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Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102255. [PMID: 37842552 PMCID: PMC10570719 DOI: 10.1016/j.eclinm.2023.102255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers. Methods We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769). Findings We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]). Interpretation People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA. Funding This study did not receive any funding.
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Affiliation(s)
- Maureen Moyo-Chilufya
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles Hongoro
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Human Sciences Research Council, Pretoria, South Africa
| | - Alfred Musekiwa
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Anye LC, Agbortabot Bissong ME, Njundah AL, Siewe Fodjo JN. Depression, anxiety and medication adherence among tuberculosis patients attending treatment centres in Fako Division, Cameroon: cross-sectional study. BJPsych Open 2023; 9:e65. [PMID: 37051974 PMCID: PMC10134253 DOI: 10.1192/bjo.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Tuberculosis remains a public health problem, particularly in developing countries. Patients with tuberculosis often suffer from anxiety and depression, which is likely to affect adherence to the long course of tuberculosis treatment. AIMS This study sought to investigate depression, anxiety and medication adherence among Cameroonian tuberculosis patients. METHOD A cross-sectional study was conducted from March to June 2022 across five treatment centres in Fako Division, Southwest Region, Cameroon. Data were collected via face-to-face interviews with tuberculosis patients using a structured questionnaire. Sociodemographic information was obtained, and the following tools were administered to participants: the Hospital Anxiety and Depression Scale, the Oslo Social Support Scale, and the Medication Adherence Rating Scale. Multiple logistic regression models were fitted to investigate determinants of depression and anxiety. RESULTS A total of 375 participants were recruited (mean age: 35 ± 12.2 years; 60.5% male). The prevalence rates of depression and anxiety among tuberculosis patients were 47.7% and 29.9%, respectively. After adjusting for confounders, the odds of depression were significantly increased by having extrapulmonary tuberculosis, non-adherence to treatment, having no source of income, household size <5 and poor social support. Predictors for anxiety included extrapulmonary tuberculosis, defaulting tuberculosis treatment for ≥2 months, family history of mental illness, HIV/tuberculosis co-infection, being married, poor social support and non-adherence to treatment. CONCLUSIONS The prevalence of depression and anxiety in tuberculosis patients is relatively high, and diverse factors may be responsible. Therefore, holistic and comprehensive care for tuberculosis patients by mental health practitioners is highly encouraged, especially for the high-risk groups identified.
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Age and Mental Health Symptoms Among Chinese Persons With HIV: The Mediating and Moderating Role of Perceived Discrimination. J Assoc Nurses AIDS Care 2023; 34:105-112. [PMID: 36656094 DOI: 10.1097/jnc.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ABSTRACT The association between age and mental health symptoms among persons with HIV (PWH) is inconsistent, and little is known about the mediators and moderators of this association. This study aimed to examine the association between age and mental health symptoms, as well as the mediators and moderators of perceived discrimination. Data were from 1,304 PWH who completed a cross-sectional survey in five areas of China. Multiple linear regressions showed that younger age was significantly associated with more severe mental health symptoms and that perceived discrimination moderated this relationship. The Sobel test showed that perceived discrimination also mediated the association between age and mental health symptoms. Our study indicates that perceived discrimination shapes the association between age and mental health symptoms among PWH and highlights the importance of designing age-tailored mental health intervention strategies for perceived discrimination among young PWH. Interventions addressing discrimination are necessary to help improve mental health, especially for young PWH.
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Ndenkeh JJN, Nji AM, Yumo HA, Rothe C, Kroidl A. Depression management and antiretroviral treatment outcome among people living with HIV in Northwest and East regions of Cameroon. BMC Infect Dis 2022; 22:732. [PMID: 36100890 PMCID: PMC9469586 DOI: 10.1186/s12879-022-07711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Several interventions have shown benefits in improving mental health problems such as depression which is common in people living with HIV. However, there is a paucity of evidence on the effect of these interventions in improving HIV treatment outcomes. This study aimed at bridging this evidence gap and guiding the integration of depression and HIV management, particularly in rural health settings of Cameroon.
Materials and methods
We carried out a cluster-randomized intervention study targeting persons aged 13 years and above who had been on antiretroviral treatment for 6–9 months. Participants were followed up for 12 months during which those in the intervention group underwent routine screening and management of depression. Comparisons were done using the two-way ANOVA and Chi-squared test with significance set at 5%.
