The Role of Depression Screening and Treatment in Achieving the UNAIDS 90–90–90 Goals in Sub-Saharan Africa

Abstract

Despite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90–90–90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90–90–90 lens through a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as task-shifting strategies for depression management. Due to the lack of mental health infrastructure and human resources, task-shifting approaches that integrate mental health management into existing primary and community health programs are increasingly being piloted and adopted across the region. Greater integration of such mental health care task-shifting into HIV programs will be critical to realizing the 90–90–90 goals and ending the HIV epidemic.

Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia

“…Comorbid major depression affects the clinical outcomes of HIV/AIDS [ 1 – 3 ] and contributes to a two-fold higher risk of mortality [ 4 ]. Major depression has been one of the challenges of the 90–90-90 Joint United Nations Program on HIV/AIDS (UNAIDS) [ 4 ] that aimed to end the epidemic of HIV/AIDS in the world [ 5 ].…”

“…Comorbid major depression affects the clinical outcomes of HIV/AIDS [ 1 – 3 ] and contributes to a two-fold higher risk of mortality [ 4 ]. Major depression has been one of the challenges of the 90–90-90 Joint United Nations Program on HIV/AIDS (UNAIDS) [ 4 ] that aimed to end the epidemic of HIV/AIDS in the world [ 5 ]. The sub-Saharan African (SSA) countries have been lagging far behind the target and comorbid major depression remains one of the challenges that has affected engagement with HIV care, leading to early loss to treatment and low viral suppression [ 4 , 6 ].…”

“…Major depression is the most common mental disorder among people living with HIV/AIDS (PLWHA) and is estimated to be two to three times higher in PLWHA than in general population [ 4 , 7 – 9 ]. However, prevalence reports are markedly variable across studies due partially to the use of different measurement approaches.…”

Opportunities and challenges to Integrating mental health into HIV programs in a Low- and Middle-Income Country: Insights from the Nigeria Implementation Science Alliance

“…Different integrative, task-sharing approaches involving lay health workers have been used to deliver antidepressants in Cameroon (17), to provide psychosocial interventions to PLHIV in South Africa (14), for problem solving therapy for depression and common mental disorders in Zimbabwe (21), and to improve lay health workers' knowledge and self-e cacy in managing mental disorders in Malawi (22). The integrated care approach is a promising, acceptable and feasible strategy for improving both mental health and HIV treatment outcomes in low and middle-income countries (LMIC) (23)(24)(25). However these approaches to integrate HIV and mental health services remain limited by research gaps in costeffectiveness and long-term impact of different models on patient outcomes and by barriers to their adoption in LMIC (25).…”

Opportunities and challenges to Integrating mental health into HIV programs in a Low- and Middle-Income Country: Insights from the Nigeria Implementation Science Alliance

“…Different integrative, task-sharing approaches involving lay health workers have been used to deliver antidepressants in Cameroon (17), to provide psychosocial interventions to PLHIV in South Africa (14), for problem solving therapy for depression and common mental disorders in Zimbabwe (21), and to improve lay health workers' knowledge and self-e cacy in managing mental disorders in Malawi (22). The integrated care approach is a promising, acceptable and feasible strategy for improving both mental health and HIV treatment outcomes in low and middle-income countries (LMIC) (23)(24)(25). However these approaches to integrate HIV and mental health services remain limited by research gaps in cost-effectiveness and long-term impact of different models on patient outcomes and by barriers to their adoption in LMIC (25).…”