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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Yotebieng M, Nash D, Anastos K, Parcesepe AM. Underestimation of potentially traumatic events resulting from underreporting of physical and sexual violence among people entering care for HIV in Cameroon. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:347-352. [PMID: 34941341 PMCID: PMC9218007 DOI: 10.1037/tra0001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Measures ascertaining exposure to potentially traumatic events (PTEs) frequently ask respondents about experienced physical and sexual violence. However, little is known about the performance of physical and sexual violence questions on PTE assessments and its effect on PTE classification overall. We estimated underreporting of physical and sexual violence on a PTE assessment among individuals entering HIV care in Cameroon. METHOD We compared reports of physical and sexual violence captured via a behaviorally specific measure of intimate partner violence (IPV; Demographic and Health Survey [DHS] domestic violence module = referent) to those captured via two single-item questions that assessed exposure to physical and sexual PTEs during one's adult life to determine the degree of underreporting on the single-item PTE assessment questions. We explored correlates of underreporting on the PTE assessment using Pearson's chi-squared tests. RESULTS Overall, 99 (23%) and 113 (27%) of 426 total participants reported instances of sexual and physical violence in their most recent partnership on the behaviorally specific DHS IPV module, respectively. Of those reporting sexual and physical IPV on the DHS module, just 6% (n = 6) and 52% (n = 59) reported sexual and physical violence as an adult on the single-item PTE assessment questions, respectively. Underreporting of physical violence on the PTE assessment was associated with lower educational attainment (p < .05) and reporting being punched (p < .01) or having one's hair pulled or arm twisted (p < .05) by one's most recent partner. CONCLUSIONS PTE assessment tools should assess exposure to behaviorally specific acts of violence to ensure appropriate referral to services among survivors of IPV. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Milton Wainberg
- Department of Psychiatry, Columbia University
- New York State Psychiatric Institute
| | | | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Carolina Population Center, University of North Carolina at Chapel Hill
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2
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Rubin LH, Maki PM, Dastgheyb RM, Steigman PJ, Burke-Miller J, Xu Y, Jin W, Sosanya O, Gustafson D, Merenstein D, Milam J, Weber KM, Springer G, Cook JA. Trauma Across the Life Span and Multisystem Morbidity in Women With HIV. Psychosom Med 2023; 85:341-350. [PMID: 36961349 PMCID: PMC10450638 DOI: 10.1097/psy.0000000000001192] [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] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Sexual and physical abuse are highly prevalent among women living with HIV (WLWH) and are risk factors for the development of mental health and substance use disorders (MHDs, SUDs), and cognitive and medical comorbidities. We examined empirically derived patterns of trauma, MHD, and SUD, and associations with later cognitive and health outcomes. METHODS A total of 1027 WLWH (average age = 48.6 years) in the Women's Interagency HIV Study completed the World Mental Health Composite International Diagnostic Interview from 2010 to 2013 to identify MHDs, SUDs, and age at onset of sexual and physical abuse. Then, cognitive impairment, cardiovascular/metabolic conditions, and HIV disease outcomes were assessed for up to 8.8 years. Latent class analysis identified patterns of co-occurring trauma, MHDs, and/or SUDs. Generalized estimating equations determined associations between these patterns and midlife cognitive and medical outcomes. RESULTS Six distinct profiles emerged: no/negligible sexual/physical trauma, MHD, or SUD (39%); preadolescent/adolescent sexual trauma with anxiety and SUD (22%); SUD only (16%); MHD + SUD only (12%); early childhood sexual/physical trauma only (6%); and early childhood sexual/physical trauma with later MHD + SUD (4%). Profiles including early childhood trauma had the largest number of midlife conditions (i.e., cognitive, cardiovascular, HIV-related). Preadolescent/adolescent sexual trauma with anxiety and SUD predicted both global and domain-specific cognitive declines. Only SUD without trauma predicted lower CD4, whereas childhood trauma with MHD + SUD predicted increased CD8. CONCLUSIONS WLWH have complex multisystem profiles of abuse, MHD, and/or SUD that predict midlife cognitive, metabolic/cardiovascular, and HIV outcomes. Understanding the interplay between these factors over time can identify risks and personalize preventative and treatment interventions.
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Molecular and Cellular Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
| | - Raha M. Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela J. Steigman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Jane Burke-Miller
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Yanxun Xu
- Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wei Jin
- Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Oluwakemi Sosanya
- Department of General Internal Medicine, Montefiore Medical Center, Bronx, NY
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Daniel Merenstein
- Georgetown University Medical Center, Department of Medicine, Washington, DC
| | - Joel Milam
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA
| | - Kathleen M. Weber
- Cook County Health & Hospital System/Hektoen Institute of Medicine, Chicago, IL
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Judith A. Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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3
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Prevalence of potentially traumatic events and symptoms of depression, anxiety, hazardous alcohol use, and post-traumatic stress disorder among people with HIV initiating HIV care in Cameroon. BMC Psychiatry 2023; 23:150. [PMID: 36894918 PMCID: PMC9996899 DOI: 10.1186/s12888-023-04630-1] [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: 04/11/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND This study explored the relationship between specific types of potentially traumatic events (PTEs) and symptoms of mental health disorders among people with HIV (PWH) in Cameroon. METHODS We conducted a cross-sectional study with 426 PWH in Cameroon between 2019-2020. Multivariable log binominal regression was used to estimate the association between exposure (yes/no) to six distinct types of PTE and symptoms of depression (Patient Health Questionnaire-9 score > 9), PTSD (PTSD Checklist for DSM-5 score > 30), anxiety (Generalized Anxiety Disorder-7 scale score > 9), and hazardous alcohol use (Alcohol Use Disorders Identification Test score > 7 for men; > 6 for women). RESULTS A majority of study participants (96%) reported exposure to at least one PTE, with a median of 4 PTEs (interquartile range: 2-5). The most commonly reported PTEs were seeing someone seriously injured or killed (45%), family members hitting or harming one another as a child (43%), physical assault or abuse from an intimate partner (42%) and witnessing physical assault or abuse (41%). In multivariable analyses, the prevalence of PTSD symptoms was significantly higher among those who reported experiencing PTEs during childhood, violent PTEs during adulthood, and the death of a child. The prevalence of anxiety symptoms was significantly higher among those who reported experiencing both PTEs during childhood and violent PTEs during adulthood. No significant positive associations were observed between specific PTEs explored and symptoms of depression or hazardous alcohol use after adjustment. CONCLUSIONS PTEs were common among this sample of PWH in Cameroon and associated with PTSD and anxiety symptoms. Research is needed to foster primary prevention of PTEs and to address the mental health sequelae of PTEs among PWH.
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Affiliation(s)
- Angela M Parcesepe
- Gillings School of Global Public Health, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Departments of Medicine and Epidemiology & Population Health, Bronx, NY, USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
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Kidman R, Breton E, Behrman J, Kohler HP. A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi. AIDS 2022; 36:2181-2189. [PMID: 36083145 PMCID: PMC9671836 DOI: 10.1097/qad.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Adverse childhood experiences have been robustly associated with poor sexual health in later life. In low-income countries, there is growing evidence that children experience greater adversity than those in higher income countries. Research suggests this may contribute to later sexual risk taking and HIV infection, though most studies to date have been cross-sectional. DESIGN We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes. METHODS We interviewed 1878 adolescents living in Malawi in 2017-2018 (age 10-16) and again in 2021 (age 13-20). Adolescents completed the Adverse Childhood Experience - International Questionnaire. HIV-risk was assessed through both behavioral (e.g. condom use) and biological (HIV and herpes simplex virus 2 [HSV2] infection) outcomes. ordinary least squares (OLS) and logistic multivariate regression models are used to explore associations between adversity and HIV risk. RESULTS In longitudinal analyses, adverse childhood experiences (ACEs) were significantly associated with intimate partner violence and girls' behavioral risk scores only. HIV incidence was too low to model; there were no significant associations with HSV2. In cross-sectional analyses, ACEs were additionally associated with an early sexual debut, lack of condom use, a greater number of sexual partnerships, and sexually transmitted infection symptoms. CONCLUSIONS Our findings emphasize the importance of collecting prospective data: results from longitudinal and cross-sectional analyses drew qualitatively different conclusions. Cross-sectional analyses may not be accurate representations of longitudinal processes. However, they suggest that recent adversity and distress drives HIV-related behavior, perhaps more than early adversity. Interventions that combat emotional abuse or peer violence during adolescence could potentially reduce HIV risk.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine Stony Brook University (State University of New York), Stony Brook, New York
| | | | - Jere Behrman
- Departments of Economics and Sociology, Population Aging Research Center and Population Studies Center
| | - Hans-Peter Kohler
- Department of Sociology, Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Stigma Affects the Health-Related Quality of Life of People Living with HIV by Activating Posttraumatic Stress Symptoms. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09928-y. [PMID: 36414787 DOI: 10.1007/s10880-022-09928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/23/2022]
Abstract
Stigma is a strong concern in the effort to manage the impact of many chronic diseases on patients and affects the quality of life (QoL) of patients, but little is understood regarding how this happens. We explored the perspective that stigma reduces health-related QoL (HRQoL) by evoking the traumatic experiences associated with HIV diagnosis. Outpatients (n = 250) receiving HIV-related care were recruited from 2 hospitals in the southeastern region of Nigeria. Participants completed measures of stigma, posttraumatic stress symptoms, and HRQoL. Mediation analyses were conducted using Hayes PROCESS Macro for SPSS. Result showed that stigma was negatively associated with HRQoL; patients who reported more traumatic symptoms also reported poorer HRQoL. Traumatic stress symptoms mediated the path between stigma and all the dimensions of HRQoL. Findings suggest that recognizing and addressing trauma symptoms are important in the management of PLWH. Perhaps addressing trauma would reduce the impact of stigma on HRQoL.
