Antiretroviral therapy non-adherence and its relationship with cognitive impairment, alcohol use disorder, and depression in adolescents living with HIV.

OBJECTIVE: We aimed to compare antiretroviral non-adherence in the behaviourally infected (BIAs) and congenitally infected adolescents (CIAs) and explore its associations with depression, cognitive impairment, and alcohol use disorder (AUD) in adolescents living with HIV(ALWHIV) in Botswana. METHODS: This study was a cross-sectional, comparative, multi-center research that involved collecting samples from different HIV clinics in Botswana. Of the 622 ALWHIV, 223 were identified as BIAs and 399 as CIAs. They were evaluated using various tools such as MINI-KID for psychiatric disorders, DSM-5 for AUD, CAT-rapid for cognitive assessment, and Visual Analogue Scale (VAS) for non-adherence (the outcome). The data were analysed using both bivariate and multivariate regression analyses. RESULTS: The participants' mean age (SD) was 17.7(1.60). The CIAs were more likely to have cognitive impairment (t -7.25; p < 0.01), while the BIAs had more depression (χ2 = 5.86; p = 0.016) and AUD (χ2 = 4.39; p = 0.036) and were more likely to be non-adherent (t = 3.14; p = 0.002). In the CIA group, cognitive impairment (AOR = 2.86; 95% CI:1.77-4.64) (AOR = 2.79; 95%CI:1.73-4.48) and depression (AOR = 2.69; 95%CI:1.48-4.90 were associated with ART non-adherence. In the BIA group, depression (AOR = 2.55; 95%CI:1.27-5.16), AUD (AOR = 2.58; 95%CI:1.21-5.49) and struggling to accept status (AOR = 2.54; 95%CI:1.41-4.56) predicted non-adherence to treatment. CONCLUSION: The two groups of adolescents differ regarding ART non-adherence and associated psychosocial issues, indicating the need for differentiated care to address non-adherence in the ALWHIV, especially in high-burden, resource-constrained settings, such as Botswana.

Psychiatric disorders in adolescents living with HIV in Botswana.

BACKGROUND: As children living with HIV transition from adolescence into adulthood, they face a considerable burden of psychiatric disorders (PDs) which may vary between the perinatally and behaviorally infected. The knowledge of the pattern of these PDs in relation to the varying needs of the adolescents living with HIV (ALWHIV) is unclear but necessary for maximizing their linkage to care and improving their quality of life in Botswana.  AIM: To determine the pattern of PDs in ALWHIV in Botswana; to compare and explore the differences in the pattern and their associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). METHODS: A cross-sectional survey of 622 ALWHIV (399 CIA and 223 BIA) with the Mini International Neuropsychiatric Interview-Kid Screen. RESULTS: The participants' mean age (SD) was 17.71 (1.60) years, with more males (54%), of whom 52.9% had at least one PD, with depression (23.6%) and generalised anxiety disorder (18.0%) being the most prevalent. The externalising disorders were associated with being CIA (OR = 3.99; 95% CI:1.87-8.54), male gender (OR = 3.93; 95% CI:2.02-7.64), and a viral load of 400 and above copies (OR = 3.53; 95%CI:1.92-6.48). Internalising disorders were associated with being BIA (OR = 3.64; 95%; CI: 2.39-5.56), females (OR = 2.59; 95% CI:1.75-3.83), poor counselling (OR = 2.23; 95% CI: 1.42-3.51) and struggling to accept HIV status (OR = 1.73; 95% CI:1.14-2.62). CONCLUSIONS: Depression and anxiety disorders were the most prevalent PDs in ALWHIV, who differed in psychiatric presentations, the BIAs being more likely to present with internalizing disorders, while the CIAs had more externalizing disorders. Due to the varying needs of ALWHIV, individualized management plans that consider gender, mode of infection, and other psycho-social needs, should be further studied and encouraged.

Psychiatric disorders and associated risk factors in a sample of adolescents in Gaborone, Botswana: a cross-sectional study.