Results
Overall, 370 participants with a median age of 39 years (IQR: 30–49) were enrolled in this study. Of these, 42 (11.3%) were screened with moderate to severe depressive symptoms and 41 (11.1%) had poor treatment adherence. There was a significant drop in depression scores in the intervention group from 3.88 (± 3.76) to 2.29 (± 2.39) versus 4.35 (± 4.64) to 3.39 (± 3.0) in controls (p < 0.001) which was accompanied by a drop in the prevalence of moderate to severe depressive symptoms in the intervention group from 9% to 0.8% (p = 0.046). Decreased depression scores were correlated with better adherence scores with correlation coefficients of − 0.191, − 0.555, and − 0.513 at baseline, 6 months, and 12 months of follow-up respectively (p < 0.001) but there was no significant difference in adherence levels (p = 0.255) and viral suppression rates (p = 0.811) between groups.
Conclusion
The results of this study suggest that considering routine screening and management of depression as an integral component of HIV care could positively impact HIV treatment outcomes. However, there is a need for more research to identify the best combinations of context-specific and cost-effective strategies that can impactfully be integrated with HIV management.
Trial registration Trial registration Number: DRKS00027440. Name of Registry: German Clinical Trials Register. Date registration: December 10, 2021 (‘retrospectively registered’). Date of enrolment of the first participant: 05/08/2019
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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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Relationship between spiritual well-being and Health-Related Quality of Life and some related factors in patients with AIDS/HIV. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
The study of effective factors on the quality of life (QoL), as an important criterion, in the outcome of new therapeutic and preventive strategies in human immunodeficiency virus (HIV) has been considered by researchers. To study the relationship between spiritual well-being and Health-Related Quality of Life (HRQoL) and some related factors in patients with Acquired Immunodeficiency Syndrome ([AIDS]/HIV).
Methods
In this cross-sectional study, 224 people were selected as the study population (112 were male and 112 were female) from patients with AIDS/HIV at the Behavioral Counseling Center of Shiraz with available sampling method. The research tool was Palutzian & Ellison well-being scale and QoL Questionnaire (SF-36). Data were analyzed using Pearson correlation test.
Results
There was a significant direct relationship between physical function dimensions (P = 0.003). There was a significant relationship between general well-being, mental well-being, and total spiritual well-being (P < 0.001). There was a statistically significant relationship between the dimensions of QoL and spiritual well-being with some age section of the patients, and their occupation and education (P < 0.001).
Conclusions
Spirituality has an impact on the QoL dimensions. Therefore, HIV positive people's quality of life could be improved by the possibility of the spiritual well-being promotion as a method of adaptation with the disease.
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Chen S, Hong H, Xu G. Prevalence and related factors of depressive symptoms among HIV/AIDS in Ningbo, China: A cross-sectional study. Front Psychiatry 2022; 13:1004318. [PMID: 36299546 PMCID: PMC9592111 DOI: 10.3389/fpsyt.2022.1004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depressive symptoms were common among HIV/AIDS patients. Previous studies had shown that HIV-infected patients were twice as likely to be diagnosed with depression as the general population. However, only few studies have explored the prevalence and related factors of depressive symptoms among HIV/AIDS in China. MATERIALS AND METHODS A cross-sectional study was conducted to study the prevalence of depressive symptoms among HIV/AIDS from January to December 2021 through the database of HIV/AIDS antiretroviral therapy and psychological evaluation system in Ningbo, China. The Patient Health Questionnaire-2 (PHQ-2) was used to screen for depressive symptoms (PHQ-2 > 0), the Patient Health Questionnaire-9 (PHQ-9) was used to diagnose depressive symptoms, and multivariate Logistic regression model was carried on to evaluate the related factors. RESULTS A total of 3,939 HIV/AIDS patients were enrolled, and the age of initiation of antiretroviral therapy was 37.15 (IQR = 28.41-48.73) years. Among them, 3,230 (82.00%) were male, 3,844 (97.59%) were Han nationality, 1,391 (35.49%) were unmarried, 1,665 (42.27%) were homosexual transmission, and 2,194 (55.70%) were HIV-infected patients. There were 265 patients (6.73%) with depressive symptoms, and the proportion of mild, moderate, moderate and severe depressive symptoms was 4.01% (158/3939), 1.65% (65/3939), 0.76% (30/3939), and 0.30% (12/3939), respectively. Multivariate analysis showed that married [odds ratio (OR) = 0.675, 95% CI = 0.501-0.908], divorced or widowed (OR = 0.571, 95% CI = 0.380-0.860), homosexual transmission (OR = 1.793, 95% CI = 1.349-2.396) were associated with depressive symptoms among HIV/AIDS. CONCLUSION The prevalence of depressive symptoms among HIV/AIDS patients was 6.73% in Ningbo, China. More attention should be paid to the psychological status of unmarried and homosexual HIV/AIDS patients in Ningbo and timely psychological intervention or treatment should be given to those patients with depressive symptoms.
