Chikuse Elijah, Hagstrom Christine, Smith Deanna, Banda Thokozire, Chimbaka Harrison, Nkhoma Zinaumaleka, Samuko Martin, Lichenya John, Hoffman Risa, Njala Joseph, Phiri Sam, Phiri Khumbo, van Oosterhout Joep J
Partners in Hope, Lilongwe, Malawi.
University of California Los Angeles, Department of Medicine, David Geffen School of Medicine, Los Angeles, USA.
Glob Health Sci Pract. 2024 Dec 20;12(6). doi: 10.9745/GHSP-D-23-00517.
Mental health (MH) disorders are highly prevalent among people living with HIV and can have a negative impact on antiretroviral therapy (ART) outcomes. Malawi's Ministry of Health introduced MH screening in national HIV management guidelines in 2022. We describe early experience with integrated MH screening at ART clinics that have scarce human resources and limited capacity of specialist MH units. ART staff in 15 facilities were trained to use the Patient Health Questionnaire-9 (depression) and the Alcohol Use Disorders Identification Test (harmful alcohol use) screening instruments, MH registers were developed for tracking screening results and referrals, and existing MH referral units were engaged. Based on screening results, ART clients received counseling by lay cadre staff (for mild symptoms) or intensive counseling by trained psychosocial counselors and referrals to specialist MH units (for moderate to severe symptoms). From October 2022 through July 2023, 9,826 ART clients were screened from the following priority groups: returning to care after an interruption in treatment (50%), newly diagnosed (38%), and viral load ≥1,000 copies/mL (12%). Of those screened, 59% were female and 14% were aged 12-19 years. Screening coverage was 85% (9,826/11,553) among the 3 priority groups. All of the individuals who screened positive for moderate/severe depression (1.1%; n=106) or high risk for harmful alcohol use (2.3%; n=227) were referred to specialist MH units. In conclusion, thorough preparation led to high MH screening coverage among ART priority groups, and the number of referrals to specialist MH units was low. MH screening was feasible at Malawi ART clinics. Next steps include studying the clinical impact of integrated MH screening on MH outcomes and ART outcomes (retention in care and viral suppression) and scaling up integrated MH screening to all ART clinics.
心理健康（MH）障碍在艾滋病毒感染者中非常普遍，并且可能对抗逆转录病毒疗法（ART）的治疗效果产生负面影响。马拉维卫生部于2022年在国家艾滋病毒管理指南中引入了MH筛查。我们描述了在人力资源稀缺且专业MH科室能力有限的ART诊所进行综合MH筛查的早期经验。对15家医疗机构的ART工作人员进行了培训，使其使用患者健康问卷-9（用于筛查抑郁症）和酒精使用障碍识别测试（用于筛查有害饮酒）筛查工具，建立了MH登记册以跟踪筛查结果和转诊情况，并与现有的MH转诊科室进行了合作。根据筛查结果，ART患者接受了非专业干部工作人员的咨询（针对轻度症状）或由经过培训的心理社会咨询师提供的强化咨询，并被转诊至专业MH科室（针对中度至重度症状）。从2022年10月到2023年7月，对以下优先群体中的9826名ART患者进行了筛查：治疗中断后重新接受治疗的患者（50%）、新诊断的患者（38%）以及病毒载量≥1000拷贝/毫升的患者（12%）。在接受筛查的患者中，59%为女性，14%年龄在12至19岁之间。3个优先群体的筛查覆盖率为85%（9826/11553）。所有中度/重度抑郁症筛查呈阳性的个体（1.1%；n = 106）或有害饮酒高风险个体（2.3%；n = 227）均被转诊至专业MH科室。总之，充分的准备工作使得ART优先群体中的MH筛查覆盖率很高，而转诊至专业MH科室的人数较少。在马拉维的ART诊所进行MH筛查是可行的。下一步包括研究综合MH筛查对MH治疗效果和ART治疗效果（治疗依从性和病毒抑制）的临床影响，以及将综合MH筛查扩大到所有ART诊所。
