scholarly journals “I Found Out I was Pregnant, and I Started Feeling Stressed”: A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

2021 ◽  
Author(s):  
Emily L. Tuthill ◽  
Ann E. Maltby ◽  
Belinda C. Odhiambo ◽  
Eliud Akama ◽  
Jennifer A. Pellowski ◽  
...  
Keyword(s):  
Mental Health ◽  
Poor Mental Health ◽  
Financial Strain ◽  
Hiv Care ◽  
Structured Interviews ◽  
Women Living With Hiv ◽  
Pregnancy And Postpartum ◽  
Health Experiences ◽  
Living With Hiv ◽  
Perinatal Women

AbstractGlobally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28–38 weeks pregnant, 6-weeks postpartum and 5–7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Utility and acceptability of text messages for PMTCT: a qualitative assessment of user experiences (Preprint)

2021 ◽  
Author(s):  
Melinda Brown ◽  
May Maloba ◽  
Catherine Wexler ◽  
Natabhona Mabachi ◽  
Sharon Koech ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Clinical Care ◽  
Text Messages ◽  
Hiv Care ◽  
Qualitative Assessment ◽  
Women Living With Hiv ◽  
Pregnancy And Postpartum ◽  
Living With Hiv ◽  
The Impact

BACKGROUND Evidence that text messages can support patient adherence to HIV care is growing. We conducted a pilot study of the HIV Infant Tracking System (HITSystem 2.0), an intervention that includes SMS to patients to support maternal medication adherence, appointment attendance, and hospital-based deliveries during the antenatal period. OBJECTIVE The objective of this study was to qualitatively assess women’s experiences receiving SMS to understand message utility and acceptability with the goal of refining and strengthening the intervention. METHODS As part of an intervention development pilot study, we conducted semi-structured interviews with 33 women living with HIV who received SMS through the HITSystem 2.0 throughout their pregnancy and postpartum period. Interview questions assessed women’s feedback of the SMS, the impact of the SMS on their PMTCT care, and suggestions for improvement. RESULTS Participants described how SMS reinforced existing strategies for medication adherence and served as cues to action for antenatal appointments and hospital-based deliveries. SMS also provided encouragement and enhanced their sense of engagement with their clinical care team. Given the neutral content of the messages, most women reported no concerns about message confidentiality. Recommendations to enhance utility included greater customizability (timing and frequency of messages) and a few women suggested more comprehensive counseling regarding the SMS content to anticipate at the time of enrollment. CONCLUSIONS SMS content was deemed useful and acceptable by pregnant and postpartum women living with HIV and engaged in PMTCT services. Participant recommendations to increase message customization options have been adopted to enhance the intervention. CLINICALTRIAL Trial registration: clinicaltrials.gov, NCT02726607. Registered 01 April 2016. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02726607

scholarly journals Ethnic inequalities in mental health and socioeconomic status among older women living with HIV: results from the PRIME Study

2021 ◽  
pp. sextrans-2020-054788
Author(s):  
Danielle Solomon ◽  
Shema Tariq ◽  
Jon Alldis ◽  
Fiona Burns ◽  
Richard Gilson ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Older Women ◽  
Social Isolation ◽  
Ethnically Diverse ◽  
Hiv Care ◽  
Diverse Group ◽  
Women Living With Hiv ◽  
Women With Hiv ◽  
Living With Hiv

ObjectivesWomen living with HIV in the UK are an ethnically diverse group with significant psychosocial challenges. Increasing numbers are reaching older age. We describe psychological and socioeconomic factors among women with HIV in England aged 45–60 and explore associations with ethnicity.MethodsAnalysis of cross-sectional data on 724 women recruited to the PRIME Study. Psychological symptoms were measured using the Patient Health Questionnaire 4 and social isolation with a modified Duke-UNC Functional Social Support Scale.ResultsBlack African (BA) women were more likely than Black Caribbean or White British (WB) women to have a university education (48.3%, 27.0%, 25.7%, respectively, p<0.001), but were not more likely to be employed (68.4%, 61.4%, 65.2%, p=0.56) and were less likely to have enough money to meet their basic needs (56.4%, 63.0%, 82.9%, p<0.001). BA women were less likely to report being diagnosed with depression than WB women (adjusted odds ratio (aOR) 0.40, p<0.001) but more likely to report current psychological distress (aOR 3.34, p<0.05).ConclusionsWe report high levels of poverty, psychological distress and social isolation in this ethnically diverse group of midlife women with HIV, especially among those who were BA. Despite being more likely to experience psychological distress, BA women were less likely to have been diagnosed with depression suggesting a possible inequity in access to mental health services. Holistic HIV care requires awareness of the psychosocial needs of older women living with HIV, which may be more pronounced in racially minoritised communities, and prompt referral for support including psychology, peer support and advice about benefits.

