在全球 IeDEA 联盟中，在中低收入国家的 HIV 治疗环境中对精神健康和物质使用障碍进行筛查和管理。

Screening and management of mental health and substance use disorders in HIV treatment settings in low- and middle-income countries within the global IeDEA consortium.

机构信息

University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.

Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.

出版信息

J Int AIDS Soc. 2018 Mar;21(3):e25101. doi: 10.1002/jia2.25101.

DOI:10.1002/jia2.25101

PMID:29603887

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5878412/

Abstract

INTRODUCTION

Integration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

METHODS

We surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia-Pacific and sub-Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post-traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders.

RESULTS

Most sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD, 55% for SUDs and 29% for other mental health disorders. Depression, PTSD, SUDs and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on-site management of depression, PTSD, and SUDs, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On-site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUDs was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children.

CONCLUSIONS

Significant gaps exist in the management of MSDs in HIV care settings in LMICs, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSDs and HIV care is needed.

摘要

简介

将精神健康和物质使用障碍（MSD）的筛查和管理服务整合到艾滋病毒护理环境中，已被确定为改善中低收入国家（LMIC）艾滋病毒感染者/艾滋病患者（PLWHA）的精神健康和艾滋病毒治疗结果的一项有前途的策略。关于 LMIC 中的艾滋病毒治疗点筛查和管理 MSD 的数据有限。本研究的目的是评估参与国际艾滋病流行病学数据库评估联盟（IeDEA）的 LMIC 中的艾滋病毒诊所筛查和治疗 MSD 的做法。

方法

我们对来自加勒比、中美洲和南美洲、亚太地区和撒哈拉以南非洲的 29 个 LMIC 的 95 个艾滋病毒诊所进行了分层随机抽样调查。该调查获取了现场特征以及抑郁、创伤后应激障碍（PTSD）、物质使用障碍（SUD）和其他精神健康障碍的筛查和治疗信息。

结果

大多数地点（n=76，80%）位于城市地区。精神健康筛查因障碍而异：57%的调查地点筛查抑郁，19%筛查 PTSD，55%筛查 SUD，29%筛查其他精神健康障碍。70%、51%、41%和 47%的地点分别报告在现场管理抑郁、PTSD、SUD 和其他精神健康障碍。分别有 42%、14%、26%和 19%的地点报告了抑郁、PTSD 和 SUD 以及其他精神健康障碍的筛查和现场管理的综合可用性。与城市环境相比，农村环境报告的抑郁和 PTSD 的现场管理明显较少（抑郁：分别为 33%和 78%；PTSD：分别为 24%和 58%）。与仅治疗成人或同时治疗成人和儿童的艾滋病毒方案相比，仅治疗儿童的艾滋病毒方案报告的抑郁和 SUD 筛查最少。