcare providers' challenges with providing HIV services to psychiatric inpatients. Setting This study was conducted at the national psychiatric referral hospital in Botswana. Methods The authors conducted in-depth interviews with 25 healthcare providers serving HIV-positive psychiatric inpatients. Data analysis was performed using a thematic analysis approach. Results Healthcare providers reported challenges with transporting patients to access off-site HIV services, longer waiting periods for antiretroviral therapy (ART) initiation, patient confidentiality, fragmented services for treatment of comorbidities, and a lack of patient data integration between the national psychiatric referral hospital and other facilities such as the Infectious Diseases Care Clinic (IDCC) at the nearby district hospital. Providers' recommendations for addressing these challenges included the establishment of an IDCC at the national psychiatric referral hospital, connecting the psychiatric facility to the patient data management system to ensure integration of patient data, and provision of HIV-related in-service training to nurses. Conclusion Psychiatric healthcare providers advocated for on-site integration of care for psychiatric illness and HIV among inpatients to address the challenges of ART provision. Contribution The findings suggest the need to improve the provision of HIV services in the psychiatric hospitals in order to ensure better outcomes for this often-overlooked population. These findings are useful in improving clinical practice for HIV in psychiatric settings.
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Affiliation(s)
- Maria A Qambayot
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sarita Naidoo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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11
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Wainberg M, Pence B, Pefura-Yone E, Yotebieng M, Nsame D, Anastos K, Nash D. Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National 'Treat All' Policy. AIDS Behav 2021; 25:4018-4028. [PMID: 34091803 PMCID: PMC8938985 DOI: 10.1007/s10461-021-03328-3] [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] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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12
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Zimba CC, Akiba CF, Matewere M, Thom A, Udedi M, Masiye JK, Kulisewa K, Go VFL, Hosseinipour MC, Gaynes BN, Pence BW. Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers. Int J Ment Health Syst 2021; 15:59. [PMID: 34116699 PMCID: PMC8196431 DOI: 10.1186/s13033-021-00480-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Methods Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Results Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Conclusion Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786
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Affiliation(s)
| | - Christopher F Akiba
- Gillings School of Global and Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Annie Thom
- Malawi Ministry of Health, Lilongwe, Malawi
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13
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Collins PY, Velloza J, Concepcion T, Oseso L, Chwastiak L, Kemp CG, Simoni J, Wagenaar BH. Intervening for HIV prevention and mental health: a review of global literature. J Int AIDS Soc 2021; 24 Suppl 2:e25710. [PMID: 34164934 PMCID: PMC8222838 DOI: 10.1002/jia2.25710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre-exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. METHODS We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. RESULTS AND DISCUSSION We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. CONCLUSIONS Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.
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Affiliation(s)
- Pamela Y Collins
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | | | - Linda Oseso
- HIV Vaccine Trials Network, Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | - Jane Simoni
- Department of PsychologyUniversity of WashingtonSeattleWAUSA
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14
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Bantjes J, Kagee A. Suicide Prevention in HIV Treatment Centres: Population Attributable Risk Analysis of Treating Common Mental Disorders. AIDS Behav 2021; 25:1864-1872. [PMID: 33387136 DOI: 10.1007/s10461-020-03116-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
The aim was to establish the potential reduction in non-fatal suicidal behaviour (NFSB) that could be achieved by treating common mental disorders (CMDs) among persons receiving HIV treatment. Data were collected from antiretroviral therapy (ART) patients in South Africa (n = 688). Structured Clinical Interviews assessed CMDs and the Mini International Neuropsychiatric Interview assessed 1-month prevalence of NFSB and suicide risk. Population Attributable Risk (PAR) analysis established the potential reduction in prevalence of NFSB and suicide risk that could be achieved by treating CMDs, with the simplifying assumption of a causal relationship between psychopathology and suicidality. Treating CMDs could result in as much as a 63.9% proportional reduction in the prevalence of suicide ideation, 84.2% proportional reduction in the prevalence of suicide plan, and 63.4% proportional decrease in prevalence of suicide risk. There is potential to significantly reduce NFSB among ART patients. Pragmatic trials are needed to evaluate the effects of treating CMDs in HIV treatment centres.
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Affiliation(s)
- Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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15
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Trang K, Ly AT, Lam LX, Brown CA, To MQ, Sullivan PS, Worthman CM, Giang LM, Jovanovic T. Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam. Soc Sci Med 2021; 279:113978. [PMID: 34000583 PMCID: PMC8684791 DOI: 10.1016/j.socscimed.2021.113978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam. METHODS Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA. RESULTS Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs. CONCLUSIONS Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.
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Affiliation(s)
- Kathy Trang
- Institute of Human Development and Social Change, New York University, New York, NY, United States.
| | - An Thanh Ly
- Australian Research Center in Sex, Health and Society, LaTrobe University, Melbourne, Australia; Department of Global Health, School of Preventive Medicine and Public Health, Hanoi Medical University, Viet Nam
| | - Le Xuan Lam
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam
| | - Carolyn A Brown
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Margaret Q To
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carol M Worthman
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State, University, Detroit, MI, United States
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16
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Anyayo L, Ashaba S, Kaggwa MM, Maling S, Nakimuli-Mpungu E. Health-related quality of life among patients with bipolar disorder in rural southwestern Uganda: a hospital based cross sectional study. Health Qual Life Outcomes 2021; 19:84. [PMID: 33691720 PMCID: PMC7945052 DOI: 10.1186/s12955-021-01729-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bipolar disorder is a psychiatric disorder that alters mood and affects over 55 million people globally with an estimated lifetime prevalence of approximately 0.8-1.1%. In Africa, the lifetime prevalence of the bipolar spectrum disorders is slightly lower at 0.1-0.6%. Bipolar disorder is ranked the sixth leading cause of disability with high rates of morbidity and mortality and negatively impacts quality of life of those affected. METHODS The aim of the study was to determine the health-related quality of life of patients with bipolar disorder attending a mental health clinic in south western Uganda. We enrolled a consecutive sample of 169 participants and evaluated their health-related quality of life using the medical outcomes health survey short form-36 (SF-36) scale. We used bivariate and multivariable logistic regression to determine associations between quality of life, sociodemographic and clinical factors setting the physical and mental component categories of quality life scale as the main outcome variables. RESULTS The mean age of the participants was 37.23 (12.83) and slightly over half (54.4%) were females. More than half (66.86%) of the participants had poor physical component summary (mean = 45.06, SD = 8.44) while 81% of the participants had poor mental component summary (mean = 41.95, SD = 8.45). Poor physical quality of life had a statistically significant association with history of suicidal thoughts (OR = 2.75, 95% CI = 1.14-6.63, P = 0.02), while poor mental quality of life had a statistically significant association with history of suicidal thoughts (OR = 3.94, CI = 1.22-12.71, P = 0.02) and history of psychotic symptoms (OR = 2.46, CI = 1.07-5.64, P = 0.03). CONCLUSION The mental and physical quality of life of our participants was poor and history of suicidal thoughts and psychotic symptoms were associated with poor quality of life. There is need to address psychotic symptoms and suicidal thoughts in the management of patients with bipolar disorder to improve health related outcomes and quality of life.
