Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study

Khem N Pokhrel, Vidya D Sharma, Kalpana G Pokhrel, Sanjeev R Neupane, Linda B Mlunde, Krishna C Poudel, Masamine Jimba, Khem N Pokhrel, Vidya D Sharma, Kalpana G Pokhrel, Sanjeev R Neupane, Linda B Mlunde, Krishna C Poudel, Masamine Jimba

Abstract

Background: HIV-positive people often experience mental health disorders and engage in substance use when the disease progresses. In resource limited settings, mental health services are not integrated into HIV services. In Nepal, HIV-positive people do receive psychosocial support and other basic health care services from a community home-based care intervention; however, the effects of the intervention on health outcomes is not yet known. Therefore, we examined the impact of the intervention on mental health and antiretroviral therapy (ART) adherence.

Methods: We conducted an intervention study to identify the effects of a community home-based care intervention on mental health disorders, substance use, and non-adherence to ART among HIV-positive people in Nepal from March to August 2015. In total, 344 participated in the intervention and another 338 were in the control group. The intervention was comprised of home-based psychosocial support and peer counseling, adherence support, basic health care, and referral services. We measured the participants' depression, anxiety, stress, substance use, and non-adherence to ART. We applied a generalized estimating equation to examine the effects of intervention on health outcomes.

Results: The intervention had positive effects in reducing depressive symptoms [Adjusted Odds Ratio (AOR) = 0.44, p < 0.001)], anxiety (AOR = 0.54, p = 0.014), stress (β = - 3.98, p < 0.001), substance use (AOR = 0.51, p = 0.005), and non-adherence to ART (AOR = 0.62, p = 0.025) among its participants at six-month follow-up.

Conclusions: The intervention was effective in reducing mental health disorders, substance use, and non-adherence to ART among HIV-positive people. Community home-based care intervention can be applied in resource limited setting to improve the mental health of the HIV-positive people. Such intervention should be targeted to include more HIV-positive people in order to improve their ART adherence.

Trial registration: ClinicalTrials.gov ID: NCT03505866 , Released Date: April 20, 2018.

Keywords: Anti-retroviral therapy; HIV; Mental health; Nepal; Substance use.

Conflict of interest statement

Ethics approval and consent to participate

NA (No images, videos, and individual details of the participants are presented)