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence BW, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. J Affect Disord 2022; 308:421-431. [PMID: 35452755 PMCID: PMC9520993 DOI: 10.1016/j.jad.2022.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/19/2022] [Accepted: 04/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes. METHODS We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models. RESULTS Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8). LIMITATIONS Given the design of our study, findings are subject to recall and social desirability bias. CONCLUSIONS Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.
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Affiliation(s)
- Lindsey M Filiatreau
- Washington University in St. Louis, School of Medicine, Department of Psychiatry, St. Louis, MO, United States of America; Washington University in St. Louis, Brown School, International Center for Child Health and Development, St. Louis, MO, United States of America; University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America.
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Columbia University, Department of Psychiatry, New York, NY, United States of America
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, New York, NY, United States of America
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Department of Medicine, Bronx, NY, United States of America; Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M Parcesepe
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, United States of America; University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, United States of America
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7
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Ajeh R, Nash D. Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon. PLoS One 2022; 17:e0270042. [PMID: 35771857 PMCID: PMC9246197 DOI: 10.1371/journal.pone.0270042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa. METHODS We conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity. RESULTS Among 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity. CONCLUSION Psychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.
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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, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lindsey M. Filiatreau
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, United States of America
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
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The magnitude and correlates of internalized stigma among people with mental illness attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Heliyon 2022; 8:e09431. [PMID: 35607501 PMCID: PMC9123194 DOI: 10.1016/j.heliyon.2022.e09431] [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: 01/17/2022] [Revised: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Internalized stigma is an ongoing process of psychological assimilation of the community labels towards mental illness, in which people with mental illness (PWMI) gradually lose their current positive belief and confidence in themselves and their future wishes. It affects the treatment and help-seeking behavior which leads to poor drug adherence, social marginalization, unemployment, socio-economic devastation, and poor quality of life for PWMI. Therefore, the current study aimed to determine the magnitude and correlates of high internalized stigma among People with Mental Illness (PWMI) attending the outpatient department of Amanuel mental specialized hospital, Addis Ababa, Ethiopia. Methods Institution based cross-sectional study was conducted from March 03 to March 28, 2019. A consecutive sampling technique was used to select an estimated 406 study participants. Internalized stigma was assessed using a 29 Item Internalized Stigma of Mental Illness (ISMI-29) tool. Data were entered and analyzed using SPSS 22 software. A Binary logistic regression model was fitted to identify correlates of internalized stigma. An adjusted odds ratio (AOR) with a 95% confidence interval was computed to determine the strength of association and the level of significance was declared with a p-value <0.05. Result Of the total study participants, 388 respondents agreed to participate in the study giving a response rate of 96%. The magnitude of high internalized stigma among the study participants was 61.3% (95% CI: 58.2, 64.4). Poor social support (AOR = 1.973; 95%CI = 1.189, 3.27) and being unemployed (AOR = 2.87, 95% CI = 1.192–6.931) were significant correlates of high internalized stigma among PWMI. Conclusion Overall, around three in five PWMI experienced high internalized stigma. Poor social support and being unemployed were significant correlates of high internalized stigma. Large scale community-based study supplemented by qualitative design is highly recommended to identify additional correlates of internalized stigma and understand perspectives of PWMI.
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9
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Folayan MO, Ibigbami O, ElTantawi M, Abeldaño GF, Ara E, Ayanore MA, Ellakany P, Gaffar B, Al-Khanati NM, Idigbe I, Ishabiyi AO, Jafer M, Khan ATA, Khalid Z, Lawal FB, Lusher J, Nzimande NP, Osamika BE, Popoola BO, Quadri MFA, Roque M, Shamala A, Al-Tammemi AB, Yousaf MA, Virtanen JI, Zuñiga RAA, Okeibunor JC, Nguyen AL. Factors associated with COVID-19 pandemic induced post-traumatic stress symptoms among adults living with and without HIV in Nigeria: a cross-sectional study. BMC Psychiatry 2022; 22:48. [PMID: 35062920 PMCID: PMC8777174 DOI: 10.1186/s12888-021-03617-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/24/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nigeria is a country with high risk for traumatic incidences, now aggravated by the COVID-19 pandemic. This study aimed to identify differences in COVID-19 related post-traumatic stress symptoms (PTSS) among people living and not living with HIV; to assess whether PTSS were associated with COVID-19 pandemic-related anger, loneliness, social isolation, and social support; and to determine the association between PTSS and use of COVID-19 prevention strategies. METHODS The data of the 3761 respondents for this analysis was extracted from a cross-sectional online survey that collected information about mental health and wellness from a convenience sample of adults, 18 years and above, in Nigeria from July to December 2020. Information was collected on the study's dependent variable (PTSS), independent variables (self-reported COVID-19, HIV status, use of COVID-19 prevention strategies, perception of social isolation, access to emotional support, feelings of anger and loneliness), and potential confounder (age, sex at birth, employment status). A binary logistic regression model tested the associations between independent and dependent variables. RESULTS Nearly half (47.5%) of the respondents had PTSS. People who had symptoms but were not tested (AOR = 2.20), felt socially isolated (AOR = 1.16), angry (AOR = 2.64), or lonely (AOR = 2.19) had significantly greater odds of reporting PTSS (p < 0.001). People living with HIV (AOR = 0.39), those who wore masks (AOR = 0.62) and those who had emotional support (AOR = 0.63), had lower odds of reporting PTSS (p < .05). CONCLUSION The present study identified some multifaceted relationships between post-traumatic stress, HIV status, facemask use, anger, loneliness, social isolation, and access to emotional support during this protracted COVID-19 pandemic. These findings have implications for the future health of those affected, particularly for individuals living in Nigeria. Public health education should be incorporated in programs targeting prevention and prompt diagnosis and treatment for post-traumatic stress disorder at the community level.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria. .,Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, 22005, Nigeria.