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Affiliation(s)
| | | | | | - Samuel Maling
- Mbarara University of Science and Technology, Mbarara, Uganda
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17
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Parcesepe AM, Cordoba E, Gallis JA, Headley J, Tchatchou B, Hembling J, Soffo C, Baumgartner JN. Common mental disorders and intimate partner violence against pregnant women living with HIV in Cameroon: a cross-sectional analysis. BMC Pregnancy Childbirth 2021; 21:178. [PMID: 33663428 PMCID: PMC7934543 DOI: 10.1186/s12884-021-03673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa. METHODS This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD. RESULTS Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD. CONCLUSIONS Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC 27599 USA
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC USA
| | - Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC USA
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18
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Colson PW, Franks J, Wu Y, Winterhalter FS, Knox J, Ortega H, El-Sadr WM, Hirsch-Moverman Y. Adherence to Pre-exposure Prophylaxis in Black Men Who Have Sex with Men and Transgender Women in a Community Setting in Harlem, NY. AIDS Behav 2020; 24:3436-3455. [PMID: 32385678 DOI: 10.1007/s10461-020-02901-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While oral pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention, consistent use is necessary to achieve its intended impact. We compared effectiveness of enhanced PrEP (enPrEP) adherence support to standard of care (sPrEP) among Black MSM and TGW attending a community clinic in Harlem, NY. EnPrEP included peer navigation, in-person/online support groups, and SMS messages. Self-reported adherence over previous 30 days, collected in quarterly interviews, was defined as ≥ 57%. Crude and adjusted analyses examined factors associated with adherence. A total of 204 participants were enrolled and randomized; 35% were lost to follow-up. PrEP adherence was 30% at 12-months; no intervention effect was observed (p = 0.69). Multivariable regression analysis found that lower adherence was associated with low education and depressive symptoms. We found that an enhanced adherence intervention did not improve PrEP adherence. Findings point to the need for innovative methods to improve PrEP adherence among Black MSM and TGW.Clinical Trial Registration NCT02167386, June 19, 2014.
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Martin F, Nalukenge W, Lazarus O, Birungi J, Seeley J. "Vital": HIV counselling and testing staff's views of addressing mental health with HIV in Uganda. BMC Health Serv Res 2020; 20:1027. [PMID: 33172447 PMCID: PMC7654166 DOI: 10.1186/s12913-020-05881-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/31/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental health is linked to HIV outcomes, including linkage into care and adherence to medication. Integrated care for mental and physical health is recommended. HIV testing and counselling sessions represent an opportunity to implement interventions to address mental health, however it is first necessary to understand the roles, current practice, knowledge and attitudes of the testing and counselling staff. METHODS This qualitative study used semi-structured interviews with HIV testing and counselling staff at four centres of a HIV healthcare provider charity in Uganda. Interviews focused on their current practice, perceptions of mental health and their role in supporting this, challenges of this work, training and support needs, and views of potential greater emphasis on mental health work in their role. Data were audio-recorded, transcribed verbatim, and analysed thematically. RESULTS Data from twenty-one testing and counselling staff revealed five themes. Clients presented to counselling staff with needs spanning bio-psycho-social domains, where psychological health was intertwined with HIV management, medication adherence, and seen as "inseparable" from HIV itself. Mental health was largely thought about as "madness", identifiable from extreme behaviour. As such, common mental health problems of anxiety and depression were not often seen as part of mental health. Approaches to intervening with mental health were seen as behavioural, with some ideas about changing thinking styles. Participants demonstrated significant practice of common techniques to address mental health. Needs were identified for further training in suicide risk assessment and identification of depression, together with greater clinical supervision. Participants described significant conflict within their roles, particularly balancing time demands and need to achieve testing targets against the need to offer adequate mental health support to clients in need. CONCLUSIONS HIV testing and counselling staff described a diverse role that already includes addressing mental health. Mental health is "vital" to their work, however the time needed to address it is at odds with current testing targets. They require more training and resources to effectively address mental health, which is vital to optimising HIV outcomes. Interventions to integrate mental health support into HIV testing and counselling sessions need to be further researched and optimised.
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Affiliation(s)
- Faith Martin
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Winfred Nalukenge
- MRC/UVRI and LSHTM Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
| | - Oucul Lazarus
- The AIDS Support Organisation, Mulago Hospital Complex, P.O BOX 10443, Kampala, Uganda
| | - Josephine Birungi
- MRC/UVRI and LSHTM Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
- The AIDS Support Organisation, Mulago Hospital Complex, P.O BOX 10443, Kampala, Uganda
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, P.O.Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
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Parcesepe AM, Lancaster K, Edelman EJ, DeBoni R, Ross J, Atwoli L, Tlali M, Althoff K, Tine J, Duda SN, Wester CW, Nash D. Substance use service availability in HIV treatment programs: Data from the global IeDEA consortium, 2014-2015 and 2017. PLoS One 2020; 15:e0237772. [PMID: 32853246 PMCID: PMC7451518 DOI: 10.1371/journal.pone.0237772] [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: 03/10/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathryn Lancaster
- Department of Epidemiology, The Ohio State University, Columbus, Ohio, United States of America
| | - E Jennifer Edelman
- Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Raquel DeBoni
- National Institute of Infectology, Evandro Chagas, Fiocruz, Brazil
| | - Jeremy Ross
- TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Keri Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Judicaël Tine
- Maladies Infectieuses du Centre Hospitalier, National Universitaire de FANN, Dakar, Senegal
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - C William Wester
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, City University of New York, New York, New York, United States of America
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21
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Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis. AIDS Behav 2020; 24:1752-1764. [PMID: 31720956 DOI: 10.1007/s10461-019-02706-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite the substantial burden of HIV in Africa, and the knowledge that depression causes worse HIV outcomes, the burden of depression in people living with HIV in Africa is unknown. We searched Pubmed and four other databases using key terms: depression, Africa, HIV, and prevalence from 2008 to 2018. We summarized depression prevalence by country. We estimated the burden of depression using our prevalence data and 2018 UNAIDS HIV estimates. Our search yielded 70 articles across 16 African countries. The overall prevalence of major depression in those HIV-infected using a diagnostic interview was 15.3% (95% CI 12.5-17.1%). We estimate that 3.63 million (99.7% CI 3.15-4.19 million) individuals with HIV in Sub-Saharan Africa have major depression and provide country-level estimates. We estimate that 1.57 million (99.7% CI 1.37-1.82 million) DALYs are lost among people with depression and HIV in Sub-Saharan Africa. There is a significant burden of depression in Africans with HIV. Further work to screen for and treat depression in Sub-Saharan Africa is needed to improve HIV outcomes and achieve the 90-90-90 UNAIDS goals.