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20:1571–1582. doi: 10.1097/01.aids.0000238402.70379.d4.
    1. Olisah VO, Baiyewu O, Sheikh TL. Depression underdiagnosis and the effects on quality of life in outpatients with HIV at a Nigerian university teaching hospital. Afr J AIDS Res. 2011;10:247–254. doi: 10.2989/16085906.2011.626294.
    1. Freeman M, Patel V, Collins PY, Bertolote J. Integrating mental health in global initiatives for HIV/AIDS. Br J Psychiatry. 2005;187:1–3. doi: 10.1192/bjp.187.1.1.
    1. Memiah P, Shumba C, Etienne-Mesubi M, Agbor S, Hossain MB, Komba P, et al. The effect of depressive symptoms and CD4 count on adherence to highly active antiretroviral therapy in sub-Saharan Africa. J Int Assoc Provid AIDS Care. 2014;13:346–352. doi: 10.1177/2325957413503368.
    1. Wakawa IA, Said JM, Abba WM, Shehu S, Rabbebe IB, Beida O. The impact of comorbid clinical depression on the health-related quality of life of adults on highly active antiretroviral therapy in Maiduguri, Northeastern Nigeria. Indian J Psychol Med. 2014;36:408–417. doi: 10.4103/0253-7176.140731.
    1. Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. J Acquir Immune Defic Syndr. 2001;27:251–259. doi: 10.1097/00042560-200107010-00006.
    1. Pence BW, Miller WC, Gaynes BN, Eron JJ. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;44:159–166. doi: 10.1097/QAI.0b013e31802c2f51.
    1. Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112:178–193. doi: 10.1016/j.drugalcdep.2010.06.014.
    1. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav. 2012;16:2119–2143. doi: 10.1007/s10461-012-0212-3.
    1. World Health Organization. Psychosocial support. Geneva: WHO; 2010.
    1. Amirkhanian YA, Kelly JA, McAuliffe TL. Psychosocial needs, mental health, and HIV transmission risk behavior among people living with HIV/AIDS in St Petersburg, Russia. AIDS. 2003;17:2367–2374. doi: 10.1097/00002030-200311070-00012.
    1. Wu L, Li X. Community-based HIV/AIDS interventions to promote psychosocial well-being among people living with HIV/AIDS: a literature review. Health Psychol Behav Med. 2013;1:31–46. doi: 10.1080/21642850.2013.822798.
    1. Kabore I, Bloem J, Etheredge G, Obiero W, Wanless S, Doykos P, et al. The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa. AIDS Patient Care STDs. 2010;24:581–594. doi: 10.1089/apc.2009.0307.
    1. Muñoz M, Bayona J, Sanchez E, Arevalo J, Sebastian JL, Arteaga F, et al. Matching social support to individual needs: a community-based intervention to improve HIV treatment adherence in a resource-poor setting. AIDS Behav. 2011;15:1454–1464. doi: 10.1007/s10461-010-9697-9.
    1. Basso CR, Helena ET, Caraciolo JM, Paiva V, Nemes MI. Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial. AIDS Behav. 2013;17:181–192. doi: 10.1007/s10461-012-0175-4.
    1. World Health Organization. Community Home-based care in resource-limited settings. A framework for action. Geneva: WHO; 2002.
    1. Van Tam V, Larsson M, Pharris A, Diedrichs B, Nguyen HP, Nguyen CT, et al. Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: a randomised controlled trial from North-Eastern Vietnam. Health Qual Life Outcomes. 2012;10:53. doi: 10.1186/1477-7525-10-53.
    1. Weidle PJ, Wamai N, Solberg P, Liechty C, Sendagala S, Were W, et al. Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda. Lancet. 2006;368(9547):1587–1594. doi: 10.1016/S0140-6736(06)69118-6.
    1. Wang H, Zhou J, Huang L, Li X, Fennie KP, Williams AB. Effects of nurse-delivered home visits combined with telephone calls on medication adherence and quality of life in HIV-infected heroin users in Hunan of China. J Clin Nurs. 2010;19:380–388. doi: 10.1111/j.1365-2702.2009.03048.x.
    1. Ministry of Health and Population Nepal. WHO-AIMS report on Mental health system in Nepal. Kathmandu: MoHP; 2006.
    1. Amiya RM, Poudel KC, Poudel-Tandukar K, Pandey BD, Jimba M. Perceived family support, depression, and suicidal ideation among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. PLoS One. 2014;9:e90959. doi: 10.1371/journal.pone.0090959.
    1. National Centre for AIDS and STD Control, Ministry of Health and Population. Community and Home-based Care in Nepal. Kathmandu: MoHP; 2008.
    1. National Centre for AIDS and STD Control, Ministry of Health and Population. Cumulative situation of HIV in Nepal. Kathmandu: MoHP; 2014.
    1. National Centre for AIDS and STD Control, Ministry of Health and Population. Country progress report on HIV/AIDS response, Nepal, 2014. Kathmandu: MoHP; 2014.
    1. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. doi: 10.1177/014662167700100306.