| | - Olanrewaju Ibigbami
- grid.10824.3f0000 0001 2183 9444Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Maha ElTantawi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.7155.60000 0001 2260 6941Department of Pediatric Dentistry and Dental public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,School of Medicine, University of Sierra Sur, Oaxaca, Mexico
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.412997.00000 0001 2294 5433Government College for Women, Maulana Azad Road, Srinagar, J&K India
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.449729.50000 0004 7707 5975Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.411975.f0000 0004 0607 035XDepartment of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.411975.f0000 0004 0607 035XDepartment of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.449576.d0000 0004 5895 8692Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.416197.c0000 0001 0247 1197Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.16463.360000 0001 0723 4123Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.411831.e0000 0004 0398 1027Department of Preventive Dental Sciences, Jazan University, Jazan, Saudi Arabia ,grid.5012.60000 0001 0481 6099Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Abeedah Tu-Allah Khan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.11173.350000 0001 0670 519XSchool of Biological Sciences, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.11173.350000 0001 0670 519XSchool of Biological Sciences, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.9582.60000 0004 1794 5983Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.449469.20000 0004 0516 1006Regent’s University London, London, United Kingdom
| | - Ntombifuthi P. Nzimande
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.9008.10000 0001 1016 9625Department of Economic and Social Geography, University of Szeged, Szeged, Hungary
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.259956.40000 0001 2195 6763Department of Psychology, Miami University Oxford, Ohio, USA
| | - Bamidele Olubukola Popoola
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.9582.60000 0004 1794 5983Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.411831.e0000 0004 0398 1027Department of Preventive Dental Sciences, Division of Dental Public Health, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mark Roque
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.412892.40000 0004 1754 9358Department of Maternity & Childhood Nursing, College of Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Anas Shamala
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.444917.b0000 0001 2182 316XDepartment of Preventive and Biomedical Science, College of Dentistry, University of Science & Technology, Sanaa, Yemen
| | - Ala’a B. Al-Tammemi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.7122.60000 0001 1088 8582Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary ,grid.7122.60000 0001 1088 8582Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.11173.350000 0001 0670 519XInstitute of Zoology, University of the Punjab, Quaid-i-Azam Campus, Lahore, 54590 Pakistan
| | - Jorma I. Virtanen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.1374.10000 0001 2097 1371Faculty of Medicine, University of Turku, Turku, Finland
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,Postgraduate Department, University of Sierra Sur, Oaxaca, Mexico
| | - Joseph Chukwudi Okeibunor
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.463718.f0000 0004 0639 2906Research Development and Innovations, Assistant Regional Director Cluster, WHO Regional Office for Africa, Brazzaville, Congo
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria ,grid.42505.360000 0001 2156 6853Department of Family Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA USA
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Onu DU. Adherence to antiretroviral therapy mediates the link between posttraumatic stress disorder symptoms and health-related quality of life. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/00812463211048122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human immunodeficiency virus is one of the trauma-inducing chronic illnesses with attendant-negative impact on health-related quality of life. Substantial literature exists on the association of posttraumatic stress disorder symptoms and health-related quality of life among people living with human immunodeficiency virus, but little is known about the pathways explaining this link. This study therefore examined the mediating role of adherence to antiretroviral therapy in the association between posttraumatic stress disorder symptoms and health-related quality of life among people living with human immunodeficiency virus. Nine hundred and sixty-nine people living with human immunodeficiency virus in Nigeria who were on antiretroviral therapy completed measures of posttraumatic stress disorder symptoms, adherence to antiretroviral therapy, and health-related quality of life. Hayes PROCESS macro for SPSS was used to analyse the data. Adherence to antiretroviral therapy mediated the association between posttraumatic stress disorder symptoms and health-related quality of life in the relationship and treatment impact domains, implying that poor adherence to antiretroviral therapy is a pathway through which posttraumatic stress disorder symptoms exert negative influence on health-related quality of life of people living with human immunodeficiency virus. Interventions aimed at reducing the impact of posttraumatic stress disorder symptoms on quality of life of people living with human immunodeficiency virus should focus on improving clients’ level of adherence to antiretroviral therapy treatment.
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11
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A Prospective Study of Depressive Symptoms, Condomless Sex, and HIV Viral Load in HIV-Positive Female Sex Workers in Kenya. AIDS Behav 2021; 25:3047-3056. [PMID: 33880670 DOI: 10.1007/s10461-021-03258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
The relationships between depressive symptoms, viral suppression, and condomless sex were examined in a prospective cohort study of 369 HIV-positive Kenyan female sex workers. Participants were screened for depressive symptoms at baseline and every six months until completion of the study (up to 66 months). HIV viral load (VL) was measured every six months and prostate specific antigen (PSA) testing in vaginal secretions was performed quarterly. Mild or greater depressive symptoms were found in 100 (27.1%) women and were associated with increased risk of detectable VL (aRR 1.41, 95%CI 0.97-2.07, p-value = 0.07), but were not associated with detectable PSA. The co-occurrence of PSA detection and detectable VL at the same visit suggests the potential for HIV transmission but was uncommon (2.4% of visits). The prevalence of depressive symptoms and the association with detectable VL suggests the need for screening and treatment of depression for comprehensive HIV care in this population.
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12
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Madut DB, Park LP, Yao J, Reddy EA, Njau B, Ostermann J, Whetten K, Thielman NM. Predictors of mortality in treatment experienced HIV-infected patients in northern Tanzania. PLoS One 2020; 15:e0240293. [PMID: 33031434 PMCID: PMC7544106 DOI: 10.1371/journal.pone.0240293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background While factors that drive early mortality among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in sub-Saharan Africa (SSA) have been described, less is known about the predictors of long-term mortality for those with ART experience. Methods PLWH and on ART attending two HIV treatment clinics in Moshi, Tanzania were enrolled from 2008 through 2009 and followed for 3.5 years. Demographic, psychosocial, and clinical information were collected at enrollment. Plasma HIV RNA measurements were collected annually. Cause of death was adjudicated by two independent reviewers based on verbal autopsy information and medical records. Bivariable and multivariable analyses were conducted using Cox proportional hazard models to identify predictors of mortality. Results The analysis included 403 participants. The median (IQR) age in years was 42 (36–48) and 277 (68.7%) participants were female. The proportion of participants virologically suppressed during the 4 collection time points was 88.5%, 94.7%, 91.5%, and 94.5%. During follow-up, 24 participants died; the overall mortality rate was 1.8 deaths per 100 person-years. Of the deaths, 14 (58.3%) were suspected to be HIV/AIDS related. Predictors of mortality (adjusted hazard ratio, 95% confidence interval) were male sex (2.63, 1.01–6.83), secondary or higher education (7.70, 3.02–19.60), receiving care at the regional referral hospital in comparison to the larger zonal referral hospital (6.33, 1.93–20.76), and moderate to severe depression symptoms (6.35, 1.69–23.87). Conclusions As ART coverage continues to expand in SSA, HIV programs should recognize the need for interventions to promote HIV care engagement for men and the integration of mental health screening and treatment with HIV care. Facility-level barriers may contribute to challenges faced by PLWH as they progress through the HIV care continuum, and further understanding of these barriers is needed. The association of higher educational attainment with mortality merits further investigation.
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Affiliation(s)
- Deng B. Madut
- Department of Medicine, Duke University, Durham, NC, United States of America
- * E-mail:
| | - Lawrence P. Park
- Department of Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Jia Yao
- Center for Health Policy and Inequalities Research, Durham, NC, United States of America
- Duke Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Elizabeth A. Reddy
- Division of Infectious Disease, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kathryn Whetten
- Duke Global Health Institute, Durham, NC, United States of America
- Center for Health Policy and Inequalities Research, Durham, NC, United States of America
- Duke Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Nathan M. Thielman
- Department of Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
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Uchechukwu Onu D, Iorfa SK, Ugwu DI. Negative centralisation of HIV/AIDS trauma and health-related quality of life: do post-traumatic stress symptoms explain the link? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:206-213. [PMID: 32892702 DOI: 10.2989/16085906.2020.1797842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over-integration of HIV-related trauma into the client's memory in a negative emotional valence could be a serious health debilitating process which may result in negative post-traumatic health outcomes, affecting health-related quality of life (HRQoL) of people living with HIV (PLWH). We hypothesized that post-traumatic stress disorder (PTSD) symptoms are the mediating link between negative event centrality (NEC) and HRQoL among PLWH. Nine hundred and sixty-nine PLWH in Nigeria completed measures of NEC, PTSD symptoms and HRQoL. Model 4 of Hayes' regression-based PROCESS macro version 3.0 for SPSS was employed to investigate relationships between variables of interest. NEC was positively associated with all domains of HRQoL. PLWH who had high negatively centralized identity on HIV also had high scores on PTSD symptoms. PTSD symptoms were also positively associated with all domains of HRQoL. PTSD symptoms also mediated the relationship between NEC and all domains of HRQoL. Assessing and treating PTSD symptoms among PLWH by clinicians could be helpful in enhancing HRQoL.
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Affiliation(s)
| | - Steven Kator Iorfa
- Department of Psychology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Dorothy I Ugwu
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, Enugu State, Nigeria
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Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, Chiliza B, Koenen KC. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003090. [PMID: 32413027 PMCID: PMC7228043 DOI: 10.1371/journal.pmed.1003090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA. METHODS AND FINDINGS The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies. CONCLUSIONS In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.
