Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis

Lofgren, Sarah M; Bond, David J.; Nakasujja, Noeline; Boulware, David R.

doi:10.1007/s10461-019-02706-2

Cited by 60 publications

(73 citation statements)

References 98 publications

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“…11 Mental illness and HIV are highly comorbid and mutually reinforcing. 21 , 22 , 23 Up to 35% and 21% of patients with HIV are thought to have comorbid depression and anxiety, respectively. 21 Regarding depression, treatment improves the depressive symptoms and may improve anti-retroviral adherence and reduce HIV transmission.…”

Section: Discussionmentioning

confidence: 99%

Medicines used in mental, neurological and substance use disorders in Gauteng, South Africa: A secondary analysis of the 2017–2018 provincial pharmaceutical database, Part 1

Bouwer

Govender

Robertson

2021

South African Journal of Psychiatry

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Background Access to essential medicines is an integral part of effective health systems. Analysis of medicine procurement may assist with ensuring sustainable access. Aim To describe the profile and cost of medicines procured for managing mental, neurological and substance use (MNS) disorders during the 2017–2018 financial year. Setting The study was conducted in the public health sector in the Gauteng province, South Africa. Method A secondary analysis of the Gauteng Medical Stores Administration System database was performed. Medicine procurement for managing MNS disorders was analysed descriptively by using the World Health Organization’s Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Procurement of each medicine was evaluated in local currency (Rands) and in DDD/1000 population served. The District Health Information System was used to estimate population served. Results Of the total provincial medicines expenditure in 2017–2018, 3.73% was for MNS disorders, which is similar to the spending on cardiovascular (4%) and respiratory (3%) disorders. Antivirals for systemic use comprised 44% of the total expenditure, followed by vaccines at 13%. Of the medicines for MNS disorders, 32.5% of DDDs procured were for anti-epileptics (ATC N03A) at 47.5% of expenditure; 26.2% of DDDs were for antipsychotics (ATC N05A) at 30.9% of expenditure; and antidepressants accounted for 30.8% of DDDs at 6% of expenditure. Conclusion Less than 4% of provincial medicines expenditure was on medicines for MNS disorders, of which almost 78.4% of expenditure was on anti-epileptics and antipsychotics. With limited financial resources, evaluation of procurement patterns raises awareness of relative costs.

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Section: Discussionmentioning

confidence: 99%

Medicines used in mental, neurological and substance use disorders in Gauteng, South Africa: A secondary analysis of the 2017–2018 provincial pharmaceutical database, Part 1

Bouwer

Govender

Robertson

2021

South African Journal of Psychiatry

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“…Previous studies on the burden of psychological distress among HIV infected people have reported a value of 33% in SSA, 1 11.2% in Dilla-Ethiopia, 13 7.8% in North Shewa-Ethiopia 14 and 37.6% of HIV infected people were reported to experience mild/moderate while 29.5% experienced severe psychological distress in Oromia-Ethiopia. 15 Moreover, 24.3% of patients had common mental disorders in Debre Markos referral hospital-northwest Ethiopia 16 and 24.5% of HIV positive people suffered from co-morbidity of depression and anxiety in Addis Ababa, Ethiopia.…”

Section: Introductionmentioning

confidence: 92%

“…Mental health problems are known to be common among people living with HIV in Africa. 1 In sub-Saharan Africa (SSA), the burden of depression among people living with HIV (PLWH) ranges between 9% and 32%. 2 More than 1.57 million disability-adjusted life years (DALYs) are lost among people with depression and HIV in Sub-Saharan Africa in general and about 30 000 DALYs are lost in Ethiopia in particular.…”

