Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Institute for Global Health, University College London, London, UK.
BMC Public Health. 2021 Mar 10;21(1):478. doi: 10.1186/s12889-021-10527-z.
HIV affects many adolescent girls and young women (AGYW) in South Africa. Given the bi-directional HIV and mental health relationship, mental health services may help prevent and treat HIV in this population. We therefore examined the association between common mental disorders (CMD) and HIV-related behaviours and service utilisation, in the context of implementation of the combination DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) HIV prevention programme in rural uMkhanyakude district, KwaZulu-Natal. DREAMS involved delivering a package of multiple interventions in a single area to address multiple sources of HIV risk for AGYW.
We analysed baseline data from an age-stratified, representative cohort of 13-22 year-old AGYW. We measured DREAMS uptake as a count of the number of individual-level or community-based interventions each participant received in the last 12 months. CMD was measured using the validated Shona Symptom Questionnaire, with a cut off score ≥ 9 indicating probable CMD. HIV status was ascertained through home-based serotesting. We used logistic regression to estimate the association between CMD and HIV status adjusting for socio-demographics and behaviours.
Probable CMD prevalence among the 2184 respondents was 22.2%, increasing steadily from 10.1% among 13 year-old girls to 33.1% among 22 year-old women. AGYW were more likely to report probable CMD if they tested positive for HIV (odds ratio vs. test negative: 1.88, 95% confidence interval: 1.40-2.53). After adjusting for socio-demographics and behaviours, there was evidence that probable CMD was more prevalent among respondents who reported using multiple healthcare-related DREAMS interventions.
We found high prevalence of probable CMD among AGYW in rural South Africa, but it was only associated with HIV serostatus when not controlling for HIV acquisition risk factors. Our findings highlight that improving mental health service access for AGYW at high risk for HIV acquisition might protect them. Interventions already reaching AGYW with CMD, such as DREAMS, can be used to deliver mental health services to reduce both CMD and HIV risks. There is a need to integrate mental health education into existing HIV prevention programmes in school and communities.
艾滋病毒影响南非的许多青少年女孩和年轻妇女（AGYW）。鉴于艾滋病毒和心理健康的双向关系，心理健康服务可能有助于预防和治疗该人群的艾滋病毒。因此，我们在夸祖鲁-纳塔尔省农村乌姆坎亚库德区实施 DREAMS（坚定、有韧性、有能力、无艾滋病、有指导、安全）艾滋病毒预防方案的背景下，研究了常见精神障碍（CMD）与艾滋病毒相关行为和服务利用之间的关联。DREAMS 涉及在一个单一地区提供一揽子多项干预措施，以解决 AGYW 艾滋病毒风险的多个来源。
我们分析了分层、代表性的 13-22 岁 AGYW 队列的基线数据。我们通过计算每个参与者在过去 12 个月内接受的个体或基于社区的干预措施的数量来衡量 DREAMS 的采用情况。CMD 使用经过验证的 Shona 症状问卷进行测量，得分≥9 表示可能患有 CMD。通过家庭血清学检测确定 HIV 状况。我们使用逻辑回归估计 CMD 和 HIV 状况之间的关联，同时调整社会人口统计学和行为因素。
2184 名应答者中，可能患有 CMD 的比例为 22.2%，从 13 岁女孩的 10.1%稳步上升到 22 岁女性的 33.1%。如果检测结果为 HIV 阳性，AGYW 更有可能报告可能患有 CMD（与检测结果阴性相比的比值比：1.88，95%置信区间：1.40-2.53）。在调整社会人口统计学和行为因素后，有证据表明，报告使用多种与医疗保健相关的 DREAMS 干预措施的应答者中，可能患有 CMD 的比例更高。
我们发现南非农村地区 AGYW 中可能患有 CMD 的比例较高，但在不控制 HIV 感染风险因素的情况下，仅与 HIV 血清阳性相关。我们的研究结果表明，改善面临 HIV 高感染风险的 AGYW 的心理健康服务获取机会可能会保护她们。已经针对 CMD 接触 AGYW 的干预措施，如 DREAMS，可以用于提供心理健康服务，以降低 CMD 和 HIV 风险。需要将心理健康教育纳入学校和社区现有的艾滋病毒预防方案中。
