Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania

Abstract

AIDS-related mortality among HIV-positive adolescents has risen by 50% despite the scale up of anti-retroviral therapy (ART). ART maladherence likely plays a role in the increase of AIDS related deaths among adolescents and has been shown to be associated with psychosocial and mental health difficulties. Addressing the specific mental health needs of HIV-positive adolescents is critical to ending the HIV epidemic. This cross-sectional study prospectively enrolled HIV-positive adolescents (12-24 years) in Moshi, Tanzania. A structured questionnaire was administered that included questions about home, school, adherence, and measures of stigma (Berger Stigma Scale) and mental health. Mental health measures included depression (PHQ-9), emotional/behavioral difficulties (SDQ), and traumatic experiences/post-traumatic stress symptoms (UCLA-PTSD-RI). Mental health difficulties were prevalent among HIV-positive adolescents and were associated with incomplete adherence and stigma. Resources are needed to reduce HIV stigma and address mental health among HIV-positive adolescents in low-resource settings. This will improve not only mental health, but may also improve ART adherence and virologic suppression, improving overall health of the individual and reducing the risk of HIV transmission to others.

Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

“…In the 1990s, the American Academy of Pediatrics and the Pediatric Section of the Society for Critical Care Medicine published guidelines for establishment of pediatric critical care units (6) and for PICU admission criteria (7). The admission criteria were intentionally vague and broad, recommending admission for severe or life-threatening illness and/or illnesses requiring frequent monitoring or intensive intervention (8). The guidelines for establishing a PICU focused on staff training, nursing-to-patient ratio, equipment, and ancillary/support services needed to establish quality critical care.…”

“…Based on these guidelines, an estimated 20% of children seen in the ambulatory setting met criteria for referral to a hospital for escalation of care (10). Hospital case mortality rates have decreased only slowly from the 1990s to early 2000s, highlighting the need for improved care of the sickest hospitalized children, including triage, emergency, and critical care services (8). …”

“…There are also significant disparities in pediatric critical care capabilities within regions of any given LMIC (8). In some African countries, university and private hospitals are capable of providing pediatric critical care comparable to PICUs in HICs (8).…”

“…In some African countries, university and private hospitals are capable of providing pediatric critical care comparable to PICUs in HICs (8). In large cities throughout China, India, South Africa, South America, and the Middle East, emergency and intensive care services are often similar to HIC settings (8).…”

“…In some African countries, university and private hospitals are capable of providing pediatric critical care comparable to PICUs in HICs (8). In large cities throughout China, India, South Africa, South America, and the Middle East, emergency and intensive care services are often similar to HIC settings (8). The majority of hospitals in LMICs, however, do not have a designated PICU with pediatric trained nursing staff, adequate nurse to patient ratios to care for critical patients, appropriate equipment, monitoring capability, or ancillary support (9).…”