Psychosocial Intervention Model of Kerala, India During Pandemic COVID-19: “Ottakkalla Oppamundu (You’re not alone, we’re with you)”

Globally, the coronavirus disease 2019 (COVID-19) pandemic has resulted in several psychosocial manifestations across all socioeconomic strata. This study attempted to explore the details of a psychosocial support system implemented in Kerala, India, to address psychosocial issues during this pandemic. It employed a descriptive approach using qualitative and quantitative methods. The results can be summarized into 4 overarching themes: (1) process of implementation, (2) issues addressed, (3) experiences, and (4) success stories. This intervention targeted the whole population, with a specific focus on quarantined/isolated individuals and selected vulnerable groups. COVID pandemic has sowed several negative emotions, such as anxiety; and stigma and fearful thoughts, including suicidal ideations; trepidation regarding family members; and misinfodemics in general. Social and religious corollaries of the pandemic have intensified the psychological agony. The study provides an overview of the psychosocial intervention adopted by the state during the pandemic, which has helped both the beneficiaries and the providers. It has also helped to promote positive thinking and change the attitude toward the disease among the beneficiaries. It is highly commendable that timely intervention could obviate quite a few psychiatric emergencies, including suicides and aggressive behaviors. Considering its efficiency, flexibility, and sustainability, this model can be replicated in any setting.

Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy. Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.

Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy. Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.

Psychosocial Impact of COVID-19 Pandemic in Elderly Psychiatric Patients: a Longitudinal Study

The study was designed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and perceived psychosocial support for elderly psychiatric patients in a longitudinal design. n = 32 patients with affective or anxiety disorders aged ≥60 years were included. Telephone interviews were conducted in April/May 2020 (T1) and August 2020 (T2). The psychosocial impact (PSI) of the pandemic and psychopathology were measured. Changes between T1 and T2 were examined. Patients’ psychosocial support system six months before the pandemic and at T1/T2 was assessed. We found a significant positive correlation between general PSI and depression as well as severity of illness. General PSI differed significantly depending on social contact. Neither general PSI nor psychopathology changed significantly between T1 and T2. At T1, patients’ psychosocial support systems were reduced as compared to six months before. Patients reported an increase in psychosocial support between T1 and T2 and high demand for additional support (sports, arts/occupational therapy, physiotherapy, psychotherapy). Elderly psychiatric patients show a negative PSI of the pandemic. They are likely to suffer from an impaired psychosocial situation, emphasizing the importance of developing concepts for sufficient psychosocial support during a pandemic.

Behavioral and Clinical Characteristics and Outcomes of Treatment Among Older Patients Receiving Medical Care for HIV Infection in Iran

Background: Although the number of new HIV infections continues to decline in Iran, the number of HIV-infected patients aged ≥50 years continues to rise due to the introduction of new treatment and longer survival. The higher prevalence of medical comorbidities and treatment failure in this population is a critical challenge in HIV treatment. In the present study, prevalence of comorbidities, rate of response to treatment, and results of HIV drug resistance tests were explored in older patients. Methods: A cross-sectional study was conducted at a tertiary referral HIV center in Tehran, Iran. The data for all the HIV-positive patients older than 50 years old were collected by reviewing their medical records within the last 15 years. Data included demographic and behavioral characteristics, immunologic and virologic response, rate of treatment failure, and HIV resistance. Results: The records for 100 patients with a mean age of 62.5 (range 50-79) years were reviewed and analyzed. Medical comorbidities were observed in 20% of the patients, with HCV co-infection, diabetes mellitus, and neuropsychiatric impairments being the most common. Complete immunologic and virologic responses were respectively observed in 88 and 97% of patients. The treatment regimen was modified in 66 patients, with drug side effects being the reason in 63 patients (95.4%). HIV drug resistance tests showed a low rate of resistance (<10%) to all drugs used in this population. Conclusion: Our findings highlight the high prevalence of comorbidities in older HIV-positive individuals in Iran. A thorough endocrine and neuropsychiatric assessment at each visit is recommended for these patients. Access to an appropriate psychosocial support system will ensure earlier detection of HIV infection and comorbidities in the older population, and will undoubtedly improve the treatment outcome and quality of life among them.