BACKGROUND: Despite the high proportion of adolescents living with mental health issues in low- to middle-income countries (LMICs), especially in Botswana, there is a significant deficit of local research to guide an increase in prevention and treatment. We, therefore, aimed to assess the prevalence and associated risk factors of psychiatric disorders (PD) in a sample of secondary school students in Botswana. METHODS: This cross-sectional study included 750 students from the 13 public secondary schools in Gaborone using a multi-stage sampling technique. The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was used to screen for PDs. RESULTS: The participant's mean age was 15.26 and SD 1.57 years, with 53.6% being female. Approximately 34% had a PD, with depression being the commonest, of whom 35% were neither receiving treatment nor aware of the available services. Perinatal complications (AOR = 4.29; 95%CI: 1.04-17.70), a family history of mental illness (AOR = 2.19; 95%CI: 1.17-4.11) and substance-related problems (AOR = 1.80; 95% CI:1.22-2.65) predicted the likelihood of developing PD. CONCLUSIONS: Our findings revealed that adolescents in Botswana have many mental health issues which may affect their developmental phases. A multi-sectoral collaboration is needed for the timely detection of identified risk factors and initiation of the necessary prevention and treatment measures.

Psychiatric Disorders in Adolescents Living with HIV and Association with Antiretroviral Therapy Adherence in Sub-Saharan Africa: A Systematic Review and Meta-analysis.

In sub-Saharan Africa (SSA), a systematic approach to exploring the prevalence of psychiatric disorders (PDs) and adherence to antiretroviral treatment (ART) in adolescents living with HIV (ALWHIV) is lacking. This study aimed to systematically review the studies conducted in SSA on the prevalence of PDs among ALWHIV and their association with ART adherence. A systematic search of all English studies assessing PDs among ALWHIV using the Web of Science, PubMed, and EBSCO databases was conducted between March 1 and September 30, 2019. Forty-two studies published between 2009 to 2019 met the inclusion criteria, of which 15 were included in the meta-analysis. The most common PDs were depression (0.24, 95% CI 0.14-0.36) and anxiety disorder (0.26, 95% CI 2-0.44). The available evidence could not conclude on the definitive association between PDs and ART adherence; therefore, further research is required. However, the need for mental health integration in the care for ALWHIV is evident.

RESUMEN: En África subsahariana (SSA), falta un enfoque sistemático para explorar la prevalencia de los trastornos psiquiátricos (PDs) y la adherencia al tratamiento antirretroviral (ART) en adolescentes que viven con el VIH (ALWHIV). Este estudio tuvo como objetivo revisar sistemáticamente los estudios realizados en la SSA sobre la prevalencia de PDs en ALWHIV y su asociación con la adherencia al ART. Se realizó una búsqueda sistemática de todos los estudios en inglés que evalúan PDs entre ALWHIV utilizando las bases de datos Web of Science, PubMed y EBSCO entre el 1 de marzo y el 30 de septiembre de 2019. Cuarenta y dos estudios publicados entre 2009 y 2019 cumplieron los criterios de inclusión, de los cuales 15 se incluyeron en el metanálisis. Los TP más frecuentes fueron depresión (0.24, 95% CI 0.14­0.36) y trastorno de ansiedad (0.26, 95% CI 2­0.44). La evidencia disponible no pudo concluir sobre la asociación definitiva entre los PDs y la adherencia al ART; por lo tanto, se requiere más investigación. Sin embargo, la necesidad de la integración de la salud mental en la atención de ALWHIV es evidente.

Neuroticism, resilience, and social support: correlates of severe anxiety among hospital workers during the COVID-19 pandemic in Nigeria and Botswana.

BACKGROUND: The role of healthcare workers (HCWs) during the COVID-19 pandemic may make them more susceptible to anxiety than the general population. This study aimed to determine the prevalence of anxiety and evaluate the potential effects of resilience, neuroticism, social support, and other sociodemographic factors on anxiety among HCWs from two African countries. METHODS: A cross-sectional survey of 373 HCWs was conducted in Botswana and Nigeria, using an anxiety rating scale, neuroticism subscale of Big Five Inventory, Oslo social support scale, and Resilience Scale. Data collection was done between May 1 and September 30, 2020. RESULTS: The participants' mean age (SD) was 38.42 (8.10) years, and 65.1% were females. Forty-nine (13.1%) of the HCWs reported clinical anxiety. In the final model of hierarchical multiple regression, neuroticism (B = 0.51, t = 10.59, p = p < 0.01), resilience (B = 0.34, t = - 7.11, p < 0.01), and social support (B = 0.079, t = - 2.11, p = 0.035) were associated with severe anxiety, after controlling for the significant sociodemographic factors. CONCLUSIONS: Severe anxiety exists among HCWs in Africa, although the rate was lower than reported elsewhere. Neuroticism, resilience, and social support may be vital targets for psychological intervention in a pandemic as COVID-19; thus, their roles should be further explored.