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Affiliation(s)
- Lauren C. Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Anne Stevenson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sreeja S. Kalapurakkel
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Centre for Global Mental Health, Health Service and Population Research, Department Institute of Psychiatry, Psychology and Neuroscience King’s College, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Boniface Harerimana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Kidman R, Piccolo LR, Kohler HP. Adverse Childhood Experiences: Prevalence and Association With Adolescent Health in Malawi. Am J Prev Med 2020; 58:285-293. [PMID: 31810632 PMCID: PMC6981018 DOI: 10.1016/j.amepre.2019.08.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Childhood adversity is robustly associated with poor health across the life course. However, very few studies have examined the prevalence and implications of adverse childhood experiences in low- and middle-income countries. The objective of this study is to measure adverse childhood experiences among adolescents in Malawi and examine the association with mental and physical health outcomes. METHODS From 2017 to 2018, baseline data were collected among adolescents aged 10-16 years (n=2,089). Respondents were interviewed in their local language at their homes. Respondents completed questions on childhood adversity (Adverse Childhood Experiences-International Questionnaire), self-rated health, mortality expectations, and mental health (Beck Depression Inventory and Post-Traumatic Stress Disorder Scale). Stunting, obesity, and grip strength were measured. Analyses were conducted in 2018. Frequencies described the prevalence of adverse childhood experiences, and adjusted multivariate models examined whether cumulative adversity predicts current health. RESULTS Adolescents reported a high burden of adversity (i.e., 5 lifetime adverse childhood experiences on average). Adolescents who scored in the top adverse childhood experiences quintile were more likely to report depression (OR=3.11, 95% CI=2.10, 4.60), post-traumatic stress disorder (OR=4.19, 95% CI=2.43, 7.23), worse self-rated health (OR=3.72, 95% CI=2.03, 6.81), and a higher expected likelihood of dying in the next 5 years (RR=5.02, 95% CI=2.15, 7.88) compared with those in the bottom quintile. However, adverse childhood experiences did not demonstrate a graded relationship with obesity, stunting, or grip strength. CONCLUSIONS These patterns are quite consistent with evidence from high-income countries and suggest that primary prevention of adverse childhood experiences should be a priority to ensure lifelong health in low-resources settings.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health, State University of New York at Stony Brook, Stony Brook, New York; Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, New York.
| | - Luciane R Piccolo
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Hans-Peter Kohler
- Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania; Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Kidman R, Kohler HP. Adverse childhood experiences, sexual debut and HIV testing among adolescents in a low-income high HIV-prevalence context. AIDS 2019; 33:2245-2250. [PMID: 31449094 PMCID: PMC6832840 DOI: 10.1097/qad.0000000000002352] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate whether adverse childhood experiences are important determinants of sexual debut and HIV testing. DESIGN Adolescents (age 10-16; N = 2089) from rural Malawi were interviewed in 2017-2018 for the baseline wave of a longitudinal study of childhood adversity and HIV risk. METHODS Respondents were interviewed in their local language. Surveys captured 13 lifetime childhood adversities (using the Adverse Childhood Experience - International Questionnaire); sexual debut; and previous HIV testing. We used multivariate regression models to test whether adversity, measured both cumulatively and separately, predicted HIV risk. RESULTS For each additional adversity, there was a significant rise in the odds of sexual debut (odds ratio 1.13, confidence interval 1.07-1.20) and HIV testing (odds ratio 1.10, confidence interval 1.04-1.16). CONCLUSION Preventing HIV among all young people necessitates a paradigm shift that recognizes the importance of early life social determinants in structuring HIV risk.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY 11794
| | - Hans-Peter Kohler
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA 19104-6298
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17
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Kumwenda MK, Corbett EL, Choko AT, Chikovore J, Kaswaswa K, Mwapasa M, Sambakunsi R, Gutteberg TJ, Gordon S, Munthali A, Desmond N. Post-test adverse psychological effects and coping mechanisms amongst HIV self-tested individuals living in couples in urban Blantyre, Malawi. PLoS One 2019; 14:e0217534. [PMID: 31188865 PMCID: PMC6561556 DOI: 10.1371/journal.pone.0217534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Mandatory face-to-face counselling is necessary during HIV testing but difficult to implement within the context of HIV self-testing. We investigated adverse psychological effects and coping mechanisms following HIV-positive and HIV-discordant test results amongst self-tested individuals living in couples in urban Blantyre, Malawi. Methods Qualitative data from 35 in-depth interviews with self-tested individuals living in couples for more than 3 months were collected and analysed using thematic content analysis. Results Adverse psychological effects seemed to mostly occur among individuals learning for the first-time that they were HIV-positive or living in HIV-discordant relationship. Irrespective of test outcomes, women living in couples expressed difficulty making important decisions about the future of their relationships while men seemed to shoulder the emotional burden associated with feeling or being seen as responsible for introducing HIV into the relationship. Post-test psychosocial support and ascertained positive behaviour change of the perceived index partner allowed some couples to overcome adverse psychological effects linked to test results. Conclusion Self-tested individuals living in couples may lack collective coping capability to collaboratively manage post-test adverse events after new HIV-positive or HIV-discordant results. Psychosocial support seemed to enable couples to foster both an individual and a collective ability to manage adverse psychological effects within the context of a couple. More research is needed to ascertain the magnitude of the deficiency of collective coping competency in couples following an HIV test.
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Affiliation(s)
- Moses Kelly Kumwenda
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Helse Nord TB initiative, College of Medicine, Blantyre, Malawi
- * E-mail:
| | - Elizabeth Lucy Corbett
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Augustine Talumba Choko
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeremiah Chikovore
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - Kruger Kaswaswa
- Helse Nord TB initiative, College of Medicine, Blantyre, Malawi
| | - Mphatso Mwapasa
- Helse Nord TB initiative, College of Medicine, Blantyre, Malawi
- Population Health Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tore Jarl Gutteberg
- University of Tromso, The Arctic University of Norway, Tromsø, Norway
- University Hospital of North Norway, Tromsø, Norway
| | - Stephen Gordon
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Nicola Desmond
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wang YY, Zhao J, Zhang Q, Zhang Y, Bai B, Ng CH, Ungvari GS, Jia FJ, Xiang YT. Prevalence of depressive syndrome and their association with demographic and clinical characteristics in Chinese HIV patients. AIDS Care 2018; 30:1388-1392. [PMID: 29690783 DOI: 10.1080/09540121.2018.1465172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
To investigate the prevalence of depressive syndrome and their association with demographic and clinical characteristics in Chinese patients infected with the human immunodeficiency virus (HIV). A total of 416 patients with HIV infection were consecutively screened and enrolled in the study. Depressive syndrome was assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). The proportion of depressive syndrome was 36.3%. Patients with depressive syndrome were younger, and were more likely to have severe anxiety symptoms, religious beliefs and psychological treatment. Multiple logistic regression analyses revealed that religious beliefs (p = 0.001, OR = 3.9, 95% CI = 1.7-8.6) and more severe anxiety symptoms (p = 0.001, OR = 1.6, 95% CI = 1.4-1.7) were independently associated with depressive syndrome. Regular screening for depressive syndrome and appropriate biopsychosocial interventions are urgently needed for this population.
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Affiliation(s)
- Yuan-Yuan Wang
- a Unit of Psychiatry, Faculty of Health Sciences , University of Macau , Taipa , People's Republic of China
| | - Jin Zhao
- b Shenzhen Center for Disease Control and Prevention , Shenzhen , People's Republic of China
| | - Qinge Zhang
- c The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center , Beijing Anding Hospital, Capital Medical University , Beijing , People's Republic of China
| | - Yan Zhang
- b Shenzhen Center for Disease Control and Prevention , Shenzhen , People's Republic of China
| | - Baolian Bai
- b Shenzhen Center for Disease Control and Prevention , Shenzhen , People's Republic of China
| | - Chee H Ng
- d Department of Psychiatry , University of Melbourne , Melbourne , Australia
| | - Gabor S Ungvari
- e School of Psychiatry and Clinical Neurosciences , University of Notre Dame Australia / Graylands Hospital , Perth , Australia
| | - Fu-Jun Jia
- f Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences , Guangzhou , People's Republic of China
| | - Yu-Tao Xiang
- a Unit of Psychiatry, Faculty of Health Sciences , University of Macau , Taipa , People's Republic of China
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Ostermann J, Pence B, Whetten K, Yao J, Itemba D, Maro V, Reddy E, Thielman N. HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania. AIDS Care 2018; 27 Suppl 1:59-64. [PMID: 26616126 PMCID: PMC4685596 DOI: 10.1080/09540121.2015.1090534] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatment cascade, particularly in Sub-Saharan Africa. We used data from a cohort of HIV-infected adults in Northern Tanzania to describe associations between disclosure and engagement and retention in the HIV treatment cascade. Between 2008 and 2009, the Coping with HIV/AIDS in Tanzania (CHAT) study enrolled 260 clients newly diagnosed with HIV and 492 HIV-infected patients in established HIV care in two large HIV care and treatment centers in Northern Tanzania. Participants aged 18 and older completed annual clinical assessments and twice-annual in-person interviews for 3.5 years. Using logistic regression models, we assessed sociodemographic correlates of HIV serostatus disclosure to at least one household member, and associations between this disclosure measure and linkage to care, evaluation for antiretroviral therapy (ART) eligibility, ART coverage, and rates of undetectable HIV RNA levels during the follow-up period. Married individuals and those diagnosed earlier were more likely to have disclosed their HIV infection to at least one household member. During follow-up, HIV serostatus disclosure was associated with higher rates of linkage to care, evaluation for ART eligibility, and ART coverage. No significant association was observed with rates of undetectable viral loads. Marginal effects estimates suggest that a 10 percentage-point lower probability of linkage to care for those who did not disclose their HIV serostatus (86% vs. 96%; p = 0.035) was compounded by an 18 percentage-point lower probability of ever receiving a CD4 count (62% vs. 80%; p = .039), and a 20 percentage-point lower probability of ever receiving ART (55% vs. 75%; p = .029). If causal, these findings suggest an important role for disclosure assistance efforts across the HIV treatment cascade.