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Affiliation(s)
- Suting Chen
- School of Medicine, Ningbo University, Ningbo, China
| | - Hang Hong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Guozhang Xu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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Ahmed A, Saqlain M, Umair MM, Hashmi FK, Saeed H, Amer M, Blebil AQ, Dujaili JA. Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study. Front Public Health 2021; 9:745545. [PMID: 34660521 PMCID: PMC8514983 DOI: 10.3389/fpubh.2021.745545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 01/30/2023] Open
Abstract
Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions. Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships. Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety. Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid i Azam University Islamabad, Islamabad, Pakistan
| | - Malik Muhammad Umair
- National AIDs Control Program, Prime Minister Health Complex, Islamabad, Pakistan
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal, Lahore, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Allama Iqbal, Lahore, Pakistan
| | - Muhammad Amer
- Department of Pharmacy, The University of Lahore, Islamabad, Pakistan
| | - Ali Qais Blebil
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
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Siewe Fodjo JN, Ngarka L, Njamnshi WY, Nfor LN, Mengnjo MK, Mendo EL, Angwafor SA, Atchou Basseguin JG, Nkouonlack C, Njit EN, Ahidjo N, Chokote ES, Dema F, Fonsah JY, Tatah GY, Palmer N, Seke Etet PF, Palmer D, Nsagha DS, Etya’ale DE, Perrig S, Sztajzel R, Annoni JM, Zoung-Kanyi Bissek AC, Leke RGF, Abena Ondoa Obama MT, Nkengasong JN, Colebunders R, Njamnshi AK. Fear and depression during the COVID-19 outbreak in Cameroon: a nation-wide observational study. BMC Psychiatry 2021; 21:356. [PMID: 34266400 PMCID: PMC8280628 DOI: 10.1186/s12888-021-03323-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak. METHODS An online survey was conducted in Cameroon from June-December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time. RESULTS Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53-3.21; p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34; p < 0.001). Multivariate analyses revealed that having a postgraduate degree, a history of quarantine, flu-like symptoms during the past 14 days, and higher FCV-19S scores were associated with more severe depressive symptoms, while obtaining COVID-19 information from various sources reduced the odds for depression. CONCLUSION Depression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians.
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Affiliation(s)
- Joseph Nelson Siewe Fodjo
- grid.5284.b0000 0001 0790 3681Global Health Institute, University of Antwerp, Antwerp, Belgium ,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Wepnyu Y. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon ,Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | | | | | | | | | | | | | - Edith N. Njit
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Nene Ahidjo
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | - Fidèle Dema
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | | | - Nancy Palmer
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | - Dennis Palmer
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | | | - Stephen Perrig
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | - Roman Sztajzel
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
| | | | | | | | | | - John N. Nkengasong
- grid.503447.10000 0001 2189 9463CDC Africa, African Union, Addis Ababa, Ethiopia
| | - Robert Colebunders
- grid.5284.b0000 0001 0790 3681Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon ,Brain Research Africa Initiative (BRAIN), Geneva, Switzerland
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Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis. AIDS Behav 2020; 24:1752-1764. [PMID: 31720956 DOI: 10.1007/s10461-019-02706-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite the substantial burden of HIV in Africa, and the knowledge that depression causes worse HIV outcomes, the burden of depression in people living with HIV in Africa is unknown. We searched Pubmed and four other databases using key terms: depression, Africa, HIV, and prevalence from 2008 to 2018. We summarized depression prevalence by country. We estimated the burden of depression using our prevalence data and 2018 UNAIDS HIV estimates. Our search yielded 70 articles across 16 African countries. The overall prevalence of major depression in those HIV-infected using a diagnostic interview was 15.3% (95% CI 12.5-17.1%). We estimate that 3.63 million (99.7% CI 3.15-4.19 million) individuals with HIV in Sub-Saharan Africa have major depression and provide country-level estimates. We estimate that 1.57 million (99.7% CI 1.37-1.82 million) DALYs are lost among people with depression and HIV in Sub-Saharan Africa. There is a significant burden of depression in Africans with HIV. Further work to screen for and treat depression in Sub-Saharan Africa is needed to improve HIV outcomes and achieve the 90-90-90 UNAIDS goals.