Unmet psycho-social needs, coping strategies and psychological distress among people with cancer: Evidence from Pakistan

Objective: To explore the unmet psychosocial needs, coping styles and psychological distress among people ith cancer in Pakistan. Methods: A cross-sectional correlational study design was used for data collection. The research was conducted in Shifa International Hospital, Islamabad and Hayatabad Medical Complex, Peshawar with a sample of 182 participants diagnosed with cancer. Only those who consented to participate were approached from May to July, 2017. Supportive Care Needs Survey-Short Form 34 (SCNS-SF34), Mini-Mental Adjustment to Cancer Scale (Mini-Macs) and Hospital Anxiety Depression Scale (HADS) were used for data collection. Results: It was found that all psychosocial needs were unmet among all the participants (100%) who were suffering from cancer illness. Among five sub-domains of psychosocial needs, health information needs (35.61%) and psychological needs (30.7%) emerged to be strikingly unmet. Moreover, anxious preoccupation and hopeless/helplessness were highly endorsed maladaptive coping styles. A statistically significant relationship existed among unmet psycho-social needs, maladaptive coping and psychological distress. Conclusion: This Study outcome pointed towards gaps in delivering quality care services in Pakistani healthcare settings, inadequate attention of health professionals and serious psychological health care neglect of patients fighting with life threatening disease. This negligence may jeopardize patient’s overall health, can raise health care costs and consequently can contribute to elevated psychological distress. Hence, there is a dire need for proper psychological interventions for effective and holistic treatment planning which can improve the whole process of illness and recovery. Keywords: Cancer, Psychosocial support system, Continuous...

Needs for patients with cancer who have young children.

150 Background: The number of cancer patients has been increasing in Japan. It is estimated that 56,143 parents with 87,017 young children (under 18 years old) are diagnosed with cancer per year in Japan (Inoue, 2015). The aim of this study is to investigate the needs of cancer patients who have young children. Methods: The survey was conducted from February to April 2018 to the cancer patients who have young children treated at the National Cancer Center Hospital with the questionnaires. It was on items about parenting concerns evaluated with the 4-point Likert scale: 1. strongly disagree, 2. slightly disagree, 3. slightly agree, and 4. strongly agree. The items included “cancer notification to their children”, “parental anxieties”, and others. The items were analyzed separately. Results: The respondents were 152 (143 cancer patients (94%) and nine spouses (6%)). Most respondents (92%) agreed the importance of psychosocial support for the children and parents in hospital. The average age of their young children (n = 237) was 9.5 (ages 0 – 17). The result showed that 148 (62%) children were told true parents’ illness. This study also revealed that parents were struggling with the conflict telling their children truth. Most parents wanted to protect children from emotional distresses and were afraid of it or don’t know how to cope with some changes during treatments. Conclusions: The study describes how cancer impacts on parents for child rearing. Almost all of the patients with minor children had been found psychologically distressed. It is necessary to improve an effective psychosocial support system in hospitals for cancer patients with young children based on their needs.

Association between Employment Status and Hospitalization of Patients with Sickle Cell Disease: A Retrospective, Observational Pilot Study

Introduction: Sickle cell disease (SCD) has a negative impact on job functioning and majority of SCD patients cannot retain their jobs. Recurrent acute vaso-occlusive crises (VOC) and organ dysfunction related to SCD can limit employment options and interfere with job retention. Potential associates of unemployment and poor job performance in adults with SCD include health-related (pain frequency and intensity, health-care utilization) and psychosocial (support system, coping mechanism). Unemployment can lead to major psychosocial stress that may translate into physiologic stress resulting in increased emergency department (ED) visits and hospitalizations. Poor psychosocial state may predispose patients to increased chronic pain, and use of alcohol or illicit drugs. The aim of this study is to identify the association between the status of employment of SCD and SCD pain-related hospitalizations. Patients and Methods: This was a retrospective, observational pilot study of SCD patients at our comprehensive SCD clinic. Surveys were administered during routine clinic visits. Surveys contain multiple questions relating to patients' employment history and healthcare utilization. We excluded patients on chronic transfusion therapy and those with disabling conditions unrelated to SCD. We reviewed extensive data in our electronic medical records relating to subjects of interest. Among the patients who have at least 12 months of continuous employment status (employed or unemployed), we assessed SCD pain-related hospitalization rates in the previous 12 months period. Descriptive analysis was performed with frequency distributions. Univariate logistic regression was conducted to investigate the association between employment status and hospitalization rate. Results: A cohort of 74 SCD patients completed surveys about employment and hospitalization history. Of the patients, 51 patients showed continuous employment history greater than 12 months. Thirty-nine out of fifty-one (76.47%) were unemployed. Majority of patients (90.20%) were hospitalized at least once and sixteen patients (31.37%) were hospitalized more than 5 times during the previous 12 months. The univariate logistic regression analysis showed SCD patients with employed status were significantly less likely to be admitted to the hospital compared with unemployed SCD patients (Odds Ratio 0.255, 95% CI: 0.073-0.895). Conclusions: In this cohort, unemployed SCD patients have a significantly higher rate of hospitalization for pain crisis when compared with employed SCD patients. Development of interventions and programs that can improve job accommodation for SCD patients will likely decrease hospitalization and reduce related healthcare costs. In addition, the negative economic impact of SCD on the society will be less. Moreover, improved job accommodation will likely lead to better psychosocial and overall well-being for the patients. Providers who care for SCD patients should encourage patients to engage in job activities as tolerated which may positively influence their overall health. Disclosures No relevant conflicts of interest to declare.