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Affiliation(s)
- Jan Ostermann
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,c Department of Health Services Policy and Management , University of South Carolina , Columbia , SC , USA
| | - Brian Pence
- b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,d Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Kathryn Whetten
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,e Duke Sanford School of Public Policy , Duke University , Durham , NC , USA
| | - Jia Yao
- b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,f ADAPT Center for Cognitive/Affective Symptom Science , Duke University , Durham , NC , USA
| | | | - Venance Maro
- h Kilimanjaro Christian Medical Center , Moshi , Tanzania
| | | | - Nathan Thielman
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,j School of Medicine , Duke University , Durham , NC , USA
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20
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Pinho CM, Dâmaso BFR, Gomes ET, Trajano MDFC, Andrade MS, Valença MP. Religious and spiritual coping in people living with HIV/Aids. Rev Bras Enferm 2017; 70:392-399. [PMID: 28403299 DOI: 10.1590/0034-7167-2015-0170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 08/26/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE evaluate the religiosity and the religious/spiritual coping of people living with HIV/Aids. METHOD descriptive, cross-sectional study with quantitative approach, conducted in a reference HIV/Aids outpatient clinic in a university hospital of Recife-PE, Brazil, from June to November 2015. At total of 52 people living with HIV/Aids (PLWHA) participated in the research, which employed own questionnaire, the Duke University Religion Index (DUREL), and the Religious/Spiritual Coping Scale (RCOPE). RESULTS the sample presented high indices of organizational religiosity (4.23±1.66), non-organizational religiosity (4.63±1.50), and intrinsic religiosity (13.13±2.84). Positive RCOPE was used in high mean scores (3.66±0.88), and negative RCOPE had low use (2.12 ± 0.74). In total, use of RCOPE was high (3.77±0.74), having predominated the positive RCOPE (NegRCOPE/PosRCOPE ratio=0.65±0.46). CONCLUSION it is evident the importance of encouraging religious activity and RCOPE strategies, seen in the past as inappropriate interventions in clinical practice.
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Affiliation(s)
- Clarissa Mourão Pinho
- Associate Program in Postgraduate Program Nursing, Faculty of Nursing Nossa Senhora das Graças, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Bruno Felipe Remigio Dâmaso
- Residency Program in Nursing, University Hospital Oswaldo Cruz, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Eduardo Tavares Gomes
- Associate Program in Postgraduate Program Nursing, Faculty of Nursing Nossa Senhora das Graças, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Maria Sandra Andrade
- Associate Program in Postgraduate Program Nursing, Faculty of Nursing Nossa Senhora das Graças, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Marília Perrelli Valença
- Associate Program in Postgraduate Program Nursing, Faculty of Nursing Nossa Senhora das Graças, Universidade de Pernambuco, Recife, Pernambuco, Brazil
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Abstract
Among people living with HIV/AIDS (PLHA), the occurrence of post-traumatic stress disorder (PTSD) symptoms associated with HIV diagnosis is a common problem. This study examined HIV diagnosis-related PTSD symptoms and its associated factors among PLHA in rural China. We used baseline data from a randomized controlled trial conducted in Anhui Province, China. Surveys of 522 PLHA were conducted via computer-assisted personal interview method. PTSD symptoms were measured based on re-experiencing, avoidance and arousal of the day of HIV diagnosis. Association between PTSD symptoms and demographic characteristics, physical and social functioning were assessed by multiple regression analysis and structural equation modeling. Social functioning exhibited a direct association with HIV diagnosis-related PTSD symptoms, and also mediated the association between PTSD symptoms and age, family income, and physical functioning. The study findings underscore the importance of developing interventions that alleviate PTSD symptoms and improve social functioning among PLHA in rural China.
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Womersley JS, Seedat S, Hemmings SMJ. Childhood maltreatment and HIV-associated neurocognitive disorders share similar pathophysiology: a potential sensitisation mechanism? Metab Brain Dis 2017; 32:1717-1733. [PMID: 28681198 DOI: 10.1007/s11011-017-0062-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/16/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) are increasingly prevalent despite the use of antiretroviral therapies. Previous research suggests that individual host factors play an important role in determining susceptibility to HAND. In this review, we propose that childhood trauma (CT) and HAND share several common aetiological mechanisms, namely hypothalamic-pituitary-adrenal axis dysregulation, neuroinflammation and oxidative stress. These convergent and consequent mechanisms may translate into an increased risk of developing HAND in individuals who have experienced early life stress. We provide an overview of basic and clinical research relating to these pathophysiological mechanisms and suggest that further research examine brain-derived neurotrophic factor and telomere length as common mediating factors and potential therapeutic targets for HAND and CT. Graphical abstract Both childhood trauma and HIV-associated neurocognitive disorders are associated with HPA axis dysregulation, inflammation and oxidative stress.
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
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Pinho CM, Gomes ET, Trajano MDFC, Cavalcanti ATDAE, Andrade MS, Valença MP. Impaired religiosity and spiritual distress in people living with HIV/AIDS. ACTA ACUST UNITED AC 2017; 38:e67712. [PMID: 28723987 DOI: 10.1590/1983-1447.2017.02.67712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/17/2017] [Indexed: 11/22/2022]
Abstract
Objective To verify the inference of Nursing Diagnoses, Impaired religiosity and Spiritual distress in people living with HIV/AIDS. Methods This is a cross-sectional study with a quantitative approach, performed in a specialized Service CenteR of Recife, Pernambuco, from June to November 2015. The results related to 52 people living with HIV/AIDS and that were interviewed were analyzed by three nurse judges. Results Spiritual distress was estimated at 73.1% (38), Impaired religiosity at 36.5% (19), with an average number of defining characteristics of 3.88 ± 2.05 and 2.55±0.69. The main defining characteristic for Impaired religiosity was: "reports a need to reconnect with previous beliefs" (92.3%); and for Spiritual distress, it was: "Expresses a lack of purpose in life/expresses lack of meaning in life" (86.5%). Conclusions The results point to the need to consider the religious-spiritual dimension in care protocols and research in nursing.
