Prevalence and correlates of probable post-traumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe.

Background: We investigated the prevalence of and factors associated with post-traumatic stress disorder (PTSD) and common mental disorders (CMDs), which include depression and anxiety disorders, in a setting with a prevalence of high human immunodeficiency virus (HIV) within a primary care clinic, using the PTSD Checklist for DSM-5 and the 14-item Shona Symptom Questionnaire, both locally validated screening tools. Methods: A cross-sectional survey was carried out with adult patients (n = 204) from the largest primary care clinic facility in Harare, Zimbabwe, in June 2016. Results: A total of 83 patients (40.7%) met the criteria for probable PTSD, of whom 57 (69.5%) had comorbid CMDs. Among people living with HIV, 42 (55.3%) had PTSD. Probable PTSD was associated with having experienced a negative life event in the past 6 months [adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.49-9.34] or screening positive for one or more CMD (adjusted OR 6.48, 95% CI 3.35-2.54). Conclusion: People living with HIV showed a high prevalence of PTSD and CMD comorbidity. PTSD screening should be considered when the CMD screen is positive and there is a history of negative life events.

Antecedentes: Investigamos la prevalencia y los factores asociados con TEPT y trastornos mentales comunes (TMC) que incluyen depresión y trastornos de ansiedad en una zona de alta prevalencia del VIH, en un centro de atención primaria (APS), utilizando el cuestionario de trastorno por estrés postraumático (PCL-5) y el cuestionario de sintomas de Shona (SSQ-14), ambos instrumentos validados localmente.Métodos: se realizó un estudio transversal con pacientes adultos (n = 204) del centro de atención primaria de salud más grande de Harare en junio de 2016.Resultados: Un total de 83 (40.7%) cumplieron los criterios para probable TEPT, de los cuales 57 (69.5%) presentaron TMC comórbido. Entre las personas que viven con el VIH (PLWH), 42 (55.3%) tenían TEPT. El TEPT probable, se asoció con haber experimentado un evento de vida negativo en los últimos seis meses (AOR 3,73; IC del 95%: 1,49 - 9,34) o con el screening positivo para TMC (AOR 6,48; IC del 95%: 3,35 - 2,54).Conclusión: Las personas que viven con el VIH (PLWH) mostraron una alta prevalencia de TEPT y comorbilidad con TMC. Se debe considerar la detección de TEPT cuando el screening para TMC es positivo y hay un historial de eventos vitales negativos.

Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe.

BACKGROUND: There is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe. METHODS: A mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up. RESULTS: Five cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up. CONCLUSION: Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.