The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

The impact of the 2014–2016 Ebola epidemic in West Africa on human immunodeficiency virus (HIV) treatment in Sierra Leone is unknown, especially for groups with higher HIV prevalence such as the military. Using a retrospective study design, clinical outcomes were evaluated prior to and during the epidemic for 264 HIV-infected soldiers of the Republic of Sierra Leone Armed Forces (RSLAF) and their dependents receiving HIV treatment at the primary RSLAF HIV clinic. Medical records were abstracted for baseline clinical data and clinic attendance. Estimated risk of lost to follow-up (LTFU), default, and number of days without antiretroviral therapy (DWA) were calculated using repeated measures general estimating equations adjusted for age and gender. Due to missing data, 262 patients were included in the final analyses. There was higher risk of LTFU throughout the Ebola epidemic in Sierra Leone compared to the pre-Ebola baseline, with the largest increase in LTFU risk occurring at the peak of the epidemic (relative risk: 3.22, 95% CI: 2.22–4.67). There was an increased risk of default and DWA during the Ebola epidemic for soldiers but not for their dependents. The risk of LTFU, default, and DWA stabilized once the epidemic was largely resolved but remained elevated compared to the pre-Ebola baseline. Our findings demonstrate the negative and potentially lasting impact of the Ebola epidemic on HIV care in Sierra Leone and highlight the need to develop strategies to minimize disruptions in HIV care with future disease outbreaks.

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Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

AIDS Research and Therapy ◽

10.1186/s12981-020-00319-7 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Courtney E. Sims Gomillia ◽

Kandis V. Backus ◽

James B. Brock ◽

Sandra C. Melvin ◽

Jason J. Parham ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Median Time ◽

Viral Suppression ◽

Hiv Care ◽

Virologic Suppression ◽

Community Based ◽

Art Initiation ◽

Healthcare Center ◽

The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

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Differentiated HIV care in South Africa: the effect of fast‐track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence

Journal of the International AIDS Society ◽

10.1002/jia2.25409 ◽

2019 ◽

Vol 22 (11) ◽

Cited By ~ 5

Author(s):

Sophie JS Pascoe ◽

Matthew P Fox ◽

Amy N Huber ◽

Joshua Murphy ◽

Mokgadi Phokojoe ◽

...

Keyword(s):

South Africa ◽

Treatment Adherence ◽

Impact Evaluation ◽

Fast Track ◽

Viral Suppression ◽

Treatment Initiation ◽

Hiv Treatment ◽

Hiv Care ◽

Art Initiation ◽

The Impact

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How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

Global Health Promotion ◽

10.1177/1757975917737509 ◽

2017 ◽

Vol 26 (4) ◽

pp. 6-13 ◽

Cited By ~ 6

Author(s):

Kabelo Maleke ◽

Joseph Daniels ◽

Tim Lane ◽

Helen Struthers ◽

James McIntyre ◽

...

Keyword(s):

South Africa ◽

Social Stigma ◽

Clinical Care ◽

Traditional Healers ◽

Hiv Treatment ◽

Hiv Care ◽

Care Seeking ◽

Mpumalanga Province ◽

Sex With Men ◽

The Impact

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

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Mapping an HIV Treatment Program to Identify Barriers to Linkage in HIV Care in Resource Limited Settings

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2014/9758 ◽

2014 ◽

Vol 4 (9) ◽

pp. 973-983 ◽

Cited By ~ 1

Author(s):

Katherine Billingsley ◽

Loice Achieng ◽

Edwin Ombegoh ◽

Helen Musangi ◽

Caroline Mwangi ◽

...

Keyword(s):

Treatment Program ◽

Hiv Treatment ◽

Hiv Care ◽

Resource Limited Settings ◽

Resource Limited

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Association between Depression and HIV Treatment Outcomes in a US Military Population with HIV Infection

10.21203/rs.3.rs-25914/v1 ◽

2020 ◽

Author(s):

Brandon Carney ◽

Colton Daniel ◽

Xiaohe Xu ◽

Thankam Sunil ◽

Anuradha Ganesan ◽

...

Keyword(s):

Mental Health ◽

Treatment Outcomes ◽

Latent Class ◽

Virologic Failure ◽

Hiv Treatment ◽

Hiv Care ◽

Hiv Diagnosis ◽

Lower Odds ◽

Us Military ◽

Hiv Treatment Outcomes

Abstract Background: Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with depression. Methods: Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006-2010, with follow-up through 2015. SRA was defined as taking ³95% of ART doses and continuous ART was defined as longitudinal ART use with gaps <30 days. Continuous VL suppression was defined as maintaining VLs <200 c/mL on ART. To analyze the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD). Results: Participants had a mean age of 32 (±8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% SRA (OR 1.06, 95% CI 1.02-1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22-0.76) compared to Caucasians (OR 1.49, 95% CI 0.52-4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had a trend towards taking ART continuously (OR 1.75, 95% CI 0.99-3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38-0.91). Conclusions: Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

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A Systematic Review and Meta-Analysis on Depression and Associated Factors among Adult HIV/AIDS-Positive Patients Attending ART Clinics of Ethiopia: 2021

Depression Research and Treatment ◽

10.1155/2021/8545934 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Bitew Tefera Zewudie ◽

Shegaw Geze ◽

Yibeltal Mesfin ◽

Muche Argaw ◽

Haimanot Abebe ◽

...

Keyword(s):

Mental Health ◽

Antiretroviral Therapy ◽

Random Effect ◽

Hiv Care ◽

Hiv Positive ◽

People Living With Hiv ◽

Negative Consequences ◽

Aids Patients ◽

Depression Prevalence ◽

Hiv Aids

Introduction. Depression is the most common mental health problem in people living with the human immune virus. It ranges from 11% to 63% in low- and middle-income countries. Depression was high in people living with HIV/AIDS in developing countries, especially in the Ethiopian context. Even though depression has negative consequences on HIV-positive patients, the care given for depression in resource-limited countries like Ethiopia is below the standard in their HIV care programs. Method. International databases (Google Scholar, PubMed, Hinari, Embase, and Scopus) and Ethiopian university repository online have been covered in this review. Data were extracted using Microsoft Excel and analyzed by using the Stata version 14 software program. We detected the heterogeneity between studies using the I 2 test. We checked publication bias using a funnel plot test. Results. The overall pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was 36.3% (95% CI: 28.4%, 44.2%) based on the random effect analysis. Adult HIV/AIDS patients having CD4 count < 200 ( AOR = 5.1 ; 95% CI: 2.89, 8.99), widowed marital status ( AOR = 3.7 ; 95% CI: 2.394, 5.789), medication nonadherence ( AOR = 2.3 ; 95% CI: 1.63, 3.15), poor social support (2.986) (95% CI: 2.139, 4.169), perceived social stigma (2.938) (2.305, 3.743), opportunistic infections (3.010) (2.182, 4.151), and adverse drug reactions (4.013) (1.971, 8.167) were significantly associated with depression among adult HIV/AIDS patients on antiretroviral therapy, in Ethiopia. Conclusion and Recommendation. The pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was higher than the general population and is alarming for the government to take special consideration for HIV-positive patients. Depression assessment for all HIV-positive patients and integrating with mental health should be incorporated to ensure early detection, prevention, and treatment. Community-based and longitudinal study designs mainly focusing on the incidence and determinants of depression among adult HIV/AIDS patients should be done in the future.

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