Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa

BackgroundData on the lifetime prevalence of psychiatric disorders in South Africa are of interest, not only for the purposes of developing evidence-based mental health policy, but also in view of South Africa's particular historical and demographic circumstances.MethodA nationally representative household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses. The data-set analysed included 4351 adult South Africans of all ethnic groups.ResultsLifetime prevalence of DSM–IV/CIDI disorders was determined for anxiety disorders (15.8%), mood disorders (9.8%), substance use disorders (13.4%) and any disorder (30.3%). Lifetime prevalence of substance use disorders differed significantly across ethnic groups. Median age at onset was earlier for substance use disorders (21 years) than for anxiety disorders (32 years) or mood disorders (37 years).ConclusionsIn comparison with data from other countries, South Africa has a particularly high lifetime prevalence of substance use disorders. These disorders have an early age at onset, providing an important target for the planning of local mental health services.

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Depression symptoms, HIV testing, linkage to ART, and viral suppression among women in a high HIV burden district in KwaZulu-Natal, South Africa: A cross-sectional household study

Journal of Health Psychology ◽

10.1177/1359105320982042 ◽

2020 ◽

pp. 135910532098204

Author(s):

Kaymarlin Govender ◽

Dick Durevall ◽

Richard G Cowden ◽

Sean Beckett ◽

Ayesha BM Kharsany ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Hiv Testing ◽

Viral Suppression ◽

Hiv Positive ◽

Depression Symptoms ◽

Cross Sectional ◽

Lower Odds ◽

Hiv Positive Women ◽

Kwazulu Natal

Achieving the UNAIDS 90-90-90 targets by 2020 is contingent on identifying and addressing mental health challenges that may affect HIV testing and treatment-related behaviors. This study is based on survey data from KwaZulu-Natal, South Africa (2014–2015). HIV positive women who reported higher depression scores had a lower odds of having tested previously for HIV (15–25 years: AOR = 0.90, 95% CI [0.83, 0.98]; 26–49 years: AOR = 0.90, 95% CI [0.84, 0.96]). Because HIV testing behavior represents a gateway to treatment, the findings suggest mental health may be one challenge to attaining the UNAIDS 90-90-90 targets.

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The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111403 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11403

Author(s):

Bronwyn Myers ◽

Felicia A. Browne ◽

Tara Carney ◽

Tracy Kline ◽

Courtney Peasant Bonner ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Substance Use ◽

Adolescent Girls ◽

Young Women ◽

Cape Town ◽

Cluster Randomized Trial ◽

Sexual Risks ◽

Polydrug Use ◽

Increased Risk

Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.

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Mental health, substance use and viral load suppression in adolescents receiving ART at a large paediatric HIV clinic in South Africa

10.1101/2020.07.06.20147298 ◽

2020 ◽

Author(s):

Andreas D. Haas ◽

Karl-Günter Technau ◽

Shenaaz Pahad ◽

Kate Braithwaite ◽

Mampho Madzivhandila ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Viral Load ◽

Mental Health Problems ◽

Health Problems ◽

Viral Load Suppression ◽

Middle Income ◽

Paediatric Hiv ◽

Middle Income Countries ◽

Substance Use Problems

AbstractIntroductionThere are few data on the prevalence of mental health problems among adolescents living with HIV in low- and middle-income countries and the evidence on associations between mental health problems and viral load suppression is inconsistent. We assessed the prevalence of mental health problems among adolescents receiving antiretroviral therapy (ART) at a large paediatric HIV clinic in South Africa and examined associations between mental health problems and viral load suppression.MethodsWe implemented routine mental health screening at Rahima Moosa Mother and Child Hospital in Johannesburg. Adolescents aged 10-19 years were offered screening for depression (Patient Health Questionnaire-9 [PHQ-9]), suicide (Adolescent Innovations Project [AIP]-handbook), anxiety (General Anxiety Disorder-7 [GAD-7]), trauma (Primary Care PTSD Screen for DSM-5 [PC-PTSD-5]), and substance use (CAGE Adapted to Include Drugs [CAGE-AID]) at each routine HIV care visits. We assessed screening outcomes between February 1, 2018, and January 1, 2020 and calculated odds ratios for associations between positive screening outcomes and unsuppressed viral load (>400 HIV-RNA copies/ml).ResultsOut of 1,203 adolescents who attended the clinic, 1,088 (90.4%) were screened at a median age of 13 years (IQR 10-15). In total, 97 (8.9%) screened positive: 48 (4.4%) for depression (PHQ-9 ≥ 10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD-7 ≥ 10), 38 (3.2%) for trauma (PC-PTSD-5 ≥ 3), and 18 (1.7%) for substance use (CAGE-AID ≥ 2). Positive screening for depression (aOR 2.39, 95% CI 1.02-5.62), trauma (aOR 3.18, 95% CI 1.11-9.07), substance use (aOR 7.13, 95% CI 1.60-31.86), or any mental health condition (aOR 2.17, 95% CI 1.17-4.02) were strongly associated with unsuppressed viral load.ConclusionsHIV-positive adolescents who are affected by mental health or substance use problems are a highly vulnerable population, who merit specific clinical attention. Strategies for screening and management of mental health and substance use problems in adolescents on ART in low- and middle-income countries need to be developed and evaluated.

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Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa

10.1101/2021.11.19.21266573 ◽

2021 ◽

Author(s):

Olanrewaju Edun ◽

Yulia Shenderovich ◽

Siyanai Zhou ◽

Elona Toska ◽

Lucy C Okell ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Logistic Regression ◽

Viral Suppression ◽

Hiv Positive ◽

Art Adherence ◽

Eastern Cape ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Living With Hiv

Introduction: The World Health Organization recommends full disclosure of HIV-positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10-19) already on antiretroviral therapy (ART), disclosure rates are low. Caregivers often report the child being too young and fear of disclosure worsening adolescents mental health as reasons for non-disclosure. Evidence is limited about predictors of disclosure and its association with adherence, viral suppression, and mental health outcomes among adolescents in sub-Saharan Africa. Methods: Analyses included three rounds (2014-2018) of data collected among a closed cohort of adolescents living with HIV in Eastern Cape, South Africa. We used logistic regression with respondent random-effects to identify factors associated with disclosure, and assess differences in ART adherence, viral suppression, and mental health symptoms between adolescents by disclosure status. We also explored differences in the change in mental health symptoms and ART adherence between study rounds and disclosure groups with logistic regression. Results: 813 APHIV were interviewed at baseline, of whom 769 (94.6%) and 729 (89.7%) were interviewed at the second and third rounds, respectively. The proportion aware of their HIV-positive status increased from 63.1% at the first round to 85.5% by the third round. Older age (adjusted odds ratio (aOR): 1.24; 1.07 - 1.43) and living in an urban location (aOR: 2.76; 1.67 - 4.45) were associated with disclosure between interviews. There was no association between awareness of HIV-positive status and ART adherence, viral suppression, or mental health symptoms among all APHIV interviewed. However, among APHIV not aware of their status at baseline, adherence decreased at the second round among those who were disclosed to (N=131) and increased among those not disclosed to (N=151) (interaction aOR: 0.39; 0.19 - 0.80). There was no significant difference in the change in mental health symptoms between study rounds and disclosure groups. Conclusions: Awareness of HIV-positive status was not associated with higher rates of mental health symptoms, or lower rates of viral suppression among adolescents. Disclosure was not associated with worse mental health. These findings support the recommendation for timely disclosure to APHIV, however, adherence support post-disclosure is important.

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