Screening and management of mental health and substance use disorders in HIV treatment settings in low‐ and middle‐income countries within the global IeDEA consortium

Abstract

IntroductionIntegration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low‐ and middle‐income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.MethodsWe surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia‐Pacific and sub‐Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post‐traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders.ResultsMost sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD, 55% for SUDs and 29% for other mental health disorders. Depression, PTSD, SUDs and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on‐site management of depression, PTSD, and SUDs, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On‐site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUDs was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children.ConclusionsSignificant gaps exist in the management of MSDs in HIV care settings in LMICs, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSDs and HIV care is needed.

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

“…Substance use disorders (alcohol, injection drugs and non‐injection drugs) among PLWH are also a growing concern in SSA . While mental health and substance use disorders are associated with suboptimal HIV treatment outcomes, including late ART initiation, poor ART adherence, lack of viral suppression and increased AIDS‐related mortality , the coverage of screening, diagnosis and treatment services for these disorders is extremely limited in SSA . Key constraints include workforce shortages, limited training on mental health and substance use disorders, the lack of validated and culturally appropriate screening and diagnostic tools, as well as the lack of proven treatment interventions that can be integrated into HIV care and delivered by non‐specialists in contexts facing mental health and substance use workforce challenges . Research approaches: The magnitude of mental health and substance use disorders merits further study, along with the effects of integrated treatment for these disorders on HIV outcomes under Treat All .…”

Longitudinal trajectories of emotional problems and unmet mental health needs among people newly diagnosed with HIV in China

“…Integration of screening and managing mental health in the HIV care setting has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV in low-and middle-income countries [42]. However, significant gaps exist in health services in China.…”

Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya

“…The items were read aloud in their preferred language (English, Kiswahili, or Kikuyu) and counselors were instructed to read the items exactly as written. After completing the paper form, counselors summed the individual item scores (range: 0-27) and classified participants as having no depressive symptoms (score < 5), minimal symptoms (score [5][6][7][8][9][10][11][12][13][14], or moderate to severe symptoms (score > 14) according to previously validated cut-offs [31]. Counselors also completed debriefing reports summarizing words that participants did not understand, any instances where participants asked them to provide definitions or synonyms for a word, and general comments about the overall PHQ-9 administration experience.…”

“…Screening tools are particularly important in resource-limited settings such as Kenya where it is often not possible to conduct clinical diagnostic interviews (the 'gold-standard' for MDD diagnosis) due to shortages in clinician or counselor time, financial resources, and trained mental health personnel. In this context, screening could be integrated in HIV and reproductive health clinics to improve patient access to mental health treatment services [13][14][15].…”