Section: Introductionmentioning

confidence: 99%

“…6 Mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. 1,7 Given the strong evidence for the contribution 2 Infectious Diseases: Research and Treatment of mental health and behavioral problems to poor HIV health outcomes, there is an obvious need for universal mental health screening and the provision of mental health treatment integrated into ongoing HIV care. 7 However, most of the studies conducted in Africa among HIV patients do not use validated tools in the study areas.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, most of the studies conducted in Africa among HIV patients do not use validated tools in the study areas. 1 In Ethiopia, expansion and strengthening ART care and treatment activities are supported by the process of task shifting: training of nurses and community health agents in prevention, treatment, care, and support activities which further strengthen community linkages and ensure availability of standard minimum packages of HIV services at primary health care level. 8 Additionally, due to insufficient mental health specialists to close the enormous treatment gap for mental disorders among HIV patients, "task-shifting" (training and supporting non-specialist health workers to deliver mental healthcare) 5 may also be implemented in the HIV clinic.…”

Section: Introductionmentioning

confidence: 99%

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Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses

et al. 2021

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Background: Although there is a high burden of HIV in sub-Saharan Africa (SSA), studies on mental health issues among people living with HIV are scarce. The study addressed the transition to “test and treat” guidelines for HIV, which makes it unique regarding its evaluation of psychological distress amongst newly initiated people living with HIV in the test and treat era. Methods: We conducted a cross-sectional survey of 689 people newly diagnosed with HIV. Symptoms of psychological distress were measured using the Kessler-10 psychological distress assessment scale. Factors associated with psychological distress were captured using interviewer-administered questionnaires. Ordinal logistic regression analyses were employed to identify predictors of psychological distress. Results: The magnitude of psychological distress was 58.63% (95% CI = 55.2%-62.3%). The severity of the psychological distress of which, 17.42% had severe distress. Psychological distress was observed more among female patients (β = 0.47, AOR = 1.59, 95% CI = 1.12, 2.27), patients presented with opportunistic infections (β = 0.50, AOR = 1.65, 95% CI = 1.03, 2.66) and being non-working functional status (β = 0.99, AOR = 2.70, 95% CI = 1.64, 4.45). Moreover, patients who were malnourished (β = 0.46, AOR = 1.58, 95% CI = 1.09, 2.26), having good level of knowledge on HIV prevention (β = 0.59, 95% CI = 0.55, 0.39, 0.78), presented with sexually transmitted infection (β = 0.48, AOR = 1.61, 95% CI = 1.01, 2.58), history of alcohol use (β = 0.44, AOR = 1.55, 95% CI = 1.09, 2.21), perceived stigma (β = 0.08, AOR = 1.09 95% CI = 1.04, 1.15) and treated in health centers (β = 0.55, AOR = 1.74, 95% CI = 1.25, 2.41) had higher odds of psychological distress. Conclusion: The large majority of newly diagnosed HIV patients suffered from psychological distress. An increased vulnerability was observed among females, those with opportunistic and sexually transmitted infections, those having poor functional status and malnourished. Furthermore, HIV patients treated in health centers, those who had history of alcohol use and patients with high level of HIV related stigma are more negatively affected by the HIV diagnosis. Hence, all intervention strategies should target all the identified predictors.

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Prevalence and factors associated with common mental disorders in young people living with HIV in sub‐Saharan Africa: a systematic review

et al. 2021

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Introduction Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub‐Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA. Methods We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: “Depression OR Anxiety”, “Young people”, “HIV infections” and “sub‐Saharan Africa”. Results and discussion Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV‐negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV‐related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV‐positive status, bullying, sexual abuse, HIV‐related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms. Conclusions The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV‐negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV‐clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth‐friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.

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Burden of Depression in Outpatient HIV-Infected adults in Sub-Saharan Africa; Systematic Review and Meta-analysis

Cited by 60 publications

References 98 publications

Medicines used in mental, neurological and substance use disorders in Gauteng, South Africa: A secondary analysis of the 2017–2018 provincial pharmaceutical database, Part 1

Medicines used in mental, neurological and substance use disorders in Gauteng, South Africa: A secondary analysis of the 2017–2018 provincial pharmaceutical database, Part 1

Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses

Prevalence and factors associated with common mental disorders in young people living with HIV in sub‐Saharan Africa: a systematic review

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