Attention-deficit hyperactivity disorder in school-age children in Gaborone, Botswana: Comorbidity and risk factors.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Its occurrence and pattern of presentation are unknown in Botswana. AIM: To determine the prevalence of attention-deficit hyperactivity disorder (ADHD), associated comorbid conditions and risk factors amongst school-age children in Botswana. SETTING: Primary schools in Gaborone, Botswana. METHODS: This study used a cross-sectional design. A two-stage random sampling technique was utilised to select learners from 25 out of the 29 public schools in the city. The Vanderbilt ADHD Diagnostic Rating Scale (VADRS), teacher and parent versions, was administered. RESULTS: Of the 1737 children, 50.9% (n = 884) were male, and their mean age was 9.53 years (s.d. = 1.97). The prevalence of ADHD was 12.3% (n = 213). The most prevalent presentation was the predominantly inattentive, 7.2% (n = 125). A family history of mental illness (odds ratio [OR] = 6.59, 95% CI: 1.36-32.0) and perinatal complications (OR = 2.16, 95% CI: 1.08-4.29) emerged as the independent predictors of ADHD. CONCLUSIONS: The prevalence of ADHD in Botswana is slightly higher than that reported in the literature, but the pattern of presentations and comorbidities is similar. A positive family history of mental illness and perinatal complications independently predicted ADHD. Mental health screening amongst families of the affected individuals and improved perinatal care should be considered as health care priorities in Botswana.

Predictors of bullying reported by perpetrators in a sample of senior school students in Benin City, Nigeria.

BACKGROUND: Bullying behaviour amongst adolescents is becoming a significant public health challenge. Whilst the traditional and electronic bullying as reported by victims has been widely reported, surveys amongst perpetrators, particularly in Africa, are still lacking. AIM: This study is aimed at determining the prevalence of bullying by perpetrators and analysing the relationship between bullying perpetration and psycho-socio-demographic characteristics amongst senior school students in Benin City, Nigeria. SETTING: Senior secondary school in Benin City, Nigeria. METHODS: A cross-sectional survey of 465 final-year secondary school students aged 16-19 years, who were selected by multistage random sampling, was conducted. The students were made to fill a self-designed questionnaire, in addition to an adapted version of the Wagnild and Young's resilience scale. RESULTS: The lifetime prevalence of bullying was 16.3%. Binary logistic regression revealed bullying to be significantly associated with students who are male (adjusted odds ratio [AOD] = 2.13, confidence interval [CI] = 1.16-3.93), have poor relations with their teachers (AOR = 2.98, CI = 1.68-5.29), have used alcohol (AOR = 3.51, CI = 1.74-7.09) and are involved in cult and gangsterism (AOR = 9.14, CI = 2.55-32.75). CONCLUSION: The rate of bullying perpetration by youth in Benin City, Nigeria, is significant and is comparable to global occurrence. The predictors of bullying in this study suggest that perpetrators are individuals who may benefit from rehabilitative measures.

Psychoactive substance use among first-year students in a Botswana University: pattern and demographic correlates.