scholarly journals Cost-Effectiveness of The Healthy Options Group Psychosocial Intervention for Perinatal Women Living with HIV and Depression in Tanzania

2021 ◽  
Author(s):  
Happiness Pius Saronga ◽  
Sylvia Kaaya ◽  
Mary C. Smith Fawzi
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Total Cost ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Perinatal Women

Abstract BackgroundHealthy Options (HO) is a psychosocial support group intervention facilitated by community-based health workers (CBHWs) to treat depression in perinatal women living with HIV in Tanzania. The objective of this study was to determine incremental cost-effectiveness of HO in treating perinatal depression in HIV positive women in comparison to enhanced standard of mental health care delivered by nurse midwives.MethodsThis study is a cost-effectiveness analysis of HO, a pair-matched cluster-randomized controlled trial conducted in Tanzania. The primary outcome for this study was the level of depressive symptoms. Secondary outcomes included antiretroviral therapy adherence, safe disclosure of HIV status to partner, and food security, among others. This study applied an ingredients approach to cost all resources used in the HO intervention. We estimated total cost, unit cost and incremental cost-effectiveness ratio from a health care provider perspective. We used 3 year time horizon, univariate sensitivity analysis, and adjusted costs to 2017 value.ResultsHO demonstrated effectiveness in reducing depressive symptoms among pregnant women with HIV in Tanzania. Mean reduction in depressive symptoms was observed at 6 weeks and 9 months postpartum with statistical significance. HO costs $849 USD per woman treated (equivalent to $889 in 2017 value). Incremental cost-effectiveness ratio at 6 weeks postpartum is $81,091 per mean decrease in depressive symptoms (equivalent to $84,878 in 2017 value), and at 9 months postpartum is $280,277 per mean decrease in depressive symptoms (equivalent to $293,363 in 2017 value). With sensitivity analysis, results at 6 weeks postpartum ranged from $79,309 to $84,576 (equivalent to $83,012 to $88,525 in 2017 value), and at 9 months ranged from $ 194,001 to $1,139,546 (equivalent to $203,067 to $1,192,753 in 2017 value).ConclusionsBenefits of HO are significantly sustained through 9 months postpartum and intervention unit costs are within range of similar interventions. Human resources composed the largest share of HO total cost. Although uncertainty in the cost-effectiveness ratio of this intervention varied widely, since mental health specialists are scarce in Tanzania, working with CBHWs is likely to offer effective treatment that is more feasible and is a less costly alternative to the usual care.Trial registration: The trial is registered at Clinicaltrials.gov (NCT02039973).

scholarly journals “Pain in my heart”: Understanding perinatal depression among women living with HIV in Malawi

2020 ◽  
Author(s):  
Katherine LeMasters ◽  
Josée Dussault ◽  
Clare Barrington ◽  
Angela Bengtson ◽  
Bradley Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Narrative Analysis ◽  
Perinatal Depression ◽  
Perinatal Care ◽  
Depression Scale ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Double Burden ◽  
Women Living With Hiv ◽  
Living With Hiv

AbstractBackgroundPerinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi.MethodsWe screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis.ResultsWomen experienced a double burden of physical and mental illness, expressed as pain in one’s heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support.ConclusionsThese findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden.

scholarly journals Mental Health in Women Living With HIV: The Unique and Unmet Needs

2021 ◽  
Vol 20 ◽  
pp. 232595822098566
Author(s):  
Elizabeth M. Waldron ◽  
Inger Burnett-Zeigler ◽  
Victoria Wee ◽  
Yiukee Warren Ng ◽  
Linda J. Koenig ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Behavioral Therapy ◽  
Well Being ◽  
Future Research ◽  
Health Issues ◽  
Women Living With Hiv ◽  
Mental Health Issues ◽  
Hiv Management ◽  
Living With Hiv

Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic stress symptoms at higher rates than their male counterparts and more often than HIV-unaffected women. These mental health issues affect not only the well-being and quality of life of WLWH, but have implications for HIV management and transmission prevention. Despite these ramifications, WLWH are under-treated for mental health concerns and they are underrepresented in the mental health treatment literature. In this review, we illustrate the unique mental health issues faced by WLWH such as a high prevalence of physical and sexual abuse histories, caregiving stress, and elevated internalized stigma as well as myriad barriers to care. We examine the feasibility and outcomes of mental health interventions that have been tested in WLWH including cognitive behavioral therapy, mindfulness-based interventions, and supportive counseling. Future research is required to address individual and systemic barriers to mental health care for WLWH.

scholarly journals HIV MADE ME STRONGER: CONCEPTIONS OF SUCCESSFUL AGING AMONG OLDER WOMEN LIVING WITH HIV

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S765-S765
Author(s):  
Anna A Rubtsova ◽  
Tonya Taylor ◽  
Gina Wingood ◽  
Igho Ofotokun ◽  
Deborah Gustafson ◽  
...  
Keyword(s):  
Data Collection ◽  
Qualitative Study ◽  
Older Women ◽  
Successful Aging ◽  
Life Course Perspective ◽  
Stable Phase ◽  
Structured Interviews ◽  
Women Living With Hiv ◽  
Living With Hiv

Abstract Little is known about successful aging (SA) among older (50+) women living with HIV (OWLH). Therefore, the purpose of this qualitative study was to examine subjective understandings of SA among OWLH. Participants were OWLH enrolled in the Women’s Interagency HIV Study (WIHS) and those not enrolled in WIHS: 8 in Atlanta, GA (3 WIHS and 5 non-WIHS) and 9 in Brooklyn, NY (6 WIHS and 3 non-WIHS). Semi-structured interviews ranged from 30 to 120 minutes. Several themes emerged in participants’ definitions of SA, e.g. self-care, taking HIV medications, and being resilient (“HIV made me stronger”). Both WIHS and non-WIHS participants emphasized life course perspective in their definitions of SA -- women viewed their aging successful as a more stable phase of life in contrast to hardships they experienced while being younger (e.g., drug use, incarceration). Data collection efforts are ongoing and will allow further characterization of SA among this population.

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

scholarly journals 3242 Stressful experiences and adherence to HIV care among Black Women Living with HIV: A qualitative analysis

2019 ◽  
Vol 3 (s1) ◽  
pp. 74-74
Author(s):  
Crystal Chapman Lambert ◽  
Chastity McDavid ◽  
Tammi F. Thomas ◽  
Kiko King ◽  
Andres Azuero ◽  
...  
Keyword(s):  
Social Support ◽  
Black Women ◽  
Physical Abuse ◽  
Traumatic Events ◽  
The United States ◽  
Stressful Events ◽  
Hiv Care ◽  
Care Clinic ◽  
Women Living With Hiv ◽  
Living With Hiv

OBJECTIVES/SPECIFIC AIMS: Our primary objective was to understand the relationship between incident or recent stressful events and adherence to HIV care in the context of other person, environment, and HIV-specific stressors in a sample of Black women living with HIV (WLWH). METHODS/STUDY POPULATION: Thirty in-depth interviews were conducted with Black women living with HIV who receive care at an academic HIV primary care clinic in the Southern region of the United States to elicit stressful events influencing adherence to HIV care. Semi-structured interview guides were used to facilitate discussion regarding stressful events and adherence to HIV care. Interviews were audiotaped and transcribed verbatim. Transcripts were independently coded using a theme-based approach by two experienced coders, findings were compared, and discrepancies were resolved by discussion. RESULTS/ANTICIPATED RESULTS: Participants described frequently experiencing incident stressful events including death or serious illness of a close friend or family member, and relationship, financial, and employment difficulties. Furthermore, participants reported experiencing traumatic events such as sexual and physical abuse during childhood and adolescents. While experiencing traumatic events such as sexual and physical abuse during childhood and adolescence may be distressing, these events did not influence adherence to HIV care. However, incident stressful events as defined above did influence adherence to HIV care for some participants, but not for others. For participants who reported that stressful events did not influence adherence to HIV care, factors such as personal motivation, access to social support, and adaptive coping strategies facilitated their engagement in care. DISCUSSION/SIGNIFICANCE OF IMPACT: Experiencing stressful events, incident or traumatic, is common among Black WLWH and have the potential to negatively influence adherence to HIV care. Thus, Interventions aimed at identifying and addressing stress, social support, and coping are essential to improve adherence to HIV care behaviors.

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