Undiagnosed HIV, hepatitis B, and hepatitis C infections in people with severe psychiatric disorders in Ethiopia

Abstract

Background: Worldwide, there is limited epidemiologic evidence on the seroprevalence of undiagnosed chronic viral infections including HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among patients with severe psychiatric disorders. To our knowledge, this is the first study to explore and compare undiagnosed seroprevalence rates of HIV, HBV, and HCV infections among patients with severe psychiatric disorders. Method: In this study, we included a random sample of 309 patients with severe psychiatric disorders selected by systematic sampling technique. We used a structured clinical interview for DSM-IV (SCID) to confirm the diagnosis of severe psychiatric disorders among the participants. Binary and multivariable logistic regression models, adjusting for the potential confounding factors was used to explore the potential determinants of chronic viral infections. Result: The prevalence estimates of HIV infection among patients with severe psychiatric disorders in this study (3.24%) was roughly 3 times the estimated population prevalence of HIV infection in Ethiopia (1.1%). This study showed that the prevalence rates of HBV and HCV infections among patients with severe psychiatric disorders were 4.85 and 1.29%, respectively. Our results also showed that among patients with chronic viral infections, HIV, HBV and HCV, 76.92, 60, 80, and 75% respectively were undiagnosed. Regarding associated factors, the presence of chronic viral infection was found to be significantly associated with the age of the participants (ranging between 30 and 40 years) after adjusting for the possible confounding factors [AOR = 3.95 (95%CI.18-13.17)]. Conclusion: Even though the prevalence estimates of HIV (3.24%), HBV (4.85%), and HCV (1.29%) infections were high among patients with severe psychiatric disorders, the majority of them remained undiagnosed. HBV was found to be the commonly undiagnosed infection (4 out of 5) followed by HCV (3 out of 4) and HIV (6 out of 10). The present study provided evidence of a significant association between the age of the participant (between 30 and 40 years) and chronic viral infections in patients with severe psychiatric disorders. Increasing the awareness of psychiatry professionals and early screening, as well as interventions of chronic viral infections among patients with severe psychiatric disorders are imperative.

Hepatitis C virus in people with serious mental illness: an analysis of the care cascade at a tertiary health service with a pilot ‘identify and treat’ strategy

“…28 Universal screening paradigms would likely reduce experienced stigma, and have high acceptability among people with SMI, with consent rates ranging between 57.0% and 96.6% in cross-sectional studies. 23,29,30 HCV screening by frontline clinicians could be prompted by novel integrated strategies like alerts on EMR and supported by HCV education programmes. This could be coupled with prompts for follow-up tests and specialist referral, especially among individuals with detected or known HCV seropositive, and in doing so, could ameliorate attrition in the care cascade.…”

“…As a starting point, once‐off lifetime BBV screening with subsequent risk‐based screening should be adopted in SMI populations, in alignment with recent general population screening policy promulgated by the US Centre for Disease Control 28 . Universal screening paradigms would likely reduce experienced stigma, and have high acceptability among people with SMI, with consent rates ranging between 57.0% and 96.6% in cross‐sectional studies 23,29,30 . HCV screening by frontline clinicians could be prompted by novel integrated strategies like alerts on EMR and supported by HCV education programmes.…”

Prevalence and correlates of diagnosed and undiagnosed epilepsy and migraine headache among people with severe psychiatric disorders in Ethiopia

“…For example, a recent meta-analysis that assessed the prevalence of migraine headaches among patients with bipolar disorder involving seven studies on the subject found that roughly one-third of patients with bipolar disorder had comorbid migraine headaches (30.36%) [8]. However, the existing literature indicates that: (1) the vast majority of co-occurring medical conditions were untreated and undertreated; (2) most of them remain undiagnosed [10]; (3) even among those patients receiving treatment, the quality of service/care for both the comorbid medical condition and psychiatric disorders has been inadequate [11,12]. Scientific evidence shows that early identification and treatment of comorbid medication conditions in patients with severe psychiatric disorders are associated with improvement in outcomes, increased quality of life, reduced burden and cost associated with medical services, and improved in functionality/productivity [13,14].…”