Clinical Department, Ministry of Health, Zomba Mental Hospital, Zomba, Malawi.
Department of Psychiatry & Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
PLoS One. 2023 Feb 6;18(2):e0278160. doi: 10.1371/journal.pone.0278160. eCollection 2023.
Common mental disorders (CMDs) and risky alcohol use are highly prevalent among people living with HIV, yet many do not receive treatment for these mental health problems. In Malawi, despite a mental health policy aiming to include mental healthcare into primary health care, many clients with HIV go unscreened and untreated for mental illnesses, indicating missed opportunities to offer mental health care to people living with HIV. The aim of this study was to determine the numbers and types of missed opportunities for screening and treatment of CMDs and risky alcohol use amongst a sample of people living with HIV attending anti-retroviral (ART) clinics in Zomba Malawi. A descriptive cross-sectional clinic survey was used, at three ART clinics in the Zomba district. Random sampling was conducted for all clients attending their ART clinics on specific days. The study surveyed 382 participants living with HIV. Of these participants, the majority were women (N = 247, 64.7%), and 87 (22.8%) screened positive for CMDs and/or alcohol misuse using the self-reporting questionnaire 20 (SRQ-20) and alcohol use disorder identification test (AUDIT). Of these, only 47 (54%) had been screened by health workers for CMDs or risky alcohol use in the past 12 months, and 66 (76%) wanted to receive treatment. Of the total sample of 382 participants, only 92 (24%) and 89 (23%) had been screened for CMDs or risky alcohol use by health workers. Failures by clinical officers and nurses to screen or treat CMDs and risky alcohol use in ART clinics represent missed opportunities to address the mental health of people living with HIV. Providing psychoeducation for staff, guidelines for screening and managing CMDs and alcohol use, increasing human resources, and accelerating implementation of the mental health policy in Malawi may be a few ways of improving mental health service provision at ART clinics in Malawi.
常见精神障碍（CMDs）和危险饮酒在 HIV 感染者中普遍存在，但许多人并未接受这些心理健康问题的治疗。在马拉维，尽管有一项精神卫生政策旨在将精神保健纳入初级保健，但许多 HIV 感染者未接受精神疾病的筛查和治疗，表明错过了向 HIV 感染者提供精神保健的机会。本研究旨在确定在马拉维宗巴地区的三个抗逆转录病毒（ART）诊所接受治疗的 HIV 感染者样本中，筛查和治疗 CMDs 和危险饮酒的机会错失的数量和类型。采用描述性横断面诊所调查，在宗巴区的三个 ART 诊所进行。在特定日子里，对所有参加 ART 诊所的患者进行随机抽样。该研究调查了 382 名 HIV 感染者。其中，大多数是女性（N=247，64.7%），87 人（22.8%）使用自我报告问卷 20（SRQ-20）和酒精使用障碍识别测试（AUDIT）筛查出患有 CMDs 和/或酒精滥用。其中，只有 47 人（54%）在过去 12 个月中接受过卫生工作者筛查 CMDs 或危险饮酒，66 人（76%）希望接受治疗。在 382 名参与者的总样本中，只有 92 人（24%）和 89 人（23%）接受过卫生工作者的 CMDs 或危险饮酒筛查。临床医生和护士未能在 ART 诊所筛查或治疗 CMDs 和危险饮酒，这代表着错过了解决 HIV 感染者心理健康问题的机会。为工作人员提供心理教育、筛查和管理 CMDs 和酒精使用的指南、增加人力资源以及加快在马拉维实施精神卫生政策，可能是改善马拉维 ART 诊所精神卫生服务的几种方法。