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22
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The Impact of Clinic Policy Attendance and the Ryan White HIV/AIDS Medical Case Management Program on HIV Clinical Outcomes: A Retrospective Longitudinal Study. AIDS Behav 2020; 24:1161-1169. [PMID: 31768689 DOI: 10.1007/s10461-019-02738-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinic appointment attendance is a significant determinant of improved HIV health outcomes. A retrospective longitudinal analysis from 2009 to 2015 examined the relationship of clinic policy attendance with and without medical case management (MCM) on HIV clinical outcomes. Clinical parameters were abstracted across the study years and latent growth models measured HIV clinical outcomes as a function of time. A total of 2773 patients were included in this study. More than the majority of individuals had 75% clinic policy attendance during each of the study years and the median number of MCM contact visits with the case manager was 4.0 visits per year (p < 0.01). While the overall trend identified improved HIV clinical outcomes across the clinic population over the study period, it also revealed individuals receiving MCM and with 75% clinic policy attendance had significantly faster improvement in HIV clinical outcomes compared to the individuals who did not receive MCM nor had 75% clinic policy attendance. This study identified how MCM, in combination with clinic policy attendance efforts, are useful in quickly improving HIV viral load and CD4 T-cell count. These findings support the continued need for funding of the Ryan White Care Act as it assists with the support of MCM and appointment attendance through the guidance of wrap-around services.
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Bulstra CA, Hontelez JA, Ogbuoji O, Bärnighausen T. Which delivery model innovations can support sustainable HIV treatment? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 18:315-323. [PMID: 31779572 DOI: 10.2989/16085906.2019.1686033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rapid scale-up of antiretroviral treatment (ART) for HIV since the mid-2000s, mostly through disease-specific or "vertical" programmes, has been a highly successful undertaking, which averted millions of deaths and prevented many new infections. However, the dynamics of the HIV epidemic and changing political and financial commitment to fight the disease will likely require new models for the delivery of ART over the coming decades if the promises of universal treatment are to be met. Delivery model innovations for ART are intended to improve both the effectiveness and efficiency of the HIV treatment cascade, reaching new people who require ART and providing ART to more people without an increase in resources. We describe twelve models for ART delivery, which could be achieved through five categories of delivery innovations: integrating ART ("vertical ART plus", "partially-integrated ART" and "fully-integrated ART"); modifying steps in the ART value chain ("professional task-shifted ART", "people task-shifted ART" and "technology-supported ART"); eliminating steps in the ART value chain ("immediate ART" and "less frequent ART pick-up"); changing ART locations ("private-sector ART", "traditional-sector ART" and "ART outside the health sector"); and keeping the status quo ("vertical ART"). The different delivery model innovations are not mutually exclusive and several could be combined, such as "vertical ART plus" with "task-shifted ART". Suitability of the models will highly depend on local and national contexts, including existing health systems resources, available funding, and type of HIV epidemic. Future implementation research needs to identify which models are the best fit for different contexts.
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Affiliation(s)
- Caroline A Bulstra
- Erasmus Medical Centre, Department of Public Health, Rotterdam, The Netherlands.,Institute of Global Health, University of Heidelberg, Germany
| | - Jan Ac Hontelez
- Erasmus Medical Centre, Department of Public Health, Rotterdam, The Netherlands.,Institute of Global Health, University of Heidelberg, Germany
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke University, Durham, USA
| | - Till Bärnighausen
- Institute of Global Health, University of Heidelberg, Germany.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA.,Africa Health Research Institute, Durban, South Africa
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24
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Siril H, Smith Fawzi MC, Todd J, Somba M, Kaale A, Minja A, Killewo J, Mugusi F, Kaaya SF. The value of hope: development and validation of a contextual measure of hope among people living with HIV in urban Tanzania a mixed methods exploratory sequential study. BMC Psychol 2020; 8:5. [PMID: 31996246 PMCID: PMC6988347 DOI: 10.1186/s40359-020-0376-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/19/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hope or hopefulness enhances coping and improves quality of life in persons with chronic or incurable illnesses. Lack of hope is associated with depression and anxiety, which impact negatively on quality of life. In Tanzania, where HIV prevalence is high, the rates of depression and anxiety are over four times higher among people living with HIV (PLH) compared to persons not infected and contribute annual mortality among PLH. Tanzania has a shortage of human resources for mental health, limiting access to mental health care. Evidence-based psychosocial interventions can complement existing services and improve access to quality mental health services in the midst of human resource shortages. Facilitating hope can be a critical element of non-pharmacological interventions which are underutilized, partly due to limited awareness and lack of hope measures, adapted to accommodate cultural context and perspectives of PLH. To address this gap, we developed and validated a local hope measure among PLH in Tanzania. METHODS Two-phased mixed methods exploratory sequential study among PLH. Phase I was Hope-related items identification using deductive, inductive approaches and piloting. Phase II was an evaluation of psychometric properties at baseline and 24 months. Classical test theory, exploratory, confirmatory factor analysis (CFA) were used. RESULTS Among 722 PLH, 59% were women, mean age was 39.3 years, and majority had primary school level of education. A total of 40 hope items were reduced to 10 in a three-factor solution, explaining 69% of variance at baseline, and 93% at follow-up. Internal consistency Cronbach's alpha was 0.869 at baseline and 0.958 at follow-up. The three-factor solution depicted: positive affect; cognition of effectiveness of HIV care; and goals/plans/ future optimism. Test-retest reliability was good (r = 0.797) and a number of indices were positive for CFA model fit, including Comparative Fit Index of 0.984. CONCLUSION The developed local hope scale had good internal reliability, validity, and its dimensionality was confirmed against expectations. The fewer items for hope assessment argue well for its use in busy clinical settings to improve HIV care in Tanzania. Hope in this setting could be more than cognitive goal thinking, pathway and motivation warranting more research. TRIAL REGISTRATION The intervention was registered in USA ClinicalTrials.gov on September 26, 2012, Registration number: NCT01693458.
