Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

Andreas D Haas, Cordelia Kunzekwenyika, Stefanie Hossmann, Josphat Manzero, Janneke van Dijk, Ronald Manhibi, Ruth Verhey, Andreas Limacher, Per M von Groote, Ethel Manda, Michael A Hobbins, Dixon Chibanda, Matthias Egger, IeDEA Southern Africa, Andreas D Haas, Cordelia Kunzekwenyika, Stefanie Hossmann, Josphat Manzero, Janneke van Dijk, Ronald Manhibi, Ruth Verhey, Andreas Limacher, Per M von Groote, Ethel Manda, Michael A Hobbins, Dixon Chibanda, Matthias Egger, IeDEA Southern Africa

Abstract

Objectives: To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART).

Setting: Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe.

Design: Cross-sectional study.

Participants: HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months.

Outcome measures: The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence.

Results: Out of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50-59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70).

Conclusions: A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe.

Trial registration number: NCT03704805.

Keywords: HIV & AIDS; epidemiology; mental health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) . AIDSInfo online database [Internet]. Available:
    1. Johnson LF, Mossong J, Dorrington RE, et al. . Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med 2013;10:e1001418. 10.1371/journal.pmed.1001418
    1. Haas AD, Zaniewski E, Anderegg N, et al. . Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes. J Int AIDS Soc 2018;21:e25084. 10.1002/jia2.25084
    1. Ford N, Darder M, Spelman T, et al. . Early adherence to antiretroviral medication as a predictor of long-term HIV virological suppression: five-year follow up of an observational cohort. PLoS One 2010;5:e10460. 10.1371/journal.pone.0010460
    1. Lofgren SM, Bond DJ, Nakasujja N, et al. . Burden of depression in outpatient HIV-infected adults in sub-Saharan Africa; systematic review and meta-analysis. AIDS Behav 2020;24:1752–64. 10.1007/s10461-019-02706-2
    1. Brandt C, Zvolensky MJ, Woods SP, et al. . Anxiety symptoms and disorders among adults living with HIV and AIDS: a critical review and integrative synthesis of the empirical literature. Clin Psychol Rev 2017;51:164–84. 10.1016/j.cpr.2016.11.005
    1. Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry 2017;4:146–58. 10.1016/S2215-0366(16)30263-2
    1. Li SH, Graham BM. Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? the potential role of sex hormones. Lancet Psychiatry 2017;4:73–82. 10.1016/S2215-0366(16)30358-3
    1. Chibanda D, Verhey R, Gibson LJ, et al. . Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe. J Affect Disord 2016;198:50–5. 10.1016/j.jad.2016.03.006
    1. Chibanda D, Cowan F, Gibson L, et al. . Prevalence and correlates of probable common mental disorders in a population with high prevalence of HIV in Zimbabwe. BMC Psychiatry 2016;16:55. 10.1186/s12888-016-0764-2
    1. Haas AD, Radin E, Hakim AJ, et al. . Prevalence of nonsuppressed viral load and associated factors among HIV‐positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population‐based nationally representative surveys. J Int AIDS Soc 2020;23. 10.1002/jia2.25631
    1. Wykowski J, Kemp CG, Velloza J, et al. . Associations between anxiety and adherence to antiretroviral medications in low- and middle-income countries: a systematic review and meta-analysis. AIDS Behav 2019;23:2059–71. 10.1007/s10461-018-02390-8
    1. Haas AD, Technau K-G, Pahad S, et al. . Mental health, substance use and viral suppression in adolescents receiving art at a paediatric HIV clinic in South Africa. J Int AIDS Soc 2020;23:e25644. 10.1002/jia2.25644
    1. Haas AD, Ruffieux Y, van den Heuvel LL, Den HLLV, et al. . Excess mortality associated with mental illness in people living with HIV in Cape town, South Africa: a cohort study using linked electronic health records. Lancet Glob Health 2020;8:e1326–34. 10.1016/S2214-109X(20)30279-5
