Abstract
BackgroundThere is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middle-income countries in sub-Saharan Africa. We validated the Shona version of the PTSD Checklist for DSM-5 (PCL-5) in a primary health care clinic in Harare, Zimbabwe.MethodAdults aged 18 and above attending the clinic were enrolled over a two-week period in June 2016. After obtaining written consent, trained research assistants administered the tool to eligible participants. Study participants were then interviewed independently using the Clinician Administered PTSD Scale (CAPS-5) as the gold standard by one of five doctors with training in mental health.ResultA total of 204 participants were assessed. Of these, 91 (44.6%) were HIV positive, 100 (49%) were HIV negative, while 13 (6.4%) did not know their HIV status. PTSD was diagnosed in 40 (19.6%) participants using the gold standard procedure. Using the PCL-5 cut-off of ≥33, sensitivity and specificity were 74.5% (95%CI: 60.4–85.7); 70.6% (95%CI: 62.7–77.7), respectively. The area under the ROC curve was 0.78 (95%CI: 0.72–0.83). The Shona version of the PCL-5 demonstrated good internal consistency (Cronbach’s alpha = 0.92).ConclusionThe PCL-5 performed well in this population with a high prevalence of HIV. There is need to explore ways of integrating screening tools for PTSD in interventions delivered by lay health workers in low and middle-income countries (LMIC).
Highlights
There is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middleincome countries in sub-Saharan Africa
There is need to explore ways of integrating screening tools for PTSD in interventions delivered by lay health workers in low and middleincome countries (LMIC)
The negative experience of being Human immunodeficiency virus (HIV) positive is cumulative with people living with HIV (PLWH) exposed to multiple HIV-related stressors and losses [3] which can lead to PTSD symptomatology
Summary
There is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middleincome countries in sub-Saharan Africa. In sub-Saharan Africa, people living with HIV (PLWH) have a high rate of post-traumatic stress disorder (PTSD) [1, 2]. The negative experience of being HIV positive is cumulative with PLWH exposed to multiple HIV-related stressors and losses [3] which can lead to PTSD symptomatology. Stressors, both acute and chronic, that people in LMIC are exposed to often occur on a daily basis. In South Africa, PLWH have been found to have high prevalence of persisting psychiatric disorders with PTSD rates at follow-up of 20% being associated with a longer duration of infection and low baseline functionality [9]. Receiving an HIV-diagnosis was experienced as a traumatic index event for 36.4% in a population of recently diagnosed persons [9, 11]
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