Abstract
BackgroundIn an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems.MethodsWe describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants’ psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing.DiscussionDocumenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.
Highlights
In an effort to promote greater access to voluntary counseling and testing for human immunodeficiency virus (HIV), it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services
There are a number of plausible rival hypotheses to the dominant view that receipt of an HIV positive test result precipitates psychiatric illness, including: (1) that rates of psychopathology are high among persons seeking HIV testing; and (2) that prior mental health problems may be a superior predictor of post-HIV psychiatric disturbance than an HIV diagnosis in and of itself
No clinically significant cut-off points have been established for commonly used psychiatric symptom checklists, among persons seeking HIV testing. This gap in the literature hinders efforts to screen for common mental disorders among persons seeking HIV testing, using instruments such as the Beck depression inventory (BDI), Beck anxiety inventory (BAI), Hopkins symptom checklist (HSC), posttraumatic stress disorder symptom scale (PTSD-SS), alcohol use disorders identification test (AUDIT), and drug use disorder identification test (DUDIT). It is within this context that we describe a protocol for a study in the Western Cape province of South Africa which has the following six objectives: 1. To determine the level of psychological distress, and the prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), PTSD, and substance use disorders [as measured by the Structured Clinical Interview for diagnostic and Statistical Manual (DSM)-5 (SCID5)] among persons who are seeking HIV testing
Summary
In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. In an effort to promote greater access to voluntary counseling and Bantjes and Kagee Int J Ment Health Syst (2018) 12:16 condition of persons seeking HIV testing is absent. It is unknown what the prevalence of common mental disorders is among persons seeking HIV testing and whether such individuals are already psychiatrically disordered or emotionally distressed prior to receipt of their HIV positive result. The proposed study seeks to test these hypotheses These issues have particular salience in lowand middle-income countries, like South Africa, where medical resources are scarce and data on the prevalence and course of mental disorders are needed to plan effective and integrated mental health care services
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