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Morowatisharifabad MA, Movahed E, Farokhzadian J, Nikooie R, Askarishahi M, Bidaki R, Hosseinzadeh M. Antiretroviral therapy adherence based on information, motivation, and behavioral skills model and its association with depression among HIV-positive patients: Health promotion strategy towards the 909090 target. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:192. [PMID: 31807584 PMCID: PMC6852370 DOI: 10.4103/jehp.jehp_42_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND HIV-infected patients with poor antiretroviral therapy (ART) adherence are prone to depression, and depression can exacerbate the disease condition. This study was conducted to determine ART Adherence based on Information, Motivation, and Behavioral Skills (IMB) Model and its association with depression among HIV-positive patients. MATERIALS AND METHODS This descriptive-correlational study was carried out on people over the age of 18 years with HIV/AIDS, who referred to the Behavioral Diseases Counseling Center in Kerman City, Iran, in 2017. In this regard, 119 patients were selected using the table of random numbers. To collect the data, we used the Beck's depressioninventory-II and the IMB researcher made questionnaire to evaluate the ART adherence. RESULTS The results of the study reveal that a significant association was observed between the total adherence and all constructs of the IMB model (P < 0.001). Risk perception and self-efficacy had the highest mean scores regarding the ART adherence. The prevalence of depression was 71.5% among patients. Information, personal motivation, and total adherence had a significant association with depression. CONCLUSIONS IMB model was an appropriate and practical strategy with regard to the ART adherence among people living with HIV who are prone to depression and drug consumption is crucial for them to achieve the 90-90-90 target. This article created a questionnaire to assist policy-makers and health professionals designing interventions to improve adherence and health outcomes of ART.
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Affiliation(s)
| | - Ehsan Movahed
- Health Education and Health Promotion, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | | | - Rohollah Nikooie
- Department of Exercise Physiology, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Mohsen Askarishahi
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Bidaki
- Research Center of Addiction and Behavioral Sciences and Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Hosseinzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Trends Over Time for Adolescents Enrolling in HIV Care in Kenya, Tanzania, and Uganda From 2001-2014. J Acquir Immune Defic Syndr 2019; 79:164-172. [PMID: 29985263 DOI: 10.1097/qai.0000000000001796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The data needed to understand the characteristics and outcomes, over time, of adolescents enrolling in HIV care in East Africa are limited. SETTING Six HIV care programs in Kenya, Tanzania, and Uganda. METHODS This retrospective cohort study included individuals enrolling in HIV care as younger adolescents (10-14 years) and older adolescents (15-19 years) from 2001-2014. Descriptive statistics were used to compare groups at enrollment and antiretroviral therapy (ART) initiation over time. The proportion of adolescents was compared with the total number of individuals aged 10 years and older enrolling over time. Competing-risk analysis was used to estimate 12-month attrition after enrollment/pre-ART initiation; post-ART attrition was estimated by Kaplan-Meier method. RESULTS A total of 6344 adolescents enrolled between 2001 and 2014. The proportion of adolescents enrolling among all individuals increased from 2.5% (2001-2004) to 3.9% (2013-2014, P < 0.0001). At enrollment, median CD4 counts in 2001-2004 compared with 2013-2014 increased for younger (188 vs. 379 cells/mm, P < 0.0001) and older (225 vs. 427 cells/mm, P < 0.0001) adolescents. At ART initiation, CD4 counts increased for younger (140 vs. 233 cells/mm, P < 0.0001) and older (64 vs. 323 cells/mm, P < 0.0001) adolescents. Twelve-month attrition also increased for all adolescents both after enrollment/pre-ART initiation (4.7% vs. 12.0%, P < 0.001) and post-ART initiation (18.7% vs. 31.2%, P < 0.001). CONCLUSIONS Expanding HIV services and ART coverage was likely associated with earlier adolescent enrollment and ART initiation but also with higher attrition rates before and after ART initiation. Interventions are needed to promote retention in care among adolescents.
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Abelson A, Lyons C, Decker M, Ketende S, Mfochive Njindam I, Fouda G, Ndonko F, Levitt D, Tamoufe U, Billong S, Bissek ACZK, Baral SD. Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. Int J Soc Psychiatry 2019; 65:445-457. [PMID: 31234685 DOI: 10.1177/0020764019858646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs' experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. METHODS In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. RESULTS Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2-1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3-2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2-2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. CONCLUSION Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.
