Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Department of Psychiatry, University of Oxford, Oxford, UK.
Epidemiol Psychiatr Sci. 2021 May 17;30:e37. doi: 10.1017/S2045796021000196.
Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services.
We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.
In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes.
There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.
精神障碍在艾滋病毒感染者（PLWH）中很常见，但往往得不到治疗。本研究旨在探索南非接受抗逆转录病毒治疗（ART）项目的成年人中精神障碍治疗差距以及 ART 项目在提供精神卫生服务方面的差异。
我们进行了一项队列研究，使用 ART 项目数据，并将药房和住院数据进行了关联，以检查在南非，2012 年 1 月 1 日至 2017 年 12 月 31 日期间，15-49 岁成年人的精神障碍治疗 12 个月的患病率，以及与精神障碍治疗率相关的因素，这些成年人在南非接受了一家私立护理、一家公立三级护理和两家公立初级保健 ART 项目的治疗。我们将精神障碍治疗差距计算为 PLWH（15-49 岁）中精神障碍的 12 个月患病率与 ART 项目中精神障碍治疗的 12 个月患病率之间的差异。我们使用泊松回归计算与精神障碍治疗率相关的因素的调整后率比（aRR）。
在总共 405153 人年中，有 182285 名 ART 患者接受了随访。2017 年，私立护理机构随访患者的精神障碍治疗差距估计为 40.5%（95%置信区间[CI]为 19.5-52.9），公立初级保健机构随访患者的精神障碍治疗差距估计为 96.5%（95%CI 为 95.0-97.5），公立三级保健机构随访患者的精神障碍治疗差距估计为 65.0%（95%CI 为 36.5-85.1）。抗抑郁药、抗焦虑药和抗精神病药的治疗率分别为 17（aRR 0.06，95%CI 0.06-0.07）、50（aRR 0.02，95%CI 0.01-0.03）和 2.6（aRR 0.39，95%CI 0.35-0.43），公立初级保健项目低于私立部门项目。
南非 PLWH 中存在严重的精神障碍治疗差距，在接受公共部门与私营部门 ART 的患者之间，获得精神卫生服务方面存在显著差异。在公共部门，特别是在公立初级保健机构，患有常见精神障碍的 PLWH 大多未得到治疗。