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Affiliation(s)
- Clarissa Mourão Pinho
- Universidade de Pernambuco (UPE), Faculdade de Enfermagem Nossa Senhora das Graças, Programa Associado de Pós-Graduação em Enfermagem. Recife, Pernambuco, Brasil
| | - Eduardo Tavares Gomes
- Universidade de Pernambuco (UPE), Faculdade de Enfermagem Nossa Senhora das Graças, Programa Associado de Pós-Graduação em Enfermagem. Recife, Pernambuco, Brasil
| | - Maria de Fátima Cordeiro Trajano
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-Graduação em Saúde da Criança e do Adolescente. Recife, Pernambuco, Brasil
| | | | - Maria Sandra Andrade
- Universidade de Pernambuco (UPE), Faculdade de Enfermagem Nossa Senhora das Graças, Programa Associado de Pós-Graduação em Enfermagem. Recife, Pernambuco, Brasil
| | - Marília Perrelli Valença
- Universidade de Pernambuco (UPE), Programa de Pós-Graduação em Ciências da Saúde. Recife, Pernambuco, Brasil
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Closson K, Dietrich JJ, Nkala B, Musuku A, Cui Z, Chia J, Gray G, Lachowsky NJ, Hogg RS, Miller CL, Kaida A. Prevalence, type, and correlates of trauma exposure among adolescent men and women in Soweto, South Africa: implications for HIV prevention. BMC Public Health 2016; 16:1191. [PMID: 27884181 PMCID: PMC5123224 DOI: 10.1186/s12889-016-3832-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 11/12/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Youth trauma exposure is associated with syndemic HIV risk. We measured lifetime prevalence, type, and correlates of trauma experience by gender among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. METHODS Using data from the Botsha Bophelo Adolescent Health Survey (BBAHS), prevalence of "ever" experiencing a traumatic event among adolescents (aged 14-19) was assessed using a modified Traumatic Event Screening Inventory-Child (TESI-C) scale (19 items, study alpha = 0.63). We assessed self-reported number of potentially traumatic events (PTEs) experienced overall and by gender. Gender-stratified multivariable logistic regression models assessed independent correlates of 'high PTE score' (≥7 PTEs). RESULTS Overall, 767/830 (92%) participants were included (58% adolescent women). Nearly all (99.7%) reported experiencing at least one PTE. Median PTE was 7 [Q1,Q3: 5-9], with no gender differences (p = 0.19). Adolescent men reported more violent PTEs (e.g., "seen an act of violence in the community") whereas women reported more non-violent HIV/AIDS-related PTEs (e.g., "family member or someone close died of HIV/AIDS"). High PTE score was independently associated with high food insecurity among adolescent men and women (aOR = 2.63, 95%CI = 1.36-5.09; aOR = 2.57, 95%CI = 1.55-4.26, respectively). For men, high PTE score was also associated with older age (aOR = 1.40/year, 95%CI = 1.21-1.63); and recently moving to Soweto (aOR = 2.78, 95%CI = 1.14-6.76). Among women, high PTE score was associated with depression using the CES-D scale (aOR = 2.00, 95%CI = 1.31-3.03,) and inconsistent condom use vs. no sexual experience (aOR = 2.69, 95%CI = 1.66-4.37). CONCLUSION Nearly all adolescents in this study experienced trauma, with gendered differences in PTE types and correlates, but not prevalence. Exposure to PTEs were distributed along social and gendered axes. Among adolescent women, associations with depression and inconsistent condom use suggest pathways for HIV risk. HIV prevention interventions targeting adolescents must address the syndemics of trauma and HIV through the scale-up of gender-transformative, youth-centred, trauma-informed integrated HIV and mental health services.
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Affiliation(s)
- Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Janan Janine Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Addy Musuku
- Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Robert S. Hogg
- Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Cari L. Miller
- Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University (SFU), Blusson Hall Rm 10522, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
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Test site predicts HIV care linkage and antiretroviral therapy initiation: a prospective 3.5 year cohort study of HIV-positive testers in northern Tanzania. BMC Infect Dis 2016; 16:497. [PMID: 27646635 PMCID: PMC5028933 DOI: 10.1186/s12879-016-1804-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 08/23/2016] [Indexed: 01/08/2023] Open
Abstract
Background Linkage to HIV care is crucial to the success of antiretroviral therapy (ART) programs worldwide, loss to follow up at all stages of the care continuum is frequent, and long-term prospective studies of care linkage are currently lacking. Methods Consecutive clients who tested HIV-positive were enrolled from four HIV testing centers (1 health facility and 3 community-based centers) in the Kilimanjaro region of Tanzania as part of the larger Coping with HIV/AIDS in Tanzania (CHAT) prospective observational study. Biannual interviews were conducted over 3.5 years, assessing care linkage, retention, and mental health. Bivariable and multivariate logistic regression analyses were conducted to determine associations with early death (prior to the second follow up interview) and delayed (>6 months post-test) or failed care linkage. Results A total of 263 participants were enrolled between November, 2008 and August, 2009 and 240 participants not already linked to care were retained in the final dataset. By 6 months after enrollment, 169 (70.4 %) of 240 participants had presented to an HIV care and treatment facility; 41 (17.1 %) delayed more than 6 months, 15 (6.3 %) died, and 15 (6.3 %) were lost to follow up. Twenty-six patients died before their second follow up visit and were analyzed in the early death group (10.8 %). Just 15 (9.6 %) of those linked to care had started ART within 6 months, but 123 (89.1 %) of patients documented to be ART eligible by local guidelines had started ART by the end of 3.5 years. On multivariate analysis, male gender (OR 1.72; 95 % CI 1.08, 2.75), testing due to illness (OR 1.63; 95 % CI 1.01, 2.63), and higher mean depression scale scores (4 % increased risk per increase in depression score; 95 % CI 1 %, 8 %) were associated with early death. Testing at a community versus a hospital-based site (OR 2.89; 95 % CI 1.79, 4.66) was strongly associated with delaying or never entering care. Conclusions Nearly 30 % of the cohort did not have timely care linkage, ART initiation was frequently delayed, and testing at a hospital outpatient department versus community-based testing centers was strongly associated with successful care linkage.
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Hojjat SK, Hatami SE, Rezaei M, Khalili MN, Talebi MR. The efficacy of training of stress-coping strategies on marital satisfaction of spouses of veterans with post-traumatic stress disorder. Electron Physician 2016; 8:2232-7. [PMID: 27279997 PMCID: PMC4886563 DOI: 10.19082/2232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/05/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Marital satisfaction is an important factor in people's quality of life. It has become increasingly crucial in healthcare and health research and is dependent on coping styles of people exposed to traumatic events. The aim of this study was to assess the effectiveness of coping-style training on increasing the marital satisfaction of wives of veterans with post-traumatic stress disorder (PTSD). METHODS In this experimental study, 60 subjects were selected from the spouses of veterans with PTSD. The veterans were chosen from the Veterans Foundation of Northern Khorasan Province (Iran) in 2014. In this study, we used the Enrich questionnaire to determine the marital satisfaction of the aforementioned spouses. Subjects were assigned randomly to study and control groups. We used the training package of a Practical Guide for Stress Management according to cognitive behavioral approaches. Cognitive-behavioral group therapy was administered in 90-minute sessions over a 12-week period. We used the paired-samples t-test and ANCOVA to determine the effect of Cognitive Behavior Therapy (CBT) between the two groups. RESULTS The mean and the standard deviation of age in the study and control groups were 36.8 ± 4.33 years and 35.3 ± 4.7 years, respectively. According to p < 0.005, a significant difference was observed between the subjects in the two groups. Therefore, treatment with cognitive behavioral group therapy showed evidence of clinical improvements in marital satisfaction of the study group. CONCLUSION The results of our study showed that methods of coping with stress based on CBT are effective in increasing the marital satisfaction of wives of veterans with PTSD.
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Affiliation(s)
- Seyed Kaveh Hojjat
- MD, Psychiatrist, Assistant Professor, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences. Bojnurd, Iran
| | - Seyed Esmaeil Hatami
- M.Sc. of Epidemiology, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mahdi Rezaei
- MA of Clinical Psychology, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mina Norozi Khalili
- MD, Department of Community Medicine and Ethics, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Moosa Reza Talebi
- MA of General Psychology, Department of Psychology, Tonekabon Branch, Izlamic Azad University, Tonekabon, Iran
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Exploring the Impact of Childhood Abuse on HIV Social and Attitudinal Factors Among Adults With and Without this History in Sub-Saharan Africa: Findings from NIMH Project Accept (HPTN 043). AIDS Behav 2016; 20:737-45. [PMID: 26271817 DOI: 10.1007/s10461-015-1166-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Using data from four sites in three African countries, this community randomized study examined the association between childhood sexual and/or physical abuse (CSA and/or CPA) and HIV disclosure, HIV-related stigma, stress, and social support among adults with and without a history of abuse. A history of abuse among men was associated with higher levels of adult-reported stress and HIV-related stigma, and with significantly lower rates of HIV test result disclosure to current partners. Women with a history of CSA and/or CPA had significantly higher perceived stigma, discrimination and stress. Although childhood abuse was significantly associated with adult stress and stigmatization, participants with histories of CSA and/or CPA also reported significantly higher perceived social support compared to people without such experiences. These findings may reflect support received in response to disclosure of CSA or CPA or emotional ambivalence in relationships that have been found to be associated with child abuse. We conclude that it is critical for HIV prevention interventions to advocate for the primary prevention of child abuse, for early identification of adolescents and adults who report experiencing childhood abuse, and to address stigma and stress-related attitudinal, behavioral and relationship difficulties experiences as an aftermath of early abuse that increase their risk of HIV.
