The Validity of the Substance Abuse and Mental Illness Symptom Screener (SAMISS) in People Living with HIV/AIDS in Primary HIV Care in Cape Town, South Africa

Abstract

Given the high prevalence of HIV in South Africa and co-morbid mental disorders in people living with HIV/AIDs (PLWHA) we sought to validate a brief screening tool in primary HIV care. 366 PLWHA were recruited prior to combination anti-retroviral treatment (CART) initiation from two primary health HIV clinics. A mental health nurse administered a socio-demographic questionnaire and the Mini Neuropsychiatric Interview (MINI) and a lay counsellor administered the Substance and Mental Illness Symptom Screener (SAMISS). Using the MINI, 17% of participants were identified with either depression, anxiety disorders or adjustment disorder and 18% with substance or alcohol abuse/dependence. The sensitivity and specificity of the SAMISS was 94% (95% CI: 88-98%) and 58% (95% CI: 52-65%) respectively, with the alcohol component (sensitivity: 94%; specificity: 85%) performing better than the mental illness component of the SAMISS (sensitivity: 97%; specificity: 60%). The specificity of the tool improved when the cut-off for the mental illness component was increased. The SAMISS may provide a useful first tier screening tool for common mental disorders in primary care for PLWHA.