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Affiliation(s)
- Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili, University of Health and Allied Sciences (MUHAS), P.O. Box 65001, Dar es Salaam, Tanzania
| | - Mary C. Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA USA
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Magreat Somba
- Africa Academy for Public Health (AAPH), Plot # 802 Mwai Kibaki road, Dar es Salaam, Tanzania
| | - Anna Kaale
- Africa Academy for Public Health (AAPH), Plot # 802 Mwai Kibaki road, Dar es Salaam, Tanzania
| | - Anna Minja
- Africa Academy for Public Health (AAPH), Plot # 802 Mwai Kibaki road, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences (MUHAS), P.O. Box 65001, Dar es Salaam, Upanga Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine P.O. Box 65001, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sylvia F. Kaaya
- Department of Psychiatry and Mental Health, Muhimbili, University of Health and Allied Sciences (MUHAS), P.O. Box 65001, Dar es Salaam, Tanzania
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25
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Engagement in treatment for depression among people who inject drugs in Baltimore, Maryland. J Subst Abuse Treat 2019; 106:107-112. [PMID: 31540605 DOI: 10.1016/j.jsat.2019.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Mental health care may mitigate negative consequences related to substance use and bolster engagement in care for drug dependence. Despite the increased risk of depression among people who inject drugs (PWID), the longitudinal relationship of depression symptoms with depression and drug treatment utilization in this population remains uncharacterized. METHODS Data on depressive symptoms and depression treatment from current and former PWID in the ALIVE (AIDS Linked to the IntraVenous Experience) community-based cohort who had ≥3 study visits from July 2005 to June 2016 were included. We used logistic regression analysis with generalized estimating equations to examine factors associated with depression treatment in the 12 months following reported major depressive symptoms (CES-D ≥ 23) in the absence of treatment. We further examined the association between depression, depression treatment, and subsequent engagement in drug treatment among those with active substance use or alcohol dependence. RESULTS Of the 1544 participants, 34% were female, the median age was 51 years, and 91% were African-American. PWID reported major depressive symptoms at 22% of study visits. In adjusted analysis, acute emergency care, suicidal ideation, and recent alcohol or drug treatment were positively associated with initiating depression treatment. Depression was positively associated with subsequent treatment for substance dependence among those actively using (aOR = 1.30, 95% CI: 1.10-1.53). CONCLUSIONS PWID experience a high burden of depressive symptoms with significant unmet need of treatment for depression. Our findings suggest that mental health providers should bolster connections to chronic disease and alcohol and drug treatment providers.
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26
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Parcesepe AM, Mugglin C, Nalugoda F, Bernard C, Yunihastuti E, Althoff K, Jaquet A, Haas AD, Duda SN, Wester CW, Nash D. Screening and management of mental health and substance use disorders in HIV treatment settings in low- and middle-income countries within the global IeDEA consortium. J Int AIDS Soc 2019; 21:e25101. [PMID: 29603887 PMCID: PMC5878412 DOI: 10.1002/jia2.25101] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/08/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Integration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low‐ and middle‐income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Methods We surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia‐Pacific and sub‐Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post‐traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders. Results Most sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD, 55% for SUDs and 29% for other mental health disorders. Depression, PTSD, SUDs and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on‐site management of depression, PTSD, and SUDs, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On‐site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUDs was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children. Conclusions Significant gaps exist in the management of MSDs in HIV care settings in LMICs, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSDs and HIV care is needed.
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Affiliation(s)
- Angela M Parcesepe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Charlotte Bernard
- Bordeaux Population Health Research Center, University of Bordeaux, INSERM, Bordeaux, France.,INSERM, ISPED, Bordeaux Population Health Research Center, Bordeaux, France
| | - Evy Yunihastuti
- Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Keri Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Antoine Jaquet
- Bordeaux Population Health Research Center, University of Bordeaux, INSERM, Bordeaux, France
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C William Wester
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Raviola G, Naslund JA, Smith SL, Patel V. Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap. Curr Psychiatry Rep 2019; 21:44. [PMID: 31041554 DOI: 10.1007/s11920-019-1028-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing-engaging non-specialist providers-to deliver mental health care. RECENT FINDINGS There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.
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Affiliation(s)
- Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Stephanie L Smith
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
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Parcesepe A, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, Melaku Z, Elul B, Nash D. HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia. AIDS Behav 2018; 22:3815-3825. [PMID: 29453552 DOI: 10.1007/s10461-018-2059-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. This work aims to advance a more comprehensive understanding of interrelationships among three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. We analyzed cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Interventions to increase social support may be insufficient to improve the mental health of people living with HIV who experienced enacted HIV-related stigma. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.
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Affiliation(s)
- Angela Parcesepe
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599-7445, USA.
| | - Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Robert Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Tsigereda Gadisa
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Zenebe Melaku
- ICAP-Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Batya Elul
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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29
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Parcesepe AM, Bernard C, Agler R, Ross J, Yotebieng M, Bass J, Kwobah E, Adedimeji A, Goulet J, Althoff KN. Mental health and HIV: research priorities related to the implementation and scale up of 'treat all' in sub-Saharan Africa. J Virus Erad 2018; 4:16-25. [PMID: 30515310 PMCID: PMC6248852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
World Health Organization (WHO) guidelines call for antiretroviral therapy (ART) for all people living with HIV (PLWH) regardless of CD4 cell count, a policy often referred to as 'treat all'. This article seeks to: (1) provide an overview of mental health research among PLWH in sub-Saharan Africa (SSA) and interventions or strategies to address comorbid mental illness among those living with HIV; and (2) describe key mental health-related recommendations to inform the successful implementation and scale up of 'treat all' policies in SSA. An initial set of mental health-related research recommendations was developed by a working group comprising investigators affiliated with the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Recommendations were shared with those who attended the All-Africa IeDEA Meeting in Kigali, Rwanda in November 2017 and refined following the meeting. Recommendations reflect a need for epidemiological research to examine the prevalence, incidence, and impact of mental health multimorbidities on HIV treatment outcomes, intervention research to examine the extent to which improving the mental health of people living with HIV enhances HIV treatment outcomes, and implementation science research to evaluate promising models of integrated mental health and HIV care. Key research recommendations can advance understanding and treatment of mental illness among those living with HIV in sub-Saharan Africa and beyond.
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Affiliation(s)
- Angela M Parcesepe
- Corresponding author: Angela M. Parcesepe;
University of North Carolina at Chapel Hill,
Gillings School of Global Public Health,
Department of Maternal and Child Health,
CB#7445Chapel Hill,
NC,
27599-7445,
USA
| | | | - Robert Agler
- Department of Psychology, Ohio State University,
Columbus, OH,
USA
| | - Jeremy Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research,
Bangkok,
Thailand
| | - Marcel Yotebieng
- College of Public Health, Division of Epidemiology, Ohio State University,
Columbus, OH,
USA
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD,
USA
| | - Edith Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital and Moi University,
Eldoret,
Kenya
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine,
Bronx, NY,
USA
| | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD,
USA
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30
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Parcesepe AM, Bernard C, Agler R, Ross J, Yotebieng M, Bass J, Kwobah E, Adedimeji A, Goulet J, Althoff KN. Mental health and HIV: research priorities related to the implementation and scale up of ‘treat all’ in sub-Saharan Africa. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30341-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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31
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Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders. Community Ment Health J 2018; 54:1146-1153. [PMID: 29752639 PMCID: PMC6230497 DOI: 10.1007/s10597-018-0284-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/05/2018] [Indexed: 02/05/2023]
Abstract
A consistently suppressed viral load enables HIV (+) patients to live longer, healthier lives and reduces the probability of transmitting the virus. Since the prevalence of HIV is four times higher among those with psychiatric disorders than in the general population, it is likely that this group would also have greater difficulty remaining in care and achieving viral suppression. A secondary data analysis utilizing screening data from the Preventing AIDS Through Health (PATH) for Triples (PFT) Study were examined to assess HIV load suppression among 254 psychiatric inpatients with comorbid substance use disorders in Philadelphia. Viral load results from the past 12 months were obtained from medical records for 63 inpatients identified as HIV (+). The sample was predominately African American (76%), male (56%), and the average age was 43 years. Psychiatric disorders included depression (64%), schizophrenia (21%), and bipolar disorder (13%) with patients reporting use of alcohol (73%), cocaine (64%), cannabis (29%) and opioids (16%) prior to admission. Among this high risk sample of HIV (+) patients, about one-half (52%) achieved viral suppression, with recent opioid users six times more likely to have a detectable viral load than non-opioid users (OR 6.0; CI 1.1-31.7, p = .035). The 52% viral load suppression rate among psychiatric inpatient was higher than expected, given that the CDC's national suppression rate among those diagnosed with HIV in the general population is 58%. However, individuals with mental illness and substance use disorders require constant surveillance, monitoring, and supportive services to achieve viral suppression. Many of those who were virally suppressed were engaged in Philadelphia's extensive treatment network, whereas those who were detectable and enrolled in the PFT intervention were often homeless with unstable psychiatric symptoms and current substance use disorders, particularly opioid abuse.