BACKGROUND: Substance use amongst university students is a recognized problem worldwide. Few studies have been carried out in this group in Botswana. These studies have been mostly limited to the use of alcohol and tobacco. Therefore, this study was designed to investigate the pattern of general substance use, its association with psychological distress and common socio-demographic factors among first-year undergraduates in a Botswana University. METHODS: A total of 401 students were interviewed using a modified W.H.O. student drug use questionnaire and the 12 item General Health Questionnaire (GHQ12) to assess the pattern of psychoactive substance use and its relationship with psychological distress amongst university students in Botswana. RESULTS: Alcohol was the most (31.9%) commonly used psychoactive substance. Age of debut for most psychoactive substances was between the ages of 15-18 years. Current use of alcohol (p = 0.045), amphetamine-type stimulants (p = 0.004) and benzodiazepines (p = 0.021) were associated with significant psychological distress. A positive relationship was observed between low participation in religious activities and substance use (OR = 4.63, 95%CI: 2.03-10.51), while a negative association was observed between not having a friend who uses drugs and substance use (OR = 0.44, 95%CI: 0.19-0.99). CONCLUSIONS: There is a significant substance abuse problem in the undergraduate population in Botswana. Our findings followed the global trend, with alcohol being the most commonly used substance. Religious participation demonstrates potential to be one of the solutions to this problem, but how to harness its seemingly protective influences is a field for further study.

Physical violence against health staff by mentally ill patients at a psychiatric hospital in Botswana.

BACKGROUND: Workplace violence is worrisome in the mental health sector. Little is understood about it in sub-Saharan Africa. Consequently, we decided to investigate the prevalence, related factors, and the available sources of support for the victims of workplace violence in a mental referral hospital in Botswana. METHODS: We conducted a cross-sectional retrospective survey of 201 mental health staff (MHS) of Sbrana Psychiatric Hospital, Botswana. We used a self-administered questionnaire to obtain information on socio-demographics and various aspects of work-related violence and available source of supports. We also used Andrew and Withey Job Satisfaction Questionnaire to assess the workers' level of job satisfaction. RESULTS: One hundred and seventy-nine questionnaires out of the two hundred and one returned were analyzed. One hundred and twenty-five (69.8%) of the respondents reported a lifetime experience of physical violence, while 44.1% experienced the same during the previous 12 months. Nursing services (χ2 = 29.95, p < 0.01) and long duration of service (χ2 = 29.95, p < 0.01) were associated with lifetime encounter of physical violence. Those who reported a physical assault had a higher level of job dissatisfaction than staff who never experienced violence (t = - 3.07, p = 0.02). CONCLUSIONS: The rate of physical violence among mental health workers in Botswana is comparably high, and nurses are the most exposed members of staff. Protocol development and periodic training on violence prevention are hence recommended, especially for the most exposed members of staff.

Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana.

BACKGROUND: There is a dearth of data on polypharmacy in child and adolescent mental health in Africa, especially Botswana where children and adults are treated in the same facility by general adult psychiatrists. This study was therefore designed to assess the prevalence and the risk factors of psychiatric polypharmacy among children and adolescents treated at Sbrana Psychiatric Hospital, Lobatse, Botswana. METHODS: Data involving socio-demographics, diagnosis (using ICD-10 classification) and pharmacological treatment were retrieved from the records of 120 children and adolescents aged below 18 years, between 1 January 2012 and 31 July 2016, who presented with psychiatric disorders. They were analysed with univariate and multivariate models. RESULTS: The prevalence of psychiatric polypharmacy was 29.2%. Psychiatric co-morbidity (OR = 3.374, 95% CI: 1.177-9.9673) and psychotropic side effects (OR = 5.782, 95% CI: 1.636-20.430) were significantly associated with polypharmacy after regression analysis. CONCLUSION: Psychiatric co-morbidity and psychotropic side effects were significant risk factors for polypharmacy in Botswana.

Gender and other risk factors associated with risky behaviours among Nigerian adolescents.

Risky behaviours in adolescents, apart from substance use, and their associate factors, have not been thoroughly investigated in Nigeria. Hence, there is a need to study the prevalence of risky behaviours and their relationship with gender and other potential risk factors. Data comprising socio-demographic, risky behaviours, personality traits, religious orientation and substance use were obtained from 300 randomly selected secondary school students. Two risk groups (low and high) based on the number of risky behaviours were determined. Male was a risk factor for theft (OR = 2.1; 95%CI = 1.17-3.95), bullying (OR = 2.76; 95%CI = 1.37-5.56) and fighting (OR = 2.14; 95%CI = 1.35-3.40). Fifty-two (17.3%) of the students were of high-risk behaviour group. Furthermore, private school (ß = 1.05; P = 0.010), poor perceived relationship with teachers (ß = 1.21; P = 0.002), polygamy (ß = 1.20; P = 0.002) and lifetime cigarette use (ß = 1.07; P = 0.027) were predictors of high-risk behaviour group. Substantial proportion of adolescents in Nigeria exhibit risky behaviours of which gender and other factors play a significant role.