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Affiliation(s)
- Anna Abelson
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele Decker
- 2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Serge Billong
- 6 Groupe Technique Central du Comité National de Lutte contre le SIDA, Yaoundc, Cameroon
| | | | - Stefan D Baral
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bigna JJ, Tounouga DN, Kenne AM, Djikeussi TK, Foka AJ, Um LN, Asangbeh SL, Sibetcheu AT, Kaze AD, Ndangang MS, Nansseu JR. Epidemiology of depressive disorders in people living with HIV in Africa: a systematic review and meta-analysis: Burden of depression in HIV in Africa. Gen Hosp Psychiatry 2019; 57:13-22. [PMID: 30654293 DOI: 10.1016/j.genhosppsych.2018.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The burden of HIV infection is higher in Africa where 70% of people living with HIV (PLHIV) resides. Since depression can negatively impact the course of HIV infection, it is therefore important to accurately estimate its burden among PLHIV in the continent. METHODS We searched multiple databases to identify articles published between January 2000 and February 2018, reporting the prevalence of (major) depressive disorders in PLHIV residing in Africa. We used a random-effects meta-analysis model to pool studies. RESULTS Overall, 118 studies (60,476 participants, 19 countries) were included. There was no publication bias. The overall prevalence estimates of depressive disorders and probable major depressive disorders were 36.5% (95% CI 32.3-41.0; 101 studies) and 14.9% (12.1-17.9; 55 studies) respectively. The heterogeneity of the overall prevalence of depressive disorders was significantly explained by screening tool used, period (higher prevalence in recent studies) and distribution in sub-regions. The study setting, site, CD4 cell counts, age, sex, proportion of people with undetectable viral load were not sources of heterogeneity. CONCLUSIONS This study shows that more than one third of PLHIV face depressive disorders and half of them having major form, with heterogeneous distribution in the continent. As such, depressive disorders deserve more attention from HIV healthcare providers for improved detection and overall proper management.
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Affiliation(s)
- Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaounde, Cameroon.
| | | | | | - Tatiana K Djikeussi
- Department for the Control of Disease, Epidemics and Pandemics Diseases, Ministry of Public Health, Yaounde, Cameroon
| | - Audrey Joyce Foka
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Lewis N Um
- Mfou District Hospital, Ministry of Public Health, Mfou, Cameroon
| | - Serra Lem Asangbeh
- Department of Clinical Research, National Agency on Research for HIV and Viral Hepatitis, Yaounde, Cameroon
| | - Aurelie T Sibetcheu
- Department of Pediatrics and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Arnaud D Kaze
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Marie S Ndangang
- Department of Medical Information and Informatics, Rouen University Hospital, Rouen, France
| | - Jobert Richie Nansseu
- Department for the Control of Disease, Epidemics and Pandemics Diseases, Ministry of Public Health, Yaounde, Cameroon; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
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Kanmogne GD, Fonsah JY, Tang B, Doh RF, Kengne AM, Umlauf A, Tagny CT, Nchindap E, Kenmogne L, Franklin D, Njamnshi DM, Mbanya D, Njamnshi AK, Heaton RK. Effects of HIV on executive function and verbal fluency in Cameroon. Sci Rep 2018; 8:17794. [PMID: 30542105 PMCID: PMC6290794 DOI: 10.1038/s41598-018-36193-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/16/2018] [Indexed: 01/02/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) are frequently associated with impaired executive function and verbal fluency. Given limited knowledge concerning HAND in Sub-Saharan-Africa and lack of Cameroonian adult neuropsychological (NP) test norms, we administered four executive function [Halstead Category Test (HCT), Wisconsin Card Sorting Test (WCST), Color Trails-II (CTT2), and Stroop Color-Word-Interference (SCWT)] and three verbal fluency (Category, Action, and Letter Fluency) tests to 742 adult Cameroonians (395 HIV-, 347 HIV+). We developed demographically-corrected NP test norms and examined the effects of HIV and related variables on subjects' executive function and verbal fluency. HIV+ subjects had significantly lower T-scores on CTT2 (P = 0.005), HCT (P = 0.032), WCST (P < 0.001); lower executive function composite (P = 0.002) and Action Fluency (P = 0.03) T-scores. ART, viremia, and CD4 counts did not affect T-scores. Compared to cases harboring other viral subtypes, subjects harboring HIV-1 CRF02_AG had marginally higher CTT2 T-scores, significantly higher SCWT (P = 0.015) and executive function (P = 0.018) T-scores. Thus, HIV-1 infection in Cameroon is associated with impaired executive function and some aspects of verbal fluency, and viral genotype influenced executive function. We report the first normative data for assessing executive function and verbal fluency in adult Cameroonians and provide regression-based formulas for computing demographically-adjusted T-scores. These norms will be useful for investigating HIV/AIDS and other diseases affecting cognitive functioning in Cameroon.
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Affiliation(s)
- Georgette D Kanmogne
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Julius Y Fonsah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Roland F Doh
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anne M Kengne
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Claude T Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | | | - Donald Franklin
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Dora M Njamnshi
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Dora Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Alfred K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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