There is virtually no screening and treatment for mental disorders in many HIV clinics around the world

The proportion of HIV treatment screening clinics for depression, anxiety and post-traumatic stress disorder (PTSD) is 50%, 14% and 12% respectively in many regions of the world, Dr. Angela Parcesepe of the University of North Carolina reported on the 24th International AIDS Conference (AIDS 2022) in Montreal this week. Moreover, both screening and medication for depression, anxiety, and PTSD were offered in only 36%, 11%, and 8% of sites, respectively.

Common mental disorders, including depression, anxiety, and PTSD, are highly prevalent among people living with HIV and are associated with poor HIV treatment outcomes. Integrating their screening and treatment into HIV care can improve mental health, HIV treatment outcomes, and quality of life. Nevertheless, data on the availability of mental health screening and treatment in HIV clinics remain scarce.

Glossary of terms

depression

A mental problem causing long-term low mood that interferes with daily life.

anxiety

A feeling of uneasiness, such as anxiety or fear, which can be mild or severe. Anxiety disorders are conditions in which anxiety dominates a person’s life or is experienced in certain situations.

middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are about 50 lower-middle-income countries (mostly in Africa and Asia) and about 60 upper-middle-income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

low income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. While the majority of the roughly 30 countries that are ranked as low-income are in sub-Saharan Africa, many African countries, including Kenya, Nigeria, South Africa and Zambia, are in the middle-income groups.

Using data from the International Epidemiological Databases for AIDS Evaluation (IeDEA) consortium, the 2020 survey collected information on HIV clinics in Asia, the Caribbean, Latin America, sub-Saharan Africa, North America and Australia and reported the availability of screening and treatment for depression, anxiety and post-traumatic stress.

A total of 223 HIV treatment sites from 41 countries participated in the study. 67% were in urban settings, 50% served adults and children, 38% served adults only, and 12% served children only. Most sites (78%) are located in low- or middle-income countries.

Regarding clinical settings: Urban clinics were more likely to report screening and treatment than rural clinics. Likewise, more clinics in high-income countries offer mental health services.

Regarding Populations Served: Clinics that serve both adults and children were screened more for depression (53%) than child-only clinics (31%). However, child-only clinics screened more for anxiety (23%) than both adult and child clinics (13%).

In global regions: clinics in Latin America and the Caribbean offered screening for depression (63%) and anxiety (13%), but no sites reported PTSD screening. In African cohorts, East Africa was screened more for depression (53%) and PTSD (14%) than other African regions, but had the lowest screening for anxiety (7%). West Africa had minimal screening with depression, anxiety and PTSD screened in only 7%, 14% and 7% of sites respectively. North America topped all regions, screening for depression, anxiety and PTSD in 93%, 24% and 28% of HIV treatment sites.

Dr. Parcesepe explained to AIDS 2022 that they had previously conducted this study between 2016/2017 in 68 clinics in 27 low- and middle-income countries. They compared these results with current (2020) figures from the same 68 clinics and found that screening for depression and PTSD was now available in 31% and 24% of clinics that did not offer it in 2016/2017. However, 15% and 12% of clinics that screened for depression and PTSD in the first study stopped offering these services in 2020.

She highlighted the lack of screening and treatment for mental disorders in many rural and pediatric HIV treatment facilities, especially in low-income countries. She emphasized the need to identify and implement practical and sustainable services.

A limitation of the study was that service availability was reported by facility staff and not independently verified. She also clarified that the 2020 data was collected before COVID-19, so the reported numbers do not reflect service reductions caused by the pandemic.

References

Parcesepe A et al. Screening and treatment of common mental disorders in HIV clinics within the International Epidemiological Databases for AIDS Evaluation (IeDEA) Consortium. 24th International AIDS Conference, Montreal, Abstract OAE0502, 2022.

See the abstract on the conference website.

Leave a Comment

Your email address will not be published.