The quality of life and its inter-relationship with posttraumatic stress disorder and social support in two post-conflict communities in Nigeria.

The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community's location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables.

Neuropsychiatric manifestations of tuberous sclerosis in a young man in a psychiatric hospital in Botswana: a case report.

Tuberous sclerosis complex (TSC), first described in 1880, is a disorder that affects multiple systems. Its symptoms include seizures, intellectual disability, and angiofibromas. TSC is caused by mutations in the TSC1 and TSC2 genes and is inherited in an autosomal dominant manner. The present report describes the case of a patient with an unusual psychological presentation who was evaluated in a psychiatric hospital. A man with poorly managed epilepsy was brought to Botswana's only psychiatric hospital. After clinical assessment, a diagnosis of tuberous sclerosis complex was made, which was later confirmed through neuroimaging and genetic tests. Some of the patient's relatives also showed similar neuropsychiatric symptoms. Given that psychiatry may be the first medical contact for TSC patients, especially in low-resource settings, clinicians need to be knowledgeable of various neuropsychiatric conditions and be aware of the possibility of TSC in patients that present with neurocutaneous manifestations. A multidisciplinary team approach is vital for the investigation and management of such cases.

Association between dopamine receptor D2 Taq IA gene polymorphism (rs1800497) and personality traits.

Objective: This study aimed to find a potential association between the DRD2 Taq1A gene polymorphism (rs1800497 C32806T) and personality traits. Methods: In all, 249 youths were recruited for this study. The Short-form Revised Eysenck Personality Questionnaire was administered to assess personality traits. The participants were genotyped for the DRD2 Taq1A polymorphism using the polymerase chain reaction-restriction fragment length polymorphism method. Statistical analysis was carried out to find a possible association between the genotypes and aspects of personality traits assessed. Results: The frequencies of the A1 and A2 alleles in our sampled population were 215 (43.2%) and 283 (56.8%), while the frequencies of A1A1, A1A2, and A2A2 were 67 (26.9%), 81 (32.5%), and 101 (40.6%), respectively. The study population was not in Hardy-Weinberg equilibrium (χ2 = 17.64, p < 0.001). The A2 allele was significantly associated with extraversion. Although this allele was also associated with neuroticism, psychoticism, and lie, the association was not significant. Conclusion: The A2 allele of the DRD2 Taq1A polymorphism was found to be more associated with extraversion, as measured by the Short-form Revised Eysenck Personality Questionnaire.

Psychoactive Substance Use Disorder in HIV-Infected Adolescents in Botswana: A Comparison Between the Congenitally Infected and Behaviorally Infected Adolescents.

Substance use is a major obstacle to preventing and managing HIV among adolescents, who account for 30% of new infections in many parts of the world, including Botswana. Unfortunately, there is a paucity of data on adolescent substance use, especially in the region. Therefore, this study aimed to determine the pattern of psychoactive substance use in adolescents living with HIV (ALWHIV). It also aimed to compare and explore the pattern of substance use disorders and associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Six hundred and thirty-four ALWHIV were interviewed using a sociodemographic questionnaire, the WHO drug questionnaire, and DSM-5 criteria for substance use disorder. The participants' mean age (SD) was 17.69 (1.6) years, with a male predominance (n = 336, 53%), and the majority (n = 411, 64.8%) were CIAs. Alcohol was the most used substance among the participants, with 15.8% admitting to its current use. The BIAs were more likely to have SUD (χ2 = 17.2, P < .01), use more than one substance (χ2 = 20.3, P < .01), and more likely to use all psychoactive substances except for inhalants. In the CIAs, regular participation in religious activities was negatively associated with SUD (AOR = 0.36; 95% CI: 0.17-0.77), while struggling with HIV status acceptance was positively associated with SUD (AOR = 2.54; 95% CI: 1.15-5.61) in the BIAs. This study showed a huge burden and similar pattern of substance use disorders among the ALWHIV in Botswana, as reported elsewhere. It also identified the dissimilarities between the BIAs and CIAs regarding substance-related issues and suggested the need for differentiated care.