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Vitale A, Ryde J. Exploring Risk Factors Affecting the Mental Health of Refugee Women Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102326. [PMID: 30360458 PMCID: PMC6209869 DOI: 10.3390/ijerph15102326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022]
Abstract
Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need.
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Affiliation(s)
- Agata Vitale
- College of Liberal Arts (CoLA), Bath Spa University, Newton Park, Bath BA29BN, UK.
| | - Judy Ryde
- Trauma Foundation South West, Barrow Castle, Rush Hill, Bath BA22QR, UK.
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Pinto RM, Witte SS, Filippone PL, Choi CJ, Wall M. Policy Interventions Shaping HIV Prevention: Providers' Active Role in the HIV Continuum of Care. HEALTH EDUCATION & BEHAVIOR 2018; 45:714-722. [PMID: 29547342 DOI: 10.1177/1090198118760681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The U.S. Centers for Disease Control and Prevention (CDC) Diffusion of Effective Behavioral Interventions project has disseminated HIV behavioral interventions (EBIs) across the United States since the 1990s. In 2011, the CDC launched the High-Impact HIV Prevention (HIP) project, providing EBIs plus high-impact services (HIV testing, primary care, and support services). Providers (nurses, social workers, educators) are unable to consistently make linkages; thus, numerous at-risk individuals are not benefitting from HIP. Research on providers' roles in the HIV Continuum of Care-linking clients to HIV testing, primary care, and support services-is lacking. This article helps fill this gap with evidence that providers exposed to EBIs, whose agencies offer EBIs, more frequently link clients to high-impact services. This is based on diffusion of innovations theory, where individuals in social networks influence one another's adoption of innovations. We hypothesize that providers are exposed to EBIs via training, reading and hearing about EBIs, and/or discussing EBIs with colleagues. We used cross-sectional data from 379 providers from 36 agencies in New York City. We used multilevel ordinal logistic regression models to test associations between provider exposure to EBIs (agency provides EBIs) and frequency of linkages to high-impact services. Providers exposed to greater numbers of EBIs more frequently link clients to HIV, hepatitis C (HEP-C), and sexually transmitted infections testing; to primary care; and to drug treatment and mental health services. Providers link clients most frequently to primary care and HIV testing and least frequently to HEP-C testing and syringe exchange. Findings suggest a dose effect, with exposure to more EBIs resulting in more linkages. Findings show a staged, evidence-based prevention approach that includes exposure to EBIs, leading to providers linking clients to high-impact services. There needs to be emphasis on inspiring providers to engage with high-impact services at the elevated levels needed to end the epidemic.
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Affiliation(s)
| | | | | | - C Jean Choi
- 3 New York State Psychiatric Institute, New York, NY, USA
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Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System. J Clin Psychol Med Settings 2018; 24:245-258. [PMID: 28929269 DOI: 10.1007/s10880-017-9509-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system's six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.
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Chan BT, Pradeep A, Mayer KH, Kumarasamy N. Attitudes of Indian HIV Clinicians Toward Depression in People Living with HIV. Ann Glob Health 2018; 82:792-797. [PMID: 28283131 DOI: 10.1016/j.aogh.2016.04.672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in people living with HIV (PLHIV) and is associated with increased morbidity and mortality. In India, where access to mental health specialists is limited, little is known about the attitude of HIV clinicians toward depression in PLHIV. METHODS We administered a questionnaire to HIV clinicians attending the 2015 Chennai Antiretroviral Therapy Symposium that assessed respondents' level of agreement with 29 statements regarding the etiology, importance, and management of depression and whether they felt capable and willing to manage depression in PLHIV. RESULTS The 69 respondents were from 9 Indian states. Most respondents agreed that depression in PLHIV is a serious problem (91%) and is associated with poorer HIV-related outcomes (62%-81%). Although most respondents (76%) reported feeling comfortable discussing mental health problems with PLHIV, almost half (48%) admitted that lack of knowledge and training about mental health issues hindered the diagnosis and treatment of depression in PLHIV. With few exceptions, there were no significant differences in responses by gender, urban/rural practice location, or government versus private practice. CONCLUSIONS Indian HIV clinicians believe that depression in PLHIV is important and are willing to manage depression in the HIV primary care setting. These findings suggest that HIV clinicians require further training to deliver evidence-based interventions to treat PLHIV with depression.
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Affiliation(s)
- Brian T Chan
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Amrose Pradeep
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Kenneth H Mayer
- Harvard Medical School, Boston, MA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA; Fenway Health, Boston, MA
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Choi SKY, Boyle E, Cairney J, Grootendorst P, Gardner S, Collins EJ, Kendall C, Rourke SB. Impact of depression and recreational drug use on emergency department encounters and hospital admissions among people living with HIV in Ontario: A secondary analysis using the OHTN cohort study. PLoS One 2018; 13:e0195185. [PMID: 29630615 PMCID: PMC5891004 DOI: 10.1371/journal.pone.0195185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/19/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction Nearly half of HIV-positive patients experience mental health and substance use problems, but many do not receive adequate or ongoing mental health or addiction care. This lack of ongoing care can result in the use of costly acute care services. Prospective evaluations of the relationship between psychiatric and substance use disorders and acute care services use are lacking, and this information is needed to understand unmet needs and improve access to appropriate services. Methods We conducted a secondary data analysis from a multicenter, longitudinal, prospective cohort study (n = 3,482 adults) between October 1, 2007 and March 31, 2013. We used explanatory extended Cox proportional hazard regression models to examine the impact of current depression and recreational drug use on acute care services use, and to explore whether current depression and recreational drug use were associated with potentially avoidable acute care services use. Results Over our 5.5 year study period, HIV-positive participants with current depression-only (aHR [95% CI]:1.2[1.1–1.4]), recreational drug use-only (1.3[1.1–1.6]), or co-occurring depression and recreational drug use (1.4[1.2–1.7]) were associated with elevated hazard of emergency department (ED) encounters compared to participants without these conditions. Over half of ED encounters were potentially avoidable. Participants with current depression-only (1.3[1.1–1.5];1.3[1.03–1.6]), recreational drug use-only (1.3[1.04–1.6];1.5[1.1–1.9]), or co-occurring depression and recreational drug use (1.3[1.04–1.7];1.4[1.06–1.9]) were associated with elevated hazard of low-acuity or repeated ED encounters respectively. Conclusions We found a significant increase in ED services use and potentially avoidable ED encounters (including low-acuity or repeated ED encounters), particularly among those with either current depression or recreational drug use. These findings emphasize the challenges in managing HIV and mental health/addiction co-morbidities in the current HIV care model. Future research should evaluate integrated and collaborative care programs for improving the coordination of care and effectively treat mental health and addiction problems among HIV-positive patients in Ontario.
