在喀麦隆的国家“治疗所有”政策下，艾滋病毒护理中登记时的心理健康与抗逆转录病毒治疗的开始：一项横断面分析。

Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national "treat all" policy: a cross-sectional analysis.

机构信息

Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, North Carolina, USA.

出版信息

J Int AIDS Soc. 2021 Nov;24(11):e25842. doi: 10.1002/jia2.25842.

DOI:10.1002/jia2.25842

PMID:34811945

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8609224/

Abstract

INTRODUCTION

Rapid antiretroviral treatment (ART) initiation reduces time from HIV infection to viral suppression, decreasing HIV transmission risk. Mental health symptoms may influence timing of ART initiation. This study estimated the prevalence of ART initiation at enrolment into HIV care and the relationship between mental health and ART initiation at enrolment into HIV care.

METHODS

We conducted interviews with 426 individuals initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the association between mental health and timing of ART initiation. Depression (Patient Health Questionnaire-9; cut-point 10), anxiety (Generalized Anxiety Disorder-7; cut-point 10), post-traumatic stress disorder (PTSD) (PTSD Checklist for DSM-5; cut-point 31) and harmful alcohol use (Alcohol Use Disorders Identification Test; cut-point 16) were dichotomized to represent those with and without each exposure at first HIV care appointment. Date of ART initiation (date ART prescribed) was ascertained from medical records. Separate multivariable log-binomial regression models were used to estimate the association between mental health exposures and ART initiation at enrolment into care.

RESULTS AND DISCUSSION

Overall, 87% initiated ART at enrolment into HIV care. Approximately 20% reported depressive symptoms, 15% reported PTSD symptoms, 12% reported anxiety symptoms and 13% reported harmful alcohol use. In multivariable analyses, individuals with moderate to severe depressive symptoms had 1.7 (95% confidence interval [CI] 1.1, 2.7) times the prevalence of not initiating ART at enrolment into HIV care compared to those with no or mild depressive symptoms. Those with symptoms of PTSD, compared to those without, had 1.9 (95% CI 1.2, 2.9) times the prevalence of not initiating ART at enrolment into HIV care. Symptoms of anxiety or harmful drinking were not associated with ART initiation at enrolment into HIV care in multivariable models.

CONCLUSIONS

Symptoms of depression and PTSD were associated with lower prevalence of ART initiation at enrolment into HIV care among this sample of individuals initiating HIV care in Cameroon under a "treat all" policy. Research should examine barriers to timely ART initiation, whether incorporating mental health services into HIV care improves timely ART initiation, and whether untreated symptoms of depression and PTSD drive suboptimal HIV care outcomes.

摘要

简介

快速抗逆转录病毒治疗（ART）的启动可以缩短从 HIV 感染到病毒抑制的时间，从而降低 HIV 传播的风险。心理健康症状可能会影响 ART 启动的时间。本研究估计了在进入 HIV 护理时开始 ART 的比例，以及心理健康与进入 HIV 护理时开始 ART 之间的关系。

方法

我们对 2019 年 6 月至 2020 年 3 月期间在喀麦隆开始 HIV 护理的 426 人进行了访谈，以估计心理健康与开始 ART 的时间之间的关联。使用患者健康问卷-9（PHQ-9；cut-point 10）评估抑郁，使用广泛性焦虑障碍-7（GAD-7；cut-point 10）评估焦虑，使用 PTSD 检查表 DSM-5（PTSD Checklist for DSM-5；cut-point 31）评估创伤后应激障碍，使用酒精使用障碍识别测试（AUDIT；cut-point 16）评估有害酒精使用，将上述指标分为有和无两种情况，以代表在首次接受 HIV 护理时的暴露情况。从病历中确定开始 ART 的日期（开始 ART 处方的日期）。使用多变量对数二项式回归模型来估计心理健康暴露与进入 HIV 护理时开始 ART 之间的关联。

结果与讨论

总体而言，87%的人在进入 HIV 护理时开始接受 ART。约 20%的人报告有抑郁症状，15%的人报告有 PTSD 症状，12%的人报告有焦虑症状，13%的人报告有有害酒精使用。在多变量分析中，与无或轻度抑郁症状相比，中度至重度抑郁症状的个体在进入 HIV 护理时不开始 ART 的比例高出 1.7 倍（95%置信区间 [CI] 1.1，2.7）。与无 PTSD 症状的个体相比，有 PTSD 症状的个体在进入 HIV 护理时不开始 ART 的比例高出 1.9 倍（95% CI 1.2，2.9）。焦虑或有害饮酒症状与进入 HIV 护理时开始 ART 无关。

结论

在喀麦隆，根据“治疗所有”政策，开始接受 HIV 护理的个体中，抑郁和 PTSD 症状与进入 HIV 护理时开始 ART 的比例较低有关。研究应检查及时开始 ART 的障碍，将心理健康服务纳入 HIV 护理是否改善及时开始 ART，以及未治疗的抑郁和 PTSD 症状是否会导致 HIV 护理结果不理想。