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Gray CL, Whetten K, Messer LC, Whetten RA, Ostermann J, O'Donnell K, Thielman NM, Pence BW. Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries. AIDS Care 2016; 28:857-65. [PMID: 26936018 PMCID: PMC4917905 DOI: 10.1080/09540121.2016.1147013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millions more have been separated from their parents. As younger orphans enter adolescence, their sexual health and HIV-related risk behaviors become key considerations for their overall health. Importantly, their high prevalence of exposure to potentially traumatic events (PTEs) may put OSC at additional risk for adverse sexual health outcomes. The Positive Outcomes for Orphans study followed OSC randomly sampled from institution-based care and from family-based care, as well as a convenience sample of non-OSC, at six sites in five low-and middle-income countries. This analysis focused on the 90-month follow-up, during which adolescents 16 and older were assessed for sexual health, including age at sexual debut, past-year sex, past-year condom use, and perceptions of condom use. We specifically examined the relationship between PTEs and sexual health outcomes. Of the 1258 OSC and 138 non-OSC assessed, 11% reported ever having sex. Approximately 6% of participants reported recent sex and 5% reported having recent unprotected sex. However, 70% of those who had recent sex reported that they did not use a condom every time, and perceptions of condom use tended to be unfavorable for protection against sexual risk behavior. Nearly all (90%) of participants reported experiencing at least one lifetime PTE. For those who experienced “any” PTE, we found increased prevalence of recent sex (PR = 1.39 [0.47, 4.07]) and of recent unprotected sex (PR = 3.47 [0.60, 19.91]). This study highlights the need for caregivers, program managers, and policymakers to promote condom use for sexually active OSC and identify interventions for trauma support services. Orphans living in family-based care may also be particularly vulnerable to early sexual debut and unprotected sexual activity.
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Affiliation(s)
- Christine L Gray
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA
| | - Kathryn Whetten
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,c Terry Sanford Institute of Public Policy, Duke University , Durham , NC , USA
| | - Lynne C Messer
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.,b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,d College of Urban and Public Affairs , Portland State University , Portland , OR , USA
| | - Rachel A Whetten
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA
| | - Jan Ostermann
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA
| | - Karen O'Donnell
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,e Center for Child and Family Health , Duke University , Durham , NC , USA
| | - Nathan M Thielman
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,f Department of Medicine, Division of Infectious Diseases and International Health , Duke University , Durham , NC , USA
| | - Brian W Pence
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.,b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA
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Hansrod F, Spies G, Seedat S. Type and severity of intimate partner violence and its relationship with PTSD in HIV-infected women. PSYCHOL HEALTH MED 2014; 20:697-709. [PMID: 25300600 DOI: 10.1080/13548506.2014.967702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV has an impact on the presence and severity of both intimate partner violence (IPV) and posttraumatic stress disorder (PTSD) in infected women. However, the relationship of type and severity of IPV with PTSD in this population has not been adequately explored. We focus on the association between the type and severity of IPV and HIV status and PTSD in a sample of South African women. One hundred and sixty-nine women (114 HIV-positive and 55 HIV-negative controls), matched for geographical area, education, and socio-economic status, were recruited from HIV clinics. Clinical and demographic data were collected, including data on childhood trauma, other traumatic life events, IPV, posttraumatic stress symptoms, problematic alcohol use, and depressive symptoms. HIV-positive women had significantly more depressive symptoms, alcohol abuse, and childhood trauma exposure as well as significantly higher rates of PTSD (25.4%) when compared with uninfected women (10.9%). No significant group differences in the rate, pattern, and severity of physical, sexual, psychological, injury, and negotiation IPV were found. In logistic regression analysis, the rate and severity category of IPV did not significantly predict PTSD in HIV-positive women when childhood trauma and life events were controlled for. Our results indicate the need for screening for alcohol abuse, PTSD and depressive symptoms at HIV wellness, and ARV clinics. The high rates of PTSD in HIV-positive women indicate the need for specialized programs to manage PTSD and minimize negative sequelae in this population. These results also highlight the need for improved screening and prevention of childhood trauma and IPV both in infected and uninfected women.
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Affiliation(s)
- Fatima Hansrod
- a Faculty of Medicine and Health Sciences, Department of Psychiatry , Stellenbosch University , Cape Town , South Africa
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Belenky NM, Cole SR, Pence BW, Itemba D, Maro V, Whetten K. Depressive symptoms, HIV medication adherence, and HIV clinical outcomes in Tanzania: a prospective, observational study. PLoS One 2014; 9:e95469. [PMID: 24798428 PMCID: PMC4010413 DOI: 10.1371/journal.pone.0095469] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 11/18/2022] Open
Abstract
Depressive symptoms have been shown to independently affect both antiretroviral therapy (ART) adherence and HIV clinical outcomes in high-income countries. We examined the prospective relationship between depressive symptoms and adherence, virologic failure, and suppressed immune function in people living with HIV/AIDS in Tanzania. Data from 403 study participants who were on stable ART and engaged in HIV clinical care were analyzed. We assessed crude and adjusted associations of depressive symptoms and ART adherence, both at baseline and at 12 months, using logistic regression. We used logistic generalized estimating equations to assess the association and 95% confidence intervals (CI) between depressive symptoms and both virologic failure and suppressed immune function. Ten percent of participants reported moderate or severe depressive symptoms at baseline and 31% of participants experienced virologic failure (>150 copies/ml) over two years. Depressive symptoms were associated with greater odds of reported medication nonadherence at both baseline (Odds Ratio [OR] per 1-unit increase = 1.18, 95% CI [1.12, 1.24]) and 12 months (OR = 1.08, 95% CI [1.03, 1.14]). By contrast, increases in depressive symptom score were inversely related to both virologic failure (OR = 0.93, 95% CI [0.87, 1.00]) and immune system suppression (OR = 0.88, 95% CI [0.79, 0.99]), though the association between depressive symptoms and clinical outcomes was less precise than for the association with nonadherence. Findings indicate a positive association between depressive symptoms and nonadherence, and also an inverse relationship between depressive symptoms and clinical outcomes, possibly due to informative loss to follow-up.
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Affiliation(s)
- Nadya M. Belenky
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Brian W. Pence
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Department of Community and Family Medicine, Duke University, Durham, North Carolina, United States of America
| | | | - Venance Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Kathryn Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Department of Community and Family Medicine, Duke University, Durham, North Carolina, United States of America
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Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer. J Acquir Immune Defic Syndr 2014; 65:e104-9. [PMID: 24525471 DOI: 10.1097/01.qai.0000437619.23031.83] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo (450 km away), and their adherence to antiretrovirals (ARVs) dropped precipitously (odds ratio = 0.20, 95% confidence interval: 0.09 to 0.44, P < 0.001) after the visit. Compared with those not attending Loliondo, attendees were more likely to have been diagnosed with HIV more remotely (3.8 vs. 3.0 years before, P < 0.001), have taken ARVs longer (3.4 vs. 2.5 years, P < 0.001), have higher median CD4 lymphocyte counts (429 vs. 354 cells/mm, P < 0.001), be wealthier (wealth index: 10.9 vs. 8.8, P = 0.034), and receive care at the private versus the public hospital (P = 0.012). In multivariable logistic regression, only years since the start of ARVs remained significant (odds ratio = 1.49, 95% confidence interval: 1.23 to 1.80). Treatment fatigue may play a role in the lure of alternative healers.
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Ostermann J, Whetten K, Reddy E, Pence B, Weinhold A, Itemba D, Maro V, Mosille E, Thielman N. Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania. AIDS Care 2014; 26:1352-8. [PMID: 24517083 DOI: 10.1080/09540121.2014.882493] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV care and treatment centers (CTCs) from hospitals to local health centers. Between November 2008 and June 2009, 492 HIV-infected patients in established care at two referral hospitals in Moshi, Tanzania, and 262 persons newly diagnosed with HIV were selected for participation in a prospective cohort study entitled Coping with HIV/AIDS in Tanzania. Clinical records and participant self-reports, collected between June and November 2012, were used to describe retention in care and transitions between CTCs during the study period. After a mean follow-up period of 3.5 years, 10% of participants had died, 9% were lost to follow-up, and 11% had moved. Of the remaining participants enrolled from CTCs, more than 90% reported at least one CTC visit during the previous six months, with 98% still in care at the CTC at which they were enrolled. Nearly three out of four newly diagnosed clients listed a referral hospital as their primary CTC. Fewer than 10% of participants ever sought care at another CTC in the study area; nearly 90% of those in care bypassed their closest CTC. Administrative data from all facilities in the study area indicate that new clients, even after the scale-up from 8 CTCs in 2006 to 21 CTCs in 2008, disproportionately selected established CTCs, and client volume at newly approved facilities was highly variable. Despite the decentralization of HIV care and treatment in this setting, many patients continue to bypass their closest CTC to seek care at established facilities. Patient preferences for decentralized HIV care, which may inform optimal resource utilization, are largely unknown and warrant further investigation.