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Affiliation(s)
- Stephanie K. Y. Choi
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Eleanor Boyle
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - John Cairney
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Infant and Child Health Lab, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- School of Public Policy and Governance, University of Toronto, Ontario, Canada
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Hospital, Ontario, Canada
| | - Evan J. Collins
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Claire Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ontario, Canada
- The Ottawa Hospital, Ontario, Canada
| | - Sean B. Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
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Health-related quality of life of people with HIV: an assessment of patient related factors and comparison with other chronic diseases. AIDS 2018; 32:103-112. [PMID: 29112062 DOI: 10.1097/qad.0000000000001672] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The health-related quality of life (HRQOL) of people with HIV is lower than in the general population, but it is unknown how it compares with that of persons with other chronic medical conditions. We compared HRQOL in HIV with HRQOL in diabetes mellitus type 1, diabetes mellitus type 2 and rheumatoid arthritis (RA). In addition, we investigated factors associated with HRQOL in HIV. DESIGN Cross-sectional study. METHODS HRQOL was measured with the Medical Outcomes Study Short Form 36-item Health Survey in a nationwide sample of people with HIV in care in the Netherlands and on combination antiretroviral therapy for at least 6 months. We added data from studies in diabetes mellitus types 1 and 2, and RA. Logistic regression analysis was used to examine: the association between disease group and a poor HRQOL, and patient factors associated with poor HRQOL in HIV. RESULTS The odds of a poor physical HRQOL in the HIV group were comparable with the odds in diabetes mellitus types 1 and 2, but lower than in RA patients. The odds of a poor mental HRQOL in HIV were higher than in the other groups. In HIV, a history of AIDS, longer duration of combination antiretroviral therapy and severe comorbidity were associated with a poor physical HRQOL. Sub-Saharan African descent and CD4 cell count of less than 350 cells/μl were associated with poor mental HRQOL. CONCLUSION People with HIV were more likely to have a poor mental HRQOL than patients with other chronic conditions. Addressing mental health should be an integral part of outpatient HIV care.
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Modula MJ, Ramukumba MM. Nurses’ implementation of mental health screening among HIV infected guidelines. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Factors That Influence Linkages to HIV Continuum of Care Services: Implications for Multi-Level Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111355. [PMID: 29112126 PMCID: PMC5707994 DOI: 10.3390/ijerph14111355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/26/2017] [Accepted: 11/02/2017] [Indexed: 01/17/2023]
Abstract
Worldwide, the human immunodeficiency virus (HIV) continuum of care involves health promotion providers (e.g., social workers and health educators) linking patients to medical personnel who provide HIV testing, primary care, and antiretroviral treatments. Regrettably, these life-saving linkages are not always made consistently and many patients are not retained in care. To design, test and implement effective interventions, we need to first identify key factors that may improve linkage-making. To help close this gap, we used in-depth interviews with 20 providers selected from a sample of 250 participants in a mixed-method longitudinal study conducted in New York City (2012–2017) in order to examine the implementation of HIV services for at-risk populations. Following a sociomedical framework, we identified provider-, interpersonal- and environmental-level factors that influence how providers engage patients in the care continuum by linking them to HIV testing, HIV care, and other support services. These factors occurred in four domains of reference: Providers’ Professional Knowledge Base; Providers’ Interprofessional Collaboration; Providers’ Work-Related Changes; and Best Practices in a Competitive Environment. Of particular importance, our findings show that a competitive environment and a fear of losing patients to other agencies may inhibit providers from engaging in linkage-making. Our results suggest relationships between factors within and across all four domains; we recommend interventions to modify factors in all domains for maximum effect toward improving care continuum linkage-making. Our findings may be applicable in different areas of the globe with high HIV prevalence.
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Chuah FLH, Haldane VE, Cervero-Liceras F, Ong SE, Sigfrid LA, Murphy G, Watt N, Balabanova D, Hogarth S, Maimaris W, Otero L, Buse K, McKee M, Piot P, Perel P, Legido-Quigley H. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy Plan 2017; 32:iv27-iv47. [PMID: 29106512 PMCID: PMC5886062 DOI: 10.1093/heapol/czw169] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. METHODS This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. RESULTS Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. CONCLUSION This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden.
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Affiliation(s)
- Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Victoria Elizabeth Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Francisco Cervero-Liceras
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Louise A Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Georgina Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicola Watt
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Sue Hogarth
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- London Borough of Waltham Forest, UK
| | - Will Maimaris
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- Haringey Council, UK
| | - Laura Otero
- Nursing Section, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Kent Buse
- CIBER of Epidemiology and Public Health (CIBERESP-ISCIII), Madrid, Spain
| | - Martin McKee
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Pablo Perel
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- The World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
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Watt N, Sigfrid L, Legido-Quigley H, Hogarth S, Maimaris W, Otero-García L, Perel P, Buse K, McKee M, Piot P, Balabanova D. Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review. Health Policy Plan 2017; 32:iv13-iv26. [PMID: 28666336 PMCID: PMC5886067 DOI: 10.1093/heapol/czw149] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/15/2023] Open
Abstract
Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers-with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of the health systems in which they are embedded.
