Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national “treat all” policy: a cross‐sectional analysis

Abstract

IntroductionRapid antiretroviral treatment (ART) initiation reduces time from HIV infection to viral suppression, decreasing HIV transmission risk. Mental health symptoms may influence timing of ART initiation. This study estimated the prevalence of ART initiation at enrolment into HIV care and the relationship between mental health and ART initiation at enrolment into HIV care.MethodsWe conducted interviews with 426 individuals initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the association between mental health and timing of ART initiation. Depression (Patient Health Questionnaire‐9; cut‐point 10), anxiety (Generalized Anxiety Disorder‐7; cut‐point 10), post‐traumatic stress disorder (PTSD) (PTSD Checklist for DSM‐5; cut‐point 31) and harmful alcohol use (Alcohol Use Disorders Identification Test; cut‐point 16) were dichotomized to represent those with and without each exposure at first HIV care appointment. Date of ART initiation (date ART prescribed) was ascertained from medical records. Separate multivariable log‐binomial regression models were used to estimate the association between mental health exposures and ART initiation at enrolment into care.Results and discussionOverall, 87% initiated ART at enrolment into HIV care. Approximately 20% reported depressive symptoms, 15% reported PTSD symptoms, 12% reported anxiety symptoms and 13% reported harmful alcohol use. In multivariable analyses, individuals with moderate to severe depressive symptoms had 1.7 (95% confidence interval [CI] 1.1, 2.7) times the prevalence of not initiating ART at enrolment into HIV care compared to those with no or mild depressive symptoms. Those with symptoms of PTSD, compared to those without, had 1.9 (95% CI 1.2, 2.9) times the prevalence of not initiating ART at enrolment into HIV care. Symptoms of anxiety or harmful drinking were not associated with ART initiation at enrolment into HIV care in multivariable models.ConclusionsSymptoms of depression and PTSD were associated with lower prevalence of ART initiation at enrolment into HIV care among this sample of individuals initiating HIV care in Cameroon under a “treat all” policy. Research should examine barriers to timely ART initiation, whether incorporating mental health services into HIV care improves timely ART initiation, and whether untreated symptoms of depression and PTSD drive suboptimal HIV care outcomes.

Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial

“…Importantly, we have also found more than twice the risk of death in index participants with moderate or severe depression. The causal pathway of this association is described by multiple studies showing the negative impact of depression at each stage of HIV treatment continuum: care engagement [ 28 ], ART initiation and adherence [ 29 – 31 ], and viral suppression [ 32 , 33 ], resulting in higher mortality [ 34 – 36 ]. However, some studies reported an independent effect of depression on mortality, controlling for the effects of adherence [ 37 , 38 ] and clinical variables [ 35 , 39 ], potentially suggesting other mechanisms.…”

Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers’ perspectives

“…Research suggests the high prevalence of mental disorders among PWH may be influenced by HIV-related stigma and worry about the impact one’s HIV status has on interpersonal relationships and economic stability [ 6 ]. Mental disorders have been associated with poor HIV treatment outcomes, including delayed HIV treatment initiation, suboptimal adherence to ART, and poor retention in care [ 1 , 3 , 7 – 11 ]. Despite the high prevalence of mental disorders among PWH and the relationship with suboptimal HIV treatment outcomes, integration of mental health care into HIV care remains limited throughout SSA [ 12 , 13 ].…”

“…HIV prevalence among adults ages 15–49 in Cameroon is 2.9% [ 21 ], though prevalence varies by region [ 22 ]. Among PWH initiating HIV care in Cameroon, moderate to severe symptoms of depression, anxiety, and PTSD were reported by 20%, 12%, and 15% of PWH, respectively [ 10 , 11 ]. Cameroon’s scarcity of mental health professionals and limited resources highlights the pressing need to identify feasible strategies to address mental health needs in the population.…”

Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon

“…Psychosocial stressors have been associated with increased prevalence of mental and substance use disorders among PWH [7,12,13]. Psychosocial stressors and mental and substance use disorders have been consistently associated with poor HIV treatment outcomes, including engagement into HIV care with advanced HIV, delayed ART initiation, poor ART adherence, and virologic failure [14][15][16][17].…”