Prevalence, characteristics and correlates of a positive-dementia screen in patients on antiretroviral therapy in Bamenda, Cameroon: a cross-sectional study.

BACKGROUND: In this study we assess the prevalence, characteristics as well as socio-demographic and clinical correlates of a positive screen for HIV-associated dementia in a group of patients on antiretroviral therapy (ART) in Bamenda, Cameroon. METHODS: In a cross-sectional study, a structured questionnaire was used to collect data on 400 patients attending the Bamenda Regional Hospital AIDS-treatment Centre. Patients were assessed for neurocognitive function using the International HIV Dementia Scale (IHDS) to assess finger-tapping (FT), alternating hand sequence (AHS) and a 4-word recall (4WR), each scored on a maximum of four. RESULTS: A total of 297 (74%) participants were females. The total IHDS score ranged from 6-12 with a mean of 9.02 and 85% of subjects screened positive for dementia (≤10 on IHDS). Participants performed worst in the AHS assessment with a mean of 2.25 (IQR: 2-3). In multivariable analyses, screening positive for dementia was significantly associated with having primary education or less (aOR: 8.33, 95%CI: 3.85, 16.67), and having HIV symptoms (aOR: 12.16, 95%CI: 3.08, 48.05). CONCLUSIONS: A very high proportion of patients on ART screened positive for dementia using the IHDS. This could potentially be an indication of a high prevalence of HIV-associated neurocognitive disorders in this population and or a poor performance of the IHDS in patients on ART. Future studies will need to assess the validity of the IHDS in this population of patients on ART and also evaluate long term outcomes in patients with positive dementia screens.

Validity of an interviewer-administered patient health questionnaire-9 to screen for depression in HIV-infected patients in Cameroon.

BACKGROUND: In high-income countries, depression is prevalent in HIV patients and is associated with lower medication adherence and clinical outcomes. Emerging evidence from low-income countries supports similar relationships. Yet little research has validated rapid depression screening tools integrated into routine HIV clinical care. METHODS: Using qualitative methods, we adapted the Patient Health Questionnaire-9 (PHQ-9) depression screening instrument for use with Cameroonian patients. We then conducted a cross-sectional validity study comparing an interviewer-administered PHQ-9 to the reference standard Composite International Diagnostic Interview in 400 patients on antiretroviral therapy attending a regional HIV treatment center in Bamenda, Cameroon. RESULTS: The prevalence of major depressive disorder (MDD) in the past month was 3% (n=11 cases). Using a standard cutoff score of ≥10 as a positive depression screen, the PHQ-9 had estimated sensitivity of 27% (95% confidence interval: 6-61%) and specificity of 94% (91-96%), corresponding to positive and negative likelihood ratios of 4.5 and 0.8. There was little evidence of variation in specificity by gender, number of HIV symptoms, or result of a dementia screen. LIMITATIONS: The low prevalence of MDD yielded very imprecise sensitivity estimates. Although the PHQ-9 was developed as a self-administered tool, we assessed an interviewer-administered version due to the literacy level of the target population. CONCLUSION: The PHQ-9 demonstrated high specificity but apparently low sensitivity for detecting MDD in this sample of HIV patients in Cameroon. Formative work to define the performance of proven screening tools in new settings remains important as research on mental health expands in low-income countries.