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Affiliation(s)
- Nicola Watt
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Dept. of Medicine, University of Oxford, Oxford, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sue Hogarth
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Public Health Consultant at Tower Hamlets Together
| | - Will Maimaris
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Public Health Consultant, Haringey Council, London
| | - Laura Otero-García
- Nursing Section, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo Av., 4, Madrid and CIBER of Epidemiology and Public 15 Health (CIBERESP), Madrid, Spain
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Kent Buse
- Chief, Strategic Policy Directions, UNAIDS, Geneva, Switzerland
| | - Martin McKee
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Reducing the treatment gap for mental, neurological and substance use disorders in Africa: lessons from the Friendship Bench in Zimbabwe. Epidemiol Psychiatr Sci 2017; 26:342-347. [PMID: 28399952 PMCID: PMC6998766 DOI: 10.1017/s2045796016001128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mental, neurological and substance use disorders (MNS) are a leading cause of disability in Africa. In response to the large treatment gap for MNS, a growing body of evidence-based treatments (EBTs) is emerging from Africa; however, there is a dearth of knowledge on how to scale up EBT. The Friendship Bench intervention is a brief psychological treatment delivered through the primary health care system in Zimbabwe by trained lay health workers. It has contributed significantly towards narrowing the treatment gap for common mental disorders in Zimbabwe where it has been scaled up to over 70 primary health care facilities. A three-pronged approach consisting of community engagement, use of EBTs and a government endorsed scale-up plan is described as part of the key strategy leading to the scale up of the Friendship Bench.
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Mills JC, Harman JS, Cook RL, Marlow NM, Harle CA, Duncan RP, Bengtson AM, Pence BW. Comparative effectiveness of dual-action versus single-action antidepressants for the treatment of depression in people living with HIV/AIDS. J Affect Disord 2017; 215:179-186. [PMID: 28340444 PMCID: PMC5612416 DOI: 10.1016/j.jad.2017.03.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Depression is the most common psychiatric comorbidity among people living with HIV/AIDS (PLWHA). Little is known about the comparative effectiveness between different types of antidepressants used to treat depression in this population. We compared the effectiveness of dual-action and single-action antidepressants in PLWHA for achieving remission from depression. METHODS We used data from the Centers for AIDS Research Network of Integrated Clinic Systems to identify 1175 new user dual-action or single-action antidepressant treatment episodes occurring from 2005 to 2014 for PLWHA diagnosed with depression. The primary outcome was remission from depression defined as a Patient Health Questionnaire-9 (PHQ-9) score <5. Mean difference in PHQ-9 depressive symptom severity was a secondary outcome. The main approach was an intent-to-treat (ITT) evaluation complemented with a per protocol (PP) sensitivity analysis. Generalized linear models were fitted to estimate treatment effects. RESULTS In ITT analysis, 32% of the episodes ended in remission for both dual-action and single-action antidepressants. The odds ratio (OR) of remission was 1.02 (95%CI=0.63,1.67). In PP analysis, 40% of dual-action episodes ended in remission compared to 32% in single-action episodes. Dual-action episodes had 1.33 times the odds of remission (95%CI=0.55,3.21), however the result was not statistically significant. Non-significant differences were also observed for depressive symptom severity. LIMITATIONS Missing data was common but was addressed with inverse probability weights. CONCLUSIONS Results suggest that single-action and dual-action antidepressants are equally effective in PLWHA. Remission was uncommon highlighting the need to identify health service delivery strategies that aid HIV providers in achieving full remission of their patients' depression.
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Affiliation(s)
- Jon C Mills
- University of North Carolina, Chapel Hill, Department of Epidemiology, United States.
| | - Jeffrey S Harman
- Florida State University, Department of Behavioral Sciences and Social Medicine, United States.
| | - Robert L Cook
- University of Florida, Department of Epidemiology and Medicine, United States.
| | - Nicole M Marlow
- University of Florida, Department of Health Services Research, Management and Policy, United States.
| | - Christopher A Harle
- Indiana University, Indianapolis, Department of Health Policy and Management, United States.
| | - R Paul Duncan
- University of Florida, Department of Health Services Research, Management and Policy, United States.
| | - Angela M Bengtson
- University of North Carolina, Chapel Hill, Department of Epidemiology, United States.
| | - Brian W Pence
- University of North Carolina, Chapel Hill, Department of Epidemiology, United States.
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Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, Neria Y, Bradford JME, Oquendo MA, Arbuckle MR. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep 2017; 19:28. [PMID: 28425023 PMCID: PMC5553319 DOI: 10.1007/s11920-017-0780-z] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. RECENT FINDINGS Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.
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Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA.
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - James M Shultz
- Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, FL, 33160, USA
| | - Liat Helpman
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jennifer J Mootz
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Karen A Johnson
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jean-Marie E Bradford
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 200, Philadelphia, PA, 19104-3309, USA
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
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Abstract
In the 19th century, psychiatric institutions were the focus of thousands of articles in the leading English-language medical and psychiatric journals. This area of concern remained important through the first half of the 20th century, with some decline in the number of published articles in the second half of the 20th century as de-institutionalisation gathered pace. The number of articles about this topic has declined sharply in the past 25 years, and psychiatric institutions are not the focus of any of the Grand Challenges in Global Mental Health even though psychiatric institutions of all kinds are widely acknowledged to be the among the main sites of human rights abuses. In this commentary we present examples of impressive transformations of institutions in Sri Lanka and Vietnam, and suggest that the field of global mental health should devote more of its efforts to improving the lives of persons with mental disorders who have been incarcerated in a variety of settings, often under the care of mental health specialists.
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Affiliation(s)
- A. Cohen
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - H. Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
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Sudfeld CR, Kaaya S, Gunaratna NS, Mugusi F, Fawzi WW, Aboud S, Smithfawzi MC. Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV. AIDS 2017; 31:263-271. [PMID: 27835614 PMCID: PMC5177498 DOI: 10.1097/qad.0000000000001323] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of the study was to assess the relationship of depression at antiretroviral therapy (ART) initiation with mortality and clinical outcomes among Tanzanian women living with HIV. DESIGN We conducted a prospective cohort study of 1487 women who initiated ART in Dar es Salaam, Tanzania. METHODS Symptoms of depression and anxiety were assessed using a Tanzanian-adapted and validated version of the Hopkins Symptom Checklist. Participants attended monthly clinic visits during the first 2 years of ART and CD4 T-cell counts were assessed every 4 months. Proportional hazard models were used to assess the relationship of depression with mortality and clinical outcomes. RESULTS Symptoms consistent with depression were prevalent among 57.8% of women at ART initiation. After multivariate adjustment, including social support and stigma, depression at ART initiation was associated with increased risk of mortality [hazard ratio (HR): 1.92; 95% confidence interval (CI): 1.15-3.20; P = 0.01] and incidence of severe anemia (hemoglobin <8.5 g/dl; HR: 1.59; 95% CI: 1.07-2.37; P = 0.02). Under the assumption of causality, we estimate 36.1% (95% CI: 13.6-55.1%) of deaths among the study cohort were attributable to depression and its consequences. Depression was not significantly associated with trajectory of CD4 T-cell reconstitution or the risk of immunologic failure (P values >0.05). CONCLUSION Elimination of depression may reduce mortality during the first 2 years of ART by one-third in our study cohort. Randomized trials and rigorous implementation studies are needed to evaluate the individual and population-level effects of integrated mental health interventions and HIV treatment approaches in resource-limited settings.
