Abstract
BackgroundIn 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART). The incidence of non-communicable diseases has increased markedly in PLWH as mortality is reduced due to use of HAART. Common mental disorders (CMD) are highly prevalent in PLWH. We aimed to determine factors associated with probable CMD and depression, assessed by 2 locally validated screening tools in a population with high prevalence of HIV in Harare, Zimbabwe.MethodsWe carried out a cross-sectional survey of a systematic random sample of patients utilizing the largest primary health care facility in Harare. Adults aged ≥18 years attending over a 2-week period were eligible, excluding those who were critically ill or unable to give written informed consent. Two locally validated screening tools the Shona symptom questionnaire (SSQ-14) and the Patient Health Questionnaire (PHQ-9) were administered by trained research assistants to identify probable CMD and depression.ResultsOf the 264 participants, 165 (62.5 %) were PLWH, and 92 % of these were on HAART. The prevalence of probable CMD (SSQ14 > = 9) and depression (PHQ9 > = 11) were higher among people living with HIV than among those without HIV (67.9 and 68.5 % vs 51.4 and 47.2 % respectively). Multivariable analysis showed female gender and recent negative life events to be associated with probable CMD and depression among PLWH (gender: OR = 2.32 95 % CI:1.07–5.05; negative life events: OR = 4.14; 95 % CI 1.17–14.49) and with depression (gender: OR = 1.84 95 % CI:0.85–4.02; negative life events: OR = 4.93.; 95 % CI 1.31–18.50)ConclusionElevated scores on self-report measures for CMD and depression are highly prevalent in this high HIV prevalence population. There is need to integrate packages of care for CMD and depression in existing primary health care programs for HIV/AIDS.
Highlights
In 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART)
Other studies from poor resource settings have found that Common mental disorders (CMD) in PLWH is correlated with trauma, posttraumatic stress disorder (PTSD), stigma and social barriers such as peoples’ attitudes towards disabilities, physical and organizational obstacles, these differences appear to be due to a difference in the study setting and study population [36,37,38,39]
Association of probable CMD and depression by HIV status The prevalence of probable CMD (SSQ14 ≥ 9) and depression (PHQ9 ≥ 11) were higher among people living with HIV than among those without HIV (67.9 and 68.5 % vs 51.4 and 47.2 % respectively; Table 1)
Summary
In 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART). Common mental disorders (CMD) are highly prevalent in PLWH. Amongst people living with HIV (PLWH), CMD are a leading cause of disability [4,5,6,7] and are known to hasten HIV disease progression [8], in LMIC [4, 6, 9]. Use of targeted task-shifting psychological interventions to address CMD in PLWH requires a thorough understanding of factors associated with CMD in this population [4, 23], due partially to the need for greater monitoring and supervision of work delivered by nonspecialists [24,25,26]. In four LMIC, namely India, Zimbabwe, Chile and Brazil, female gender, poverty and recent life events were found to be common correlates of CMD in non-HIV populations [29]. Other studies from poor resource settings have found that CMD in PLWH is correlated with trauma, posttraumatic stress disorder (PTSD), stigma and social barriers such as peoples’ attitudes towards disabilities, physical and organizational obstacles, these differences appear to be due to a difference in the study setting and study population [36,37,38,39]
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