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Affiliation(s)
- Jan Ostermann
- a Duke Global Health Institute , Duke University , Durham , NC , USA
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Positive and negative religious coping, depressive symptoms, and quality of life in people with HIV. J Behav Med 2014; 37:921-30. [DOI: 10.1007/s10865-014-9552-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
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Pence BW, Whetten K, Shirey KG, Yao J, Thielman NM, Whetten R, Itemba D, Maro V. Factors associated with change in sexual transmission risk behavior over 3 years among HIV-infected patients in Tanzania. PLoS One 2013; 8:e82974. [PMID: 24367575 PMCID: PMC3867466 DOI: 10.1371/journal.pone.0082974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 11/07/2013] [Indexed: 02/06/2023] Open
Abstract
Background The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts. Methodology and Principal Findings The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6–13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11–21% at 6–36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex. Conclusions and Significance Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
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Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail: (BWP); (KW)
| | - Kathryn Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
- * E-mail: (BWP); (KW)
| | - Kristen G. Shirey
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jia Yao
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | - Nathan M. Thielman
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rachel Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | | | - Venance Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
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Whetten K, Shirey K, Pence BW, Yao J, Thielman N, Whetten R, Adams J, Agala B, Ostermann J, O'Donnell K, Hobbie A, Maro V, Itemba D, Reddy E. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One 2013; 8:e74771. [PMID: 24124455 PMCID: PMC3790775 DOI: 10.1371/journal.pone.0074771] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
Abstract
Background As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding the effect of psychosocial experiences and mental health symptomatology on ART adherence can help maximize the benefit of expanded ART programs by indicating types of services, which could be offered in combination with HIV care. Methodology The Coping with HIV/AIDS in Tanzania (CHAT) study is a longitudinal cohort study in the Kilimanjaro Region that included randomly selected HIV-infected (HIV+) participants from two local hospital-based HIV clinics and four free-standing voluntary HIV counselling and testing sites. Baseline data were collected in 2008 and 2009; this paper used data from 36 month follow-up interviews (N = 468). Regression analyses were used to predict factors associated with incomplete self-reported adherence to ART. Results Incomplete ART adherence was significantly more likely to be reported amongst participants who experienced a greater number of childhood traumatic events: sexual abuse prior to puberty and the death in childhood of an immediate family member not from suicide or homicide were significantly more likely in the non-adherent group and other negative childhood events trended toward being more likely. Those with incomplete adherence had higher depressive symptom severity and post-traumatic stress disorder (PTSD). In multivariable analyses, childhood trauma, depression, and financial sacrifice remained associated with incomplete adherence. Discussion This is the first study to examine the effect of childhood trauma, depression and PTSD on HIV medication adherence in a low income country facing a significant burden of HIV. Allocating spending on HIV/AIDS toward integrating mental health services with HIV care is essential to the creation of systems that enhance medication adherence and maximize the potential of expanded antiretroviral access to improve health and reduce new infections.
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Affiliation(s)
- Kathryn Whetten
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Kristen Shirey
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Brian Wells Pence
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jia Yao
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nathan Thielman
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, United States of America
| | - Rachel Whetten
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Julie Adams
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Bernard Agala
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jan Ostermann
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Karen O'Donnell
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Center for Child & Family Health, Duke University, Durham, North Carolina, United States of America
| | - Amy Hobbie
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Elizabeth Reddy
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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O'Donnell K, Yao J, Ostermann J, Thielman N, Reddy E, Whetten R, Maro V, Itemba D, Pence B, Dow D, Whetten K. Low rates of child testing for HIV persist in a high-risk area of East Africa. AIDS Care 2013; 26:326-31. [PMID: 23875966 DOI: 10.1080/09540121.2013.819405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Children in low- and middle-income countries (LMIC) are the least touched by recent successes in the diagnosis and treatment of HIV/AIDS globally. Early treatment is essential for a child's longer and higher quality of life; however, by 2011, only a small proportion of HIV-seropositive children in LMIC countries were receiving treatment, in part because of persisting low rates of diagnosis. This study of the prevalence and characteristics of children tested for HIV was embedded in the Coping with HIV/AIDS in Tanzania (CHAT) study in which HIV-seropositive and HIV-seronegative adults, and adults with unknown HIV status were asked about HIV testing for their children. Data were gathered from November 2009 to August 2010 during the scale-up of Prevention of Mother To Child Transmission and Early Infant Diagnosis programs in the region. Reports on 1776 children indicate that 31.7% of all children were reported to have been tested, including only 42.9% of children with an HIV-seropositive caregiver. In general, children more likely to be HIV tested were biological children of study participants, younger, of widowed adults, living in urban areas, and of HIV-seropositive parents/caregivers. Children belonging to the two indigenous tribes, Chagga and Pare, were more likely to be tested than those from other tribes. Rates of testing among children less than two years old were low, even for the HIV-seropositive caregiver group. The persistence of low testing rates is discussed in terms of the accessibility and acceptability of child testing in resource poor settings.
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Affiliation(s)
- Karen O'Donnell
- a Center for Health Policy and Inequalities Research, Duke Global Health Institute , Duke University , Durham , NC , USA
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Giacco D, Matanov A, Priebe S. Symptoms and subjective quality of life in post-traumatic stress disorder: a longitudinal study. PLoS One 2013; 8:e60991. [PMID: 23585868 PMCID: PMC3621668 DOI: 10.1371/journal.pone.0060991] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 03/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evidence suggests that post-traumatic stress disorder (PTSD) is associated with substantially reduced subjective quality of life (SQOL). This study aimed to explore whether and how changes in the levels of PTSD symptom clusters of intrusion, avoidance and hyperarousal are associated with changes in SQOL. METHODS Two samples with PTSD following the war in former Yugoslavia were studied, i.e. a representative sample of 530 people in five Balkan countries and a non-representative sample of 215 refugees in three Western European countries. They were assessed on average eight years after the war and re-interviewed one year later. PTSD symptoms were assessed on the Impact of Event Scale - Revised and SQOL on the Manchester Short Assessment of Quality of Life. Linear regression and a two-wave cross lagged panel analysis were used to explore the association between PTSD symptom clusters and SQOL. RESULTS The findings in the two samples were consistent. Symptom reduction over time was associated with improved SQOL. In multivariable analyses adjusted for the influence of all three clusters, gender and time since war exposure, only changes in hyperarousal symptoms were significantly associated with changes in SQOL. The two-wave cross-lagged panel analysis suggested that the link between hyperarousal symptoms and SQOL is bidirectional. CONCLUSIONS Low SQOL of patients with war-related PTSD is particularly associated with hyperarousal symptoms. The findings suggest a bidirectional influence: a reduction in hyperarousal symptoms may result in improved SQOL, and improvements in SQOL may lead to reduced hyperarousal symptoms.
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Affiliation(s)
- Domenico Giacco
- Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
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Corless IB, Voss J, Guarino AJ, Wantland D, Holzemer W, Jane Hamilton M, Sefcik E, Willard S, Kirksey K, Portillo C, Rivero Mendez M, Rosa ME, Nicholas PK, Human S, Maryland M, Moezzi S, Robinson L, Cuca Y. The impact of stressful life events, symptom status, and adherence concerns on quality of life in people living with HIV. J Assoc Nurses AIDS Care 2013; 24:478-90. [PMID: 23473660 DOI: 10.1016/j.jana.2012.11.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/15/2012] [Indexed: 11/29/2022]
Abstract
Studies concerning persons living with HIV (PLWH) report that stressful life events (SLEs) contribute to an exacerbation of symptoms and reduced antiretroviral (ARV) adherence and quality of life (QOL). Little is known about whether these findings are site-specific. Our study's aims were to characterize the type and frequency of SLEs for PLWH in Puerto Rico, South Africa, and the United States, and to assess the impact of SLEs by national site, symptoms, and ARV adherence concerns on QOL. The sample consisted of 704 participants. The total number of SLEs correlated significantly with the total number of symptoms, adherence concerns, and QOL (p ≤ .001). Overall, 27.2% of the variance in QOL was explained by the aforementioned variables. Although SLEs were of concern to PLWH, worries about ARV adherence were of even greater concern. Routine assessment of ARV concerns and SLEs can promote ongoing ARV adherence and improved QOL.
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