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Affiliation(s)
- Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nilupa S. Gunaratna
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fedinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C. Smithfawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Bent-Goodley TB. Social Work's Grand Challenges: Mobilizing the Profession. SOCIAL WORK 2016; 61:197-198. [PMID: 27501636 DOI: 10.1093/sw/sww035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abas M, Bowers T, Manda E, Cooper S, Machando D, Verhey R, Lamech N, Araya R, Chibanda D. 'Opening up the mind': problem-solving therapy delivered by female lay health workers to improve access to evidence-based care for depression and other common mental disorders through the Friendship Bench Project in Zimbabwe. Int J Ment Health Syst 2016; 10:39. [PMID: 27175215 PMCID: PMC4865009 DOI: 10.1186/s13033-016-0071-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/03/2016] [Indexed: 12/20/2022] Open
Abstract
Background There are few accounts of evidence-based interventions for depression and other common mental disorders (CMDs) in primary care in low-income countries. The Friendship Bench Project is a collaborative care mental health intervention in primary care in Harare for CMDs which began as a pilot in 2006. Case presentation We employed a mixture of quantitative and qualitative approaches to investigate the project’s acceptability and implementation, 4–8 years after the initial pilot study. We carried out basic descriptive analyses of routine data on attendance collected between 2010 and 2014. We also conducted five focus group discussions (FGDs) with LHWs in 2013 and 12 in-depth interviews, six with staff and six with patients, to explore experiences of the intervention, which we analysed using grounded theory. Results show that the intervention appears highly acceptable as evidenced by a consistent number of visits between 2010 and 2014 (mean 505 per year, SD 132); by the finding that the same team of female community LHWs employed as government health promoters continue to deliver assessment and problem-solving therapy, and the perceived positive benefits expressed by those interviewed. Clients described feeling ‘relieved and relaxed’ after therapy, and having their ‘mind opened’, and LHWs describing satisfaction from being agents of change. Characteristics of the LHWs (status in the community, maturity, trustworthiness), and of the intervention (use of locally validated symptom screen, perceived relevance of problem-solving therapy) and continuity of the LHW team appeared crucial. Challenges to implementation included the LHWs ongoing need for weekly supervision despite years of experience; the supervisors need for supervision for herself; training needs in managing suicidal and hostile clients; poor documentation; lack of follow-up of depressed clients; and poor access to antidepressants. Conclusions This case study shows that a collaborative care intervention for CMDs is positively received by patients, rewarding for LHWs to deliver, and can be sustained over time at low cost. Next steps include evaluation of the impact of the intervention through a randomised trial, and testing of a technological platform for supporting supervision and monitoring clients’ attendance.
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Affiliation(s)
- Melanie Abas
- Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Tarryn Bowers
- Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Ethel Manda
- Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Sara Cooper
- University of Cape Town, Cape Town, South Africa
| | | | - Ruth Verhey
- Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Neha Lamech
- Schizophrenia Research Foundation (SCARF), Chennai, India
| | - Ricardo Araya
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Dixon Chibanda
- Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe ; Zimbabwe Ministry of Health, Harare Central Hospital, ST 14 Southern, Harare, Zimbabwe
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Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, Ferrari AJ, Hyman S, Laxminarayan R, Levin C, Lund C, Medina Mora ME, Petersen I, Scott J, Shidhaye R, Vijayakumar L, Thornicroft G, Whiteford H. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet 2016; 387:1672-85. [PMID: 26454360 DOI: 10.1016/s0140-6736(15)00390-6] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally. This sobering statistic does not take into account the substantial excess mortality associated with these disorders or the social and economic consequences of MNS disorders on affected persons, their caregivers, and society. A wide variety of effective interventions, including drugs, psychological treatments, and social interventions, can prevent and treat MNS disorders. At the population-level platform of service delivery, best practices include legislative measures to restrict access to means of self-harm or suicide and to reduce the availability of and demand for alcohol. At the community-level platform, best practices include life-skills training in schools to build social and emotional competencies. At the health-care-level platform, we identify three delivery channels. Two of these delivery channels are especially relevant from a public health perspective: self-management (eg, web-based psychological therapy for depression and anxiety disorders) and primary care and community outreach (eg, non-specialist health worker delivering psychological and pharmacological management of selected disorders). The third delivery channel, hospital care, which includes specialist services for MNS disorders and first-level hospitals providing other types of services (such as general medicine, HIV, or paediatric care), play an important part for a smaller proportion of cases with severe, refractory, or emergency presentations and for the integration of mental health care in other health-care channels, respectively. The costs of providing a significantly scaled up package of specified cost-effective interventions for prioritised MNS disorders in low-income and lower-middle-income countries is estimated at US$3-4 per head of population per year. Since a substantial proportion of MNS disorders run a chronic and disabling course and adversely affect household welfare, intervention costs should largely be met by government through increased resource allocation and financial protection measures (rather than leaving households to pay out-of-pocket). Moreover, a policy of moving towards universal public finance can also be expected to lead to a far more equitable allocation of public health resources across income groups. Despite this evidence, less than 1% of development assistance for health and government spending on health in low-income and middle-income countries is allocated to the care of people with these disorders. Achieving the health gains associated with prioritised interventions will require not just financial resources, but committed and sustained efforts to address a range of other barriers (such as paucity of human resources, weak governance, and stigma). Ultimately, the goal is to massively increase opportunities for people with MNS disorders to access services without the prospect of discrimination or impoverishment and with the hope of attaining optimal health and social outcomes.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India; Sangath, Goa, India.
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | | | - Fiona J Charlson
- School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre of Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre of Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Steve Hyman
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard and Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, Washington DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Inge Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - James Scott
- The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Rahul Shidhaye
- Public Health Foundation of India, New Delhi, India; CAPHRI School for Public Health and Primary Care, Maastricht University, Netherlands
| | - Lakshmi Vijayakumar
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; SNEHA, Volunatary Health Services, Chennai, India
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Harvey Whiteford
- School of Public Health, University of Queensland, Herston, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Minick SG, Stafford CL, Kertz BL, Cully JA, Stanley MA, Davila JA, Dang BN, Rodriguez-Barradas MC, Giordano TP. Veterans' Perspectives on Interventions to Improve Retention in HIV Care. PLoS One 2016; 11:e0148163. [PMID: 26829641 PMCID: PMC4734714 DOI: 10.1371/journal.pone.0148163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/13/2016] [Indexed: 12/31/2022] Open
Abstract
Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA) is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC). Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV.
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Affiliation(s)
- Sophie G. Minick
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Crystal L. Stafford
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Barbara L. Kertz
- Infectious Disease Section, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Jeffery A. Cully
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Melinda A. Stanley
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Jessica A. Davila
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Bich N. Dang
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Maria C. Rodriguez-Barradas
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
- Infectious Disease Section, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Thomas P. Giordano
- Houston Center for Innovations in Quality, Safety and Effectiveness, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, United States of America
- * E-mail:
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