The effectiveness of psychoeducation and problem-solving on depression and treatment adherence in adolescents living with HIV in Botswana: an exploratory clinical trial.

BACKGROUND: This study aimed to explore the effectiveness of psychological interventions (PI): psychoeducation, problem-solving, and rehearsal strategies on depression and adherence in HIV-infected adolescents in Botswana. METHODS: Fifty adolescents living with HIV were randomized into control (n = 25) and intervention groups (n = 25), the latter being exposed to five weeks of PI sessions. The PHQ-9 and visual analog scale (VAS) were used to measure the outcomes: depression and adherence at pre-intervention, 5- and 24 weeks post-intervention. RESULTS: The participants' mean age (SD) was 17.38 years (1.1), the two groups being similar in socio-demographic variables: gender (χ2 = 2.22; p = 0.135) and age (U = 285, z = - 0.55, p = 0.579). The intervention group scored significantly lower on depressive symptoms (PHQ-9 [F (1,50) = 12.0, p = 0.001, ƞp2 = 0.20]) and higher on adherence score (VAS [F (1,50) = 13.5, p = 0.001, ƞp2 = 0.22]) than the control group after 5 weeks. The post-hoc analysis showed that the significant improvements in depressive symptoms (z = - 4.03, p < 0.01, r [effect size] = 0.88) and adherence (z = - 4.05, p < 0.01, r = 0.88) at post-test in the intervention group were maintained at 24 weeks. This project was registered with ClinicalTrials.gov (NCT05482217). CONCLUSION: The 5-week PI showed promising effectiveness in addressing depression and adherence in adolescents living with HIV in Botswana.

Association of Dopamine Transporter Gene (DAT1) 40 bp 3' UTR VNTR Polymorphism (rs28363170) and Cannabis Use Disorder.

Introduction: Cannabis remains the most widely used illicit drug among Nigerians, often associated with psychiatric disorders. Since genetic predisposition has been implicated in substance use disorders, we, therefore, aimed at finding out the relationship between dopamine transporter gene (DAT1) polymorphism and cannabis use disorder. Methods: We recruited 104 patients from a tertiary psychiatric facility in Lagos, Nigeria, who were diagnosed with cannabis use disorder according to ICD-10 and 96 non-smokers as a comparative group. The smokers were screened with Cannabis Use Disorder Identification Test (CUDIT), and cannabis dependence was assessed with the Severity of Dependence Scale (SDS). Genotyping was carried out for the 40 bp 3' UTR VNTR of the DAT1 (rs28363170). Results: The frequencies of 9R/9R, 9R/10R, 10R/10R among non-smokers and smokers were 14 (14.3%), 25 (26.2%), 57 (59.5%) and 17 (16.3%), 54 (51.9%), 33 (31.7%) respectively. The genotype distribution was in Hardy Weinberg equilibrium (HWE) only in the smokers' population (χ² = 1.896, P = .166). Individuals with the 10R allele were almost twice as likely as the 9R carriers to smoke cannabis (OR = 1.915, 95% CI: 1.225-2.995). However, this polymorphism was not associated with the quantity of cannabis smoked, age at onset of smoking, CUDIT, and SDS scores. Conclusion: The DAT VNTR polymorphism was associated with cannabis smoking but not cannabis use disorder.

Depression and suicidal behavior among adolescents living with HIV in Botswana: a cross-sectional study.

