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Screening and treatment of common mental disorders at HIV clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium

Title
Screening and treatment of common mental disorders at HIV clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium
Presenter
Angela Parcesepe
Authors
A. Parcesepe * (1), M. Remch (2), M. Stockton (3), C. William Wester (4), C. Bernard (5), L.A. Enane (6), A. Haas (7), J. Ross (8), R. Ajeh (9), K. Althoff (10), W. Pape (11), A. Minga (12), E. Kwobah (13), M. Tlali (14), J. Tanuma (15), D. Nsonde (16), A. Freeman (10), D. Nash (17), K. Lancaster (18), IeDEA Consortium
Institutions
(1) University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Chapel Hill, United States, (2) University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, United States, (3) Columbia University, Department of Psychiatry, New York, United States, (4) Vanderbilt University Medical Center, Department of Medicine, Nashville, United States, (5) University of Bordeaux, National Institute for Health and Medical Research, Research Institute for Sustainable Development, Bordeaux Population Health Research Centre, Bordeaux, France, (6) Indiana University School of Medicine, The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indianapolis, United States, (7) University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, (8) TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand, (9) Clinical Research Education and Networking Consultancy, Yaounde, Cameroon, (10) Johns Hopkins University, Bloomberg School of Public Health, Baltimore, United States, (11) Groupe Haitien d''Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti, (12) Centre Medical de Suivi de Donneurs de Sang/CNTS/PRIMO-CI, Abidjan, Cote D''Ivoire, (13) Moi Teaching and Referral Hospital, Department of Mental Health, Eldoret, Kenya, (14) University of Cape Town, Centre for Infectious Disease Epidemiology & Research (CIDER), School of Public Health & Family Medicine, Cape Town, South Africa, (15) National Center for Global Health and Medicine, Division of the AIDS Medical Information of AIDS Clinical Care, Tokyo, Japan, (16) CTA Brazzaville, Brazzaville, Congo, the, (17) City University of New York, Institute for Implementation Science in Population health, New York, United States, (18) The Ohio State University, Department of Epidemiology, Columbus, United States

BACKGROUND: Common mental disorders (CMDs), including depression, anxiety, and post-traumatic stress disorder (PTSD) are highly prevalent among people living with HIV and associated with poor HIV treatment outcomes. Integrating screening and treatment of CMDs into HIV care can improve mental health, HIV treatment outcomes, and quality of life. Data regarding the availability of mental health screening and treatment at HIV clinics remain scarce.
METHODS: We describe the reported availability of mental health screening and treatment from a survey of HIV treatment sites in Africa, the Asia-Pacific, the Caribbean, Central and South America, and North America regions participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. The survey captured information on site characteristics and reported availability of screening and treatment for depression, anxiety, and PTSD in 2020.
RESULTS: Among the 223 HIV treatment sites that completed the mental heath portion of the survey, 67% were located in urban settings, 50% served adult and pediatric populations, and 38% served only adults. Most sites (78%) were located in low- or middle-income countries (LMIC). Overall, 50%, 14%, and 12% of sites reported using a validated instrument to screen for depression, anxiety, and PTSD, respectively. Screening and counseling/psychotherapy were available for treatment of depression, anxiety, and PTSD at 46%, 13%, and 11% of sites, respectively. Screening and psychiatric medication was available for the treatment of depression, anxiety, and PTSD at 36%, 11%, and 8% of clinics, respectively. Screening and treatment for all disorders assessed was more commonly reported at urban compared to rural sites and at sites in high-income countries compared to sites in LMIC.


All
n=223
n (%)		Low-income countries
n=51
n (%)		Middle-income countries
n=121
n (%)		High-income countries
n=51
n (%)
Depression
Screening		112 (50)27 (53)48 (40)37 (73)
Screening and counseling102 (46)24 (47)44 (36)34 (67)
Screening and psychiatric
medication		80 (36)18 (36)27 (22)35 (69)
PTSD
Screening		27 (12)3 (6)14 (12)10 (20)
Screening and counseling24 (11)3 (6)12 (10)9 (18)
Screening and psychiatric
medication		17 (8)2 (4)6 (5)9 (18)
Anxiety
Screening		32 (14)2 (4)17 (14)13 (25)
Screening and counseling29 (13)2 (4)16 (13)11 (22)
Screening and psychiatric
medication		24(11)2 (4)10 (8)12 (24)

CONCLUSIONS: Substantial gaps exist in the availability of mental health services at HIV treatment sites, particularly in rural and LMIC settings. Identification of barriers and implementation of feasible and sustainable strategies to integrate mental health services into HIV care is needed.