Department of Epidemiology, University of Washington, Seattle.
Department of Global Health, University of Washington, Seattle.
Clin Infect Dis. 2018 Oct 15;67(9):1411-1418. doi: 10.1093/cid/ciy309.
Facility- and community-based efforts to improve human immunodeficiency virus (HIV) testing in sub-Saharan Africa may benefit from understanding how mental health influences HIV care-seeking behavior.
We conducted a study among adults presenting for HIV testing in the Umlazi township of South Africa. Prior to testing, we measured depression using the 9-item Patient Health Questionnaire and anxiety using the 7-item Generalized Anxiety Disorder scale. We categorized patients as delayed presenters (presenting to clinic >3 months after first HIV-positive test), late testers (presenting within 3 months of diagnosis with a CD4 count ≤200 cells per µL), or neither. We used multinomial logistic regression adjusting for sociodemographic and behavioral characteristics to determine the effects of depression and anxiety on HIV care-seeking behavior.
Among 1482 HIV-infected adults, 59% were female and mean age was 33 years. The prevalence of depression in the cohort was 33% and anxiety was 9%. In adjusted models, mild to moderate depression was not associated with delayed presentation or late testing. HIV-infected adults with severe depression had 3.6 greater odds (95% confidence interval [CI], 1.2-10.2) of delayed presentation and 2.2 greater odds (95% CI, 1.01-4.8) of late testing compared with those without depression. Individuals with generalized anxiety had 2.3 greater odds (95% CI, 1.3-4.2) of delayed presentation compared with those without anxiety.
Severe depression was associated with delayed presentation and late testing, while anxiety was associated only with delayed presentation. Screening for mental health services may improve antiretroviral therapy initiation and linkage to care following HIV testing.
在撒哈拉以南非洲地区，医疗机构和社区为改善人类免疫缺陷病毒（HIV）检测所做的努力可能得益于了解心理健康如何影响 HIV 患者寻求医疗服务的行为。
我们在南非乌姆拉齐镇进行了一项针对接受 HIV 检测的成年人的研究。在检测之前，我们使用 9 项患者健康问卷（PHQ-9）评估抑郁症状，使用 7 项广泛性焦虑症量表（GAD-7）评估焦虑症状。我们将患者分为延迟就诊者（首次 HIV 阳性检测后 >3 个月就诊）、延迟检测者（在诊断后 3 个月内就诊，CD4 计数≤200 个细胞/µL）或两者都不是。我们使用调整了社会人口学和行为特征的多项逻辑回归来确定抑郁和焦虑对 HIV 患者寻求医疗服务行为的影响。
在 1482 名 HIV 感染的成年人中，59%为女性，平均年龄为 33 岁。队列中抑郁的患病率为 33%，焦虑的患病率为 9%。在调整后的模型中，轻度至中度抑郁与延迟就诊或延迟检测无关。与无抑郁的患者相比，患有严重抑郁的 HIV 感染者延迟就诊的可能性增加了 3.6 倍（95%置信区间 [CI]，1.2-10.2），延迟检测的可能性增加了 2.2 倍（95% CI，1.01-4.8）。与无焦虑的患者相比，患有广泛性焦虑的患者延迟就诊的可能性增加了 2.3 倍（95% CI，1.3-4.2）。
严重抑郁与延迟就诊和延迟检测相关，而焦虑仅与延迟就诊相关。对心理健康服务进行筛查可能会改善 HIV 检测后的抗逆转录病毒治疗启动和与医疗服务的衔接。