    1. Uthman OA, Magidson JF, Safren SA, et al. . Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep 2014;11:291–307. 10.1007/s11904-014-0220-1
    1. Meffert SM, Neylan TC, McCulloch CE, et al. . East African HIV care: depression and HIV outcomes. Glob Ment Health 2019;6:e9. 10.1017/gmh.2019.6
    1. Shi Y, Zhao M, Chen S, et al. . Effects of cognitive behavioral therapy on people living with HIV and depression: a systematic review and meta-analysis. Psychol Health Med 2019;24:578–94. 10.1080/13548506.2018.1549739
    1. Sin NL, DiMatteo MR. Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis. Ann Behav Med 2014;47:259–69. 10.1007/s12160-013-9559-6
    1. Ruffieux Y, Efthimiou O, Van den Heuvel LL, et al. . The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records. Epidemiol Psychiatr Sci 2021;30:e37. 10.1017/S2045796021000196
    1. Sikkema KJ, Dennis AC, Watt MH, et al. . Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries. Glob Ment Health 2015;2:1–26. 10.1017/gmh.2015.17
    1. Chibanda D, Weiss HA, Verhey R, et al. . Effect of a primary care-based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. JAMA 2016;316:2618. 10.1001/jama.2016.19102
    1. Chibanda D. Reducing the treatment gap for mental, neurological and substance use disorders in Africa: lessons from the Friendship bench in Zimbabwe. Epidemiol Psychiatr Sci 2017;26:342–7. 10.1017/S2045796016001128
    1. AIS . AIDS Indicator Survey (AIS) [Internet], 2017. Available:
    1. Patel V, Simunyu E, Gwanzura F, et al. . The Shona symptom questionnaire: the development of an Indigenous measure of common mental disorders in Harare. Acta Psychiatr Scand 1997;95:469–75. 10.1111/j.1600-0447.1997.tb10134.x
    1. Cummings P. Methods for estimating adjusted risk ratios. Stata J 2009;9:175–96. 10.1177/1536867X0900900201
    1. Simoni JM, Kurth AE, Pearson CR, et al. . Self-Report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav 2006;10:227–45. 10.1007/s10461-006-9078-6
    1. Seedat S, Scott KM, Angermeyer MC, et al. . Cross-National associations between gender and mental disorders in the world Health organization world mental health surveys. Arch Gen Psychiatry 2009;66:785. 10.1001/archgenpsychiatry.2009.36
    1. Kuehner C. Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr Scand 2003;108:163–74. 10.1034/j.1600-0447.2003.00204.x
    1. Oram S, Khalifeh H, Howard LM. Violence against women and mental health. Lancet Psychiatry 2017;4:159–70. 10.1016/S2215-0366(16)30261-9
    1. World Health Organization . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection recommendations for a public health approach. 2 edn. Geneva: World Health Organization, 2016.
    1. IeDEA and COHERE Cohort Collaborations . Global trends in CD4 cell count at the start of antiretroviral therapy: collaborative study of treatment programs. Clin Infect Dis 2018;66:893–903. 10.1093/cid/cix915
    1. Ngum PA, Fon PN, Ngu RC, et al. . Depression among HIV/AIDS patients on highly active antiretroviral therapy in the southwest regional hospitals of Cameroon: a cross-sectional study. Neurol Ther 2017;6:103–14. 10.1007/s40120-017-0065-9
    1. Office of the Surgeon General (US) Center for Mental Health Services (US), National Institute of Mental Health (US) . Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the surgeon General. Rockville, MD, 2001.
    1. Safren SA, Bedoya CA, O'Cleirigh C, et al. . Cognitive behavioural therapy for adherence and depression in patients with HIV: a three-arm randomised controlled trial. Lancet HIV 2016;3:e529–38. 10.1016/S2352-3018(16)30053-4
    1. Safren SA, O'Cleirigh CM, Bullis JR, et al. . Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol 2012;80:404–15. 10.1037/a0028208
    1. Brown LK, Kennard BD, Emslie GJ, et al. . Effective treatment of depressive disorders in medical clinics for adolescents and young adults living with HIV: a controlled trial. J Acquir Immune Defic Syndr 2016;71:38–46. 10.1097/QAI.0000000000000803

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