BACKGROUND: Depression and suicidal behavior are the main causes of disability and morbidity, especially in adolescents living with HIV (ALWHIV). Data regarding these are lacking in Botswana, a country with a predominantly youthful population and ranked among the top four in the world most affected by HIV. Therefore, the present study aimed to estimate the prevalence of depression and suicidal behavior and explore their associated factors in Botswana ALWHIV. METHODS: Responses were obtained from 622 ALWHIV using the DSM-5 and the Mini-International Neuropsychiatric Interview for Children and Adolescents. RESULTS: The mean age (SD) of the participants was 17.7 (1.60) years and more males (54.3%) participated than females. Depression and suicidal behavior rates among adolescents were 23% and 18.9%, respectively. Female participants were more likely to be depressed (AOR = 1.96; 95% CI 1.11-3.45) and have suicidal behaviour (AOR = 6.60; 95% CI 3.19-13.7). Loss of mother (AOR = 2.87; 95% CI 1.08-7.62) and viral load of 400 copies and above (AOR = 5.01; 95% CI 2.86-8.78) were associated with depression. Alcohol use disorder (AOR = 3.82; 95% CI 1.83-7.96) and negative feelings about status (AOR = 8.79; 95% CI 4.62-16.7) were associated with suicidal behavior. Good support (AOR = 0.42; 95% CI 0.23-0.76) and increased frequency of religious activities were protective (AOR = 0.33; 95% CI 0.14-0.79) against depression and suicidal behaviour, respectively. CONCLUSION: Therefore, routine psychologic screening, which includes identifying psychological stressors and maladaptive coping, family and caregiver support services, and psychosocial support platforms, should be integrated into the management package for ALWHIV in Botswana.

Pattern of substance use and substance use disorder in adolescent learners at public secondary schools in Gaborone, Botswana.

INTRODUCTION: Substance use amongst adolescents remains a global public health challenge. The potential negative health outcomes of substance use suggest the need to understand the pattern of use and the associated factors among adolescents. This study aimed to describe the prevalence of substance use, SUDs, and PD and the associated factors in adolescent learners at public schools in Gaborone, Botswana. METHODS: A cross-sectional study was conducted at 13 public secondary schools in Gaborone among 742 students. Assessment tools included the World Health Organization drug questionnaire, DSM-5 interview for SUD, and the General Health Questionnaire-12. RESULTS: The mean age (SD) of the participants was 15.26 (1.57) years, and there were more females (55.5%). Over two-fifths (44.6%) of learners reported psychoactive substance use in the past 12 months, and 31.5% meeting DSM 5 criteria for a SUD. Alcohol was the most used psychoactive substance (25.1%). Male gender (AOR = 1.94; 95% CI: 1.26-2.995), having a friend (AOR = 4.27; 95% CI: 2.68-6.78), or father (AOR = 1.87; 95% CI: 1.14-3.04), who uses substance, and higher levels of PD (AOR = 1.09; 95% CI: 1.03-1.17) remained significantly associated with SUD. Regular participation in religious activities negatively correlated with SUD (AOR = 0.61; 95% CI: 0.38-0.96). CONCLUSION: The high prevalence of substance use and SUDs among in-school adolescents is concerning. Substance use programs need to include family-focused and religious-based therapy and youth empowerment in developing positive peer relationships. Also, they should be integrated with mental health screening to assess comorbid PD.

Psychosocial predictors of anxiety and depression in a sample of healthcare workers in Botswana during the COVID-19 pandemic: A multicenter cross-sectional study.

Objectives: This study aimed to investigate the psychological impact of the COVID-19 outbreak on healthcare workers across multiple hospitals in different districts in Botswana. Methods: We conducted a cross-sectional study in five public-funded hospitals from three districts in Botswana from 1 June 2020 to 30 October 2020. We used the neuroticism subscale of the 44-item Big Five Inventory, Patient Health Questionnaire, the Oslo 3-item Social Support Scale, the Anxiety Rating Scale, and the 14-item Resilience Scale to obtain data from 355 healthcare workers. Results: The participants' mean age (standard deviation) was 33.77 (6.84) years. More females (207, 59%) responded than males (144, 41%). Anxiety and depression were experienced by 14% and 23% of the participants, respectively. After multiple regression analyses, neuroticism predicted depression (B = 0.22; p < 0.01) and anxiety disorder (B = 0.31; p < 0.01). Lower educational status (B = -0.13; p = 0.007) predicted anxiety and younger age (B = -0.10; p = 0.038) predicted depression, while resilience negatively correlated with both disorders. Conclusion: There is a need to develop and implement interventions targeted at these identified risk and protective factors that can be easily delivered to healthcare workers during this pandemic.