Mental health and retention in HIV care: A systematic review and meta-analysis

Abstract

Objective: Mental health (MH) diagnoses, which are prevalent among persons living with HIV infection, might be linked to failed retention in HIV care. This review synthesized the quantitative evidence regarding associations between MH diagnoses or symptoms and retention in HIV care, as well as determined if MH service utilization (MHSU) is associated with improved retention in HIV care.

Method: A comprehensive search of the Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis database of electronic (e.g., MEDLINE, EMBASE, PsycINFO) and manual searches was conducted to identify relevant studies published during January 2002-August 2017. Effect estimates from individual studies were pooled by using random-effects meta-analysis, and a moderator analysis was conducted.

Results: Forty-five studies, involving approximately 57,334 participants in total, met the inclusion criteria: 39 examined MH diagnoses or symptoms, and 14 examined MHSU. Overall, a significant association existed between MH diagnoses or symptoms, and lower odds of being retained in HIV care (odds ratio, OR = 0.94; 95% confidence interval [CI] [0.90, 0.99]). Health insurance status (β = 0.004; Z = 3.47; p = .001) significantly modified the association between MH diagnoses or symptoms and retention in HIV care. In addition, MHSU was associated with an increased odds of being retained in HIV care (OR = 1.84; 95% CI [1.45, 2.33]).

Conclusions: Results indicate that MH diagnoses or symptoms are a barrier to retention in HIV care and emphasize the importance of providing MH treatment to HIV patients in need. (PsycINFO Database Record

(c) 2018 APA, all rights reserved).

Figures

Figure 1

Flow diagram of the study selection process.

Figure 2

Forest plot for the random effects meta-analysis examining the association between mental health diagnosis or symptoms and retention in HIV care. Effects are categorized by mental health variable type. CI: Confidence Interval; PTSD: Posttraumatic stress disorder; MCS: Mental health composite score

Figure 3

Forest plot for the random effects meta-analysis examining the association between mental health service usage and retention in HIV care. CI: Confidence Interval