    1. Eller LS, Mahat G. Predictors of life satisfaction in HIV-positive Nepali women. J Assoc Nurses AIDS Care. 2007;18(5):17–26. doi: 10.1016/j.jana.2007.07.002.
    1. Kessler RC, Andrews G, Mroczek D, Ustun TB, Wittchen H-U. The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF) Int J Methods Psychiatr Res. 1998;7:171–185. doi: 10.1002/mpr.47.
    1. Ghimire DJ, Chardoul S, Kessler RC, Axinn WG, Adhikari BP. Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal. Int J Methods Psychiatr Res. 2013;22:71–81. doi: 10.1002/mpr.1375.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396. doi: 10.2307/2136404.
    1. Eller LS, Mahat G. Psychological factors in Nepali former commercial sex workers with HIV. J Nurs Scholarsh. 2003;35:53–60. doi: 10.1111/j.1547-5069.2003.00053.x.
    1. Family Health International, Nepal; National Centre for AIDS and STD Control, Ministry of Health and Population. Integrated biological and behavioral survey (IBBS) among male injecting drug users (IDUs). Kathmandu: FHI Nepal; 2010. p. 87.
    1. Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG) AIDS Care. 2000;12:255–266. doi: 10.1080/09540120050042891.
    1. World Health Organization. Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for survellance. Geneva: WHO; 2014.
    1. Li L, Lee SJ, Thammawijaya P, Jiraphongsa C, Rotheram-Borus MJ. Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care. 2009;21:1007–1013. doi: 10.1080/09540120802614358.
    1. Prachakul W, Grant JS, Keltner NL. Relationships among functional social support, HIV-related stigma, social problem solving, and depressive symptoms in people living with HIV: a pilot study. J Assoc Nurses AIDS Care. 2007;18:67–76. doi: 10.1016/j.jana.2007.08.002.
    1. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3 Suppl 2):18734. doi: 10.7448/IAS.16.3.18734.
    1. Gordillo V, Fekete E, Platteau T, Antoni MH, Schneiderman N, Nöstlinger C, et al. Emotional support and gender in people living with HIV: effects on psychological well-being. J Behav Med. 2009;32:523–531. doi: 10.1007/s10865-009-9222-7.
    1. Uys LR. The practice of community caregivers in a home-based HIV/AIDS project in South Africa. J Clin Nurs. 2002;11:99–108. doi: 10.1046/j.1365-2702.2002.00566.x.
    1. Molassiotis A, Callaghan P, Twinn SF, Lam SW, Chung WY, Li CK. A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS Patient Care STDs. 2002;16(2):83–96. doi: 10.1089/10872910252806135.
    1. Naar-King S, Kolmodin K, Parsons JT, Murphy D, ATN 004 Protocol Team Adolescent Trial Network 004 Protocol Team for HIV/AIDS Intervention Psychosocial factors and substance use in high-risk youth living with HIV: a multi-site study. AIDS Care. 2010;22:475–482. doi: 10.1080/09540120903220279.
    1. Chawarski MC, Zhou W, Schottenfeld RS. Behavioral drug and HIV risk reduction counseling (BDRC) in MMT programs in Wuhan, China: a pilot randomized clinical trial. Drug Alcohol Depend. 2011;115:237–239. doi: 10.1016/j.drugalcdep.2010.09.024.
    1. Pence BW, Thielman NM, Whetten K, Ostermann J, Kumar V, Mugavero MJ. Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast. AIDS Patient Care STDs. 2008;22:869–877. doi: 10.1089/apc.2008.0022.
    1. Gusdal AK, Obua C, Andualem T, Wahlstrom R, Chalker J, Fochsen G, et al. Peer counselors’ role in supporting patients’ adherence to ART in Ethiopia and Uganda. AIDS Care. 2011;23:657–662. doi: 10.1080/09540121.2010.532531.
    1. Power R, Koopman C, Volk J, Israelski DM, Stone L, Chesney MA, et al. Social support, substance use, and denial in relationship to antiretroviral treatment adherence among HIV-infected persons. AIDS Patient Care STDs. 2003;17:245–252. doi: 10.1089/108729103321655890.
    1. Johnson MO, Charlebois E, Morin SF, Remien RH, Chesney MA, Team NIoMHHLP Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007;46:574–580. doi: 10.1097/QAI.0b013e318158a474.
    1. Attonito J, Dévieux JG, Lerner BD, Hospital MM, Rosenberg R. Antiretroviral treatment adherence as a mediating factor between psychosocial variables and HIV viral load. J Assoc Nurses AIDS Care. 2014;25:626–637. doi: 10.1016/j.jana.2014.08.001.
    1. Welch KJ. Correlates of alcohol and/or drug use among HIV-infected individuals. AIDS Patient Care STDs. 2000;14:317–323. doi: 10.1089/10872910050046340.
    1. Chang LW, Kagaayi J, Nakigozi G, Ssempijja V, Packer AH, Serwadda D, et al. Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial. PLoS One. 2010;5:e10923. doi: 10.1371/journal.pone.0010923.

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