Occupational History for Forty Adults with Sickle Cell Disease Compared with Healthy Siblings

Introduction: Despite high rates of unemployment and disability in adults with sickle cell disease (SCD), these issues remain understudied. Since SCD mostly affect people of African descent, the potential risk factors for poor job performance and unemployment in adults with SCD are a complex combination of disease, demographic, and socio-economic variables. Recurrent acute vaso-occlusive crises and organ dysfunction related to SCD can limit employment options and interfere with job retention. Potential associates of unemployment and poor job performance in adults with SCD include health-related (pain frequency and intensity, health-care utilization) and psychosocial (support system, coping mechanism). The goal of this study is to compare patients’ rates of unemployment and disability with those of their unaffected siblings. We compare patients with siblings so as to adjust for some socioeconomic variables. Patients and Methods: Patients on chronic transfusion therapy and those with additional disabling conditions were excluded. Surveys were administered during routine clinic visits. Along with demographic data, the survey also assessed use of hydroxyurea, employment status, length of employment, annual income, and job satisfaction. Moreover, patients were asked to provide the same occupational data for a sibling without SCD and whose age was within five years of the patient’s age. Clinical data including number of hospitalizations in the recent year were also gathered from the patient’s medical record. Results: A cohort of 40 adult SCD patients (28 hemoglobin SS, 8 hemoglobin SC, 1 Sβ0 and 3 Sβ+; age: median = 29, range 19-56 years; sex: 20 males, 20 females) completed surveys concerning occupational history for themselves and a sibling. Of the patients, twenty-three out of forty (57.5%) were on hydroxyurea therapy and 24/40 (60%) had 3 or more hospitalizations in the previous one year. Ten out of forty SCD patients (25%) are currently employed, compared to 26/40 (65%) of their siblings (p < .001; all tests reported are McNemar’s Exact (binomial) test). Five out of forty SCD patients (12.5%) have been employed for more than 2 years as compared to 20/40 (50%) of their siblings (p <.001). Twenty-six (65%) of SCD patients are on disability, while this is true for only four (10%) of the siblings (p< .001). It is important to note that 20 out of 26 (77%) SCD patients who are currently on disability have previously had a job. Fifteen of the twenty-six (58%) SCD patients on disability reported that they missed more than 1 day per week of work due to their SCD. Of the unemployed patients, twenty-three out of 30 (77%) wished they had a job. Conclusions: In this sample, patients with SCD have notably lower rates of current employment and sustained employment when compared with similar-age siblings without SCD.Despite the fact that 32/40 (80%) of the SCD patients have previously had a job, only 25% are currently employed. Our future research studies will focus on development of specific interventions to improve job accommodation of SCD patients. Disclosures No relevant conflicts of interest to declare.

(P1-90) Guidelines for Psychosocial Support for Uniformed Services

In the Netherlands in 2010, the multidisciplinary guidelines for the psychosocial support of uniformed services organizations (USOs) were developed. These guidelines are accepted as a national standard for psychosocial support for police, firebrigade, ambulance services, the Ministry of Defence, and coast guard. This presentation will focus on the backgrounds, development, and status of these guidelines, and an outline of the contents will be given. Members of USOs consistently are exposed to potentially shocking events. It was recognized that there is a need in the field for clarity and unambiguity about the organization of psychosocial care to this group. The goal of the guidelines is to guarantee optimal psychosocial support and care after experiencing disasters and shocking events, so that stress-related health problems among members of the emergency services are prevented. The guidelines are evidence-based, i.e., they are based on the results of the latest scientific studies, knowledge from experience (best practices), and other considerations. Consensus was reached that the promotion of the existing means of recovery of the USO member, and the facilitation of these means by peer support structures, are the key to a successful psychosocial support system. The peer support system has an important role in recognizing those affected with psychological and/or serious clinical symptoms that require diagnosis and/or treatment. Diagnosis and treatment should be exercised by mental health professionals. Therefore, they must be readily available, but should only be deployed when necessary. Three phases in the psychosocial support for USO members are discerned: (1) preparation (selection, information and training); (2) peer support and monitoring, (3) and referral for professional care (if necessary). The guidelines provide recommendations for the USO for each of these phases. National guidelines such as these should be discussed internationally to see whether they can provide a basis for further (international) implementation and use.