Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems

Lee, Jasper S.; Bainter, Sierra A.; Tsai, Alexander C.; Andersen, Lena S.; Stanton, Amelia M.; Magidson, Jessica F.; Kagee, Ashraf; Joska, John; O’Cleirigh, Conall; Safren, Steven A.

doi:10.1007/s10461-022-03906-z

Cited by 10 publications

(3 citation statements)

References 95 publications

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“…Although concurrence of and interactions between the maternal factors included in this analysis have been reported in several adult‐focused studies [ 14 , 33 ], the impact on child health is less well understood. To our knowledge, this is the first study to systematically seek evidence of HIV‐related syndemic interactions on a maternal level, with impact measured on a child health level, following current syndemic theory [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The syndemic model of health seeks to assess the co‐occurrence of and interactions between social determinants of health, biological factors and disease outcomes within the context of inequality and deprivation [ 11 ]. Reflecting the high incidence of HIV among people who are marginalised and poor, several HIV‐related syndemics have been described among women living with HIV (WLHIV), including inter‐relationships between hazardous use of alcohol, household food insecurity (HFIS) and intimate partner violence (IPV), which in turn exacerbate HIV disease severity, adversely affect adherence to ART and increase the risk of mental health challenges [ 12 , 13 , 14 ]. Each of these maternal factors is also known to increase the risks of adverse health outcomes among children globally, including CHEU [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Children of a syndemic: co‐occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV‐affected mother‐infant dyads in Cape Town, South Africa

le Roux,

Abrams,

Zerbe

et al. 2023

J Int AIDS Soc.

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IntroductionSeveral HIV‐related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding.MethodsA prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013–2017). All WLHIV initiated antenatal efavirenz‐based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2‐week recall) and neurodevelopment (BSID‐III, measured at ∼12 months’ age) were compared across bio‐social strata using generalised linear regression models, with interaction terms; maternal data included interview‐based measures for HD (AUDIT‐C), IPV (WHO VAW) and HFIS.ResultsAmong 872 breastfeeding mother‐infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight‐for‐age Z‐score (WAZ) was 0.06 (−0.14; 0.25) for food insecure CHU; −0.26 (−0.42; −0.10) for food secure CHEU; and −0.43 (−0.61; −0.25), for food insecure CHEU. Results were similar for underweight (WAZ < −2), infectious‐cause hospitalisation, cognitive and motor delay. HIV‐IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV‐HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD‐unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD‐exposed CHU; 3.57 (0.84; 15.13) for HD‐unexposed CHEU and 6.01 (2.22; 16.22) for HD‐exposed CHEU.ConclusionsThese data suggest that maternal HIV‐related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Children of a syndemic: co‐occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV‐affected mother‐infant dyads in Cape Town, South Africa

le Roux,

Abrams,

Zerbe

et al. 2023

J Int AIDS Soc.

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“…This study is being conducted within the City of Cape Town’s community health clinics located in the Khayelitsha health district within the Western Cape, South Africa. These clinics offer publicly funded, integrated HIV and TB treatment to patients from predominately low-income communities where there is a high prevalence of HIV, TB, SU, and mental health concerns [ 33 , 34 ]. At these clinics, there is an existing infrastructure of CHWs who provide basic health services and home visits to patients with HIV/TB.…”

Section: Methodsmentioning

confidence: 99%

Community health worker training to reduce mental health and substance use stigma towards patients who have disengaged from HIV/TB care in South Africa: protocol for a stepped wedge hybrid type II pilot implementation trial

Myers,

Regenauer,

Rose

et al. 2024

Implement Sci Commun

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Background South Africa has deployed community health workers (CHWs) to support individuals to enter and stay in HIV/TB care. Although CHWs routinely encounter patients with mental health (particularly depression) and substance use (SU) conditions that impact their engagement in HIV/TB care, CHWs are rarely trained in how to work with these patients. This contributes to mental health and SU stigma among CHWs, a known barrier to patient engagement in care. Mental health and SU training interventions could reduce CHW stigma and potentially improve patient engagement in care, but evidence of the feasibility, acceptability, and preliminary effectiveness of these interventions is scarce. Therefore, we designed a hybrid type 2 effectiveness-implementation pilot trial to evaluate the implementation and preliminary effectiveness of a CHW training intervention for reducing depression and SU stigma in the Western Cape, South Africa. Methods This stepped wedge pilot trial will engage CHWs from six primary care clinics offering HIV/TB care. Clinics will be block randomized into three-step cohorts that receive the intervention at varying time points. The Siyakhana intervention involves 3 days of training in depression and SU focused on psychoeducation, evidence-based skills for working with patients, and self-care strategies for promoting CHW wellness. The implementation strategy involves social contact with people with lived experience of depression/SU during training (via patient videos and a peer trainer) and clinical supervision to support CHWs to practice new skills. Both implementation outcomes (acceptability, feasibility, fidelity) and preliminary effectiveness of the intervention on CHW stigma will be assessed using mixed methods at 3- and 6-month follow-up assessments. Discussion This trial will advance knowledge of the feasibility, acceptability, and preliminary effectiveness of a CHW training for reducing depression and SU stigma towards patients with HIV and/or TB. Study findings will inform a larger implementation trial to evaluate the longer-term implementation and effectiveness of this intervention for reducing CHW stigma towards patients with depression and SU and improving patient engagement in HIV/TB care. Trial registration ClinicalTrials.gov NCT05282173. Registered on 7 March 2022.

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Prevalence and co‐occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low‐ and middle‐income countries: a cross‐sectional study

Parcesepe,

Stockton,

Bernard

et al. 2024

J Int AIDS Soc.

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IntroductionDue to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co‐occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co‐occurrence of MSDs among ageing PWH remains limited, particularly in low‐ and middle‐income countries (LMICs).MethodsWe analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co‐occurrence of unhealthy alcohol use (AUDIT‐C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ‐9 ≥10), anxiety (GAD‐7 ≥10) and post‐traumatic stress disorder (PTSD) (PCL‐5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio‐demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use.ResultsOf 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men.ConclusionsUnhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi‐focus mental health treatment approaches in HIV care settings should be examined.

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Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems

Cited by 10 publications

References 95 publications

Children of a syndemic: co‐occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV‐affected mother‐infant dyads in Cape Town, South Africa

Children of a syndemic: co‐occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV‐affected mother‐infant dyads in Cape Town, South Africa

Community health worker training to reduce mental health and substance use stigma towards patients who have disengaged from HIV/TB care in South Africa: protocol for a stepped wedge hybrid type II pilot implementation trial

Prevalence and co‐occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low‐ and middle‐income countries: a cross‐sectional study

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