Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland.
Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2020 Dec;23(12):e25644. doi: 10.1002/jia2.25644.
INTRODUCTION: Mental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders. METHODS: Adolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre-screening questions followed by full screening (conditional on positive pre-screening) for depression (Patient Health Questionnaire-9 [PHQ-9]), suicide (Adolescent Innovations Project [AIP]-handbook), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), post-traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC-PTSD-5]) and substance use (CAGE Adapted to Include Drugs [CAGE-AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening. RESULTS: Out of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre-screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ-9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD-7 ≥10), 38 (3.2%) for PTSD (PC-PTSD-5 ≥3), 18 (1.7%) for substance use (CAGE-AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load. CONCLUSIONS: ALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.
介绍：精神健康问题在感染艾滋病毒的青少年（ALHIV）中很常见，往往得不到治疗，可能会对抗逆转录病毒治疗（ART）的依从性和病毒抑制产生负面影响。我们在一家儿科艾滋病治疗诊所实施了常规心理健康筛查，以改善 ALHIV 中精神健康问题的识别和管理。在本报告中，我们检查了筛查结果、相关患者特征以及在筛查出精神障碍的 ALHIV 中未抑制病毒载量的几率。
方法：2018 年 2 月 1 日至 2020 年 1 月 1 日期间，在南非约翰内斯堡的 Rahima Moosa 医院就诊的 10 至 19 岁青少年在每次常规艾滋病毒护理就诊时都接受心理健康筛查。筛查包括四个预筛查问题，然后对抑郁（患者健康问卷-9 [PHQ-9]）、自杀（青少年创新项目[AIP]-手册）、焦虑（一般焦虑障碍-7 [GAD-7]）、创伤后应激障碍（ PTSD）（初级保健 PTSD 筛查[PC-PTSD-5]）和药物使用（CAGE 适应包括药物[CAGE-AID]）进行全面筛查（如果预筛查阳性）。我们评估了筛查结果，并计算了首次筛查时阳性筛查测试与在筛查后 100 天内、筛查前一天和筛查当天最接近的时间点未抑制病毒载量（>400 拷贝/ml）之间的关联的调整比值比。
结果：在 1203 名就诊的青少年中，有 1088 名（90.4%）接受了预筛查，其中 381 名（35.0%）接受了全面筛查，48 名（4.4%）筛查出抑郁（PHQ-9≥10），29 名（2.8%）有自杀倾向，24 名（2.2%）有焦虑（GAD-7≥10），38 名（3.2%）有 PTSD（PC-PTSD-5≥3），18 名（1.7%）有药物使用（CAGE-AID≥2），97 名（8.9%）有上述任何一种情况。抑郁（aOR 2.39，95%CI 1.02-5.62）、PTSD（aOR 3.18，95%CI 1.11-9.07）、药物使用（aOR 7.13，95%CI 1.60-31.86）或任何一种情况（aOR 2.17，95%CI 1.17-4.02）的阳性筛查与未抑制病毒载量高度相关。
结论：受心理健康问题影响的 ALHIV 病毒载量未得到抑制的比例较高，需要给予特殊的临床关注。在儿科艾滋病治疗方案中纳入常规心理健康筛查是一种可行的方法，可以识别和转介有心理健康和依从性问题的青少年接受咨询和社会心理支持服务，如果需要，还可以转介到精神病治疗。
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