Department of Maternal and Child 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.
J Int AIDS Soc. 2023 Aug;26(8):e26147. doi: 10.1002/jia2.26147.
Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020.
In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys.
Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048).
Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed.
常见精神障碍（CMD）在 HIV 感染者中高度流行。将精神卫生保健纳入 HIV 护理可能会改善心理健康和 HIV 治疗结果。我们描述了 2020 年参加国际艾滋病流行病学数据库评估联盟（IeDEA）的全球 HIV 治疗中心报告的抑郁、焦虑和创伤后应激障碍（PTSD）筛查和治疗的可用性，以及 2016/2017 年至 2020 年间中低收入国家（LMICs）站点可用性的变化。
2020 年，有 238 个向 IeDEA 联盟提供个体数据的站点有资格参加关于 CMD 筛查和治疗可用性的 IeDEA 站点调查，2016/2017 年，IeDEA 在 LMICs 的分层随机抽样站点也有资格参加该调查。我们评估了 27 个 LMICs 中 68 个参与了这两项调查的站点的时间趋势。
在有资格参加 2020 年站点调查的 238 个站点中，有 227 个（95%）参加了调查，在 41 个国家的 223 个（98%）站点提供了心理健康筛查和治疗数据。共有 29 个 LMICs 的 95 个站点完成了 2016/2017 年的调查。2020 年，68%的站点位于城市地区，77%的站点位于 LMICs。总的来说，分别有 50%、14%和 12%的站点报告使用经过验证的工具筛查抑郁症、焦虑症和 PTSD。46%、13%和 11%的站点分别提供了以咨询形式进行的抑郁症、焦虑症和 PTSD 的筛查加治疗，36%、11%和 8%的站点分别提供了以药物形式进行的抑郁症、焦虑症和 PTSD 的筛查加治疗。在参加了这两项调查的站点中，2020 年筛查抑郁症的比例高于 2016/2017 年（分别为 75%和 59%，p = 0.048）。
在 2016/2017 年至 2020 年期间，参与该研究的 LMICs 中 IeDEA 站点报告的抑郁症筛查可用性有所增加。然而，在全球范围内的 HIV 治疗站点，精神保健服务的可用性仍然存在很大差距，特别是在资源有限的环境中。需要实施可持续的策略，将精神卫生服务纳入 HIV 护理。
