Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers' perspectives.

BACKGROUND: Mental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study's objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon. METHODS: We analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study. RESULTS: Respondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers' ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon. CONCLUSIONS: Providers reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.

The STOPBANG score is effective for obstructive sleep apnea syndrome screening and correlates with its features, in a sub-Saharan African population.

INTRODUCTION: the STOPBANG score is an easy-to-use screening tool for obstructive sleep apnea (OSA), which has not been validated in sub-Saharan Africa (SSA). We sought to evaluate its diagnostic performance in Cameroun. METHODS: this community-based study took place in a sub-urban area, from November 2015 to April 2016. Adults aged ≥19 years underwent a clinical assessment, including the STOPBANG and the Epworth sleepiness scale (ESS) questionnaires. A respiratory polygraph (RP) was performed on a randomly selected sample. Diagnosis performance included sensitivity (Se), specificity (Sp), and positive and negative predictive values (PPV and NPV). An association was sought between STOPBANG and OSA features. RESULTS: a total of 3033 were interviewed, of whom 102 had a RP. Their mean age was 49.1±17.9 years, the sex ratio was 1 and the mean body mass index 29.1±6.1 kg/m2. For OSA screening (apnea-hypopnea index (AHI) ≥5), the STOPBANG score at threshold 3 obtained: Se=82.9%, Sp=34.4%, PPV=45.9% and NPV=75.0%. For moderate-to-severe OSA (IAH ≥15), these values were 93.3%, 31.1%, 18.9% and 96.4% respectively. Furthermore, STOPBANG-based high risk of OSA correlated with AHI (9.1±10.7/hr vs 3.8±3.5/hr, p=0.0003) and oxygen desaturation index (6.4±7.9/hr vs 2.6±2.1/hr, p=0.0004). There was a non-significant association with ESS (6.3±5.3 vs 4.5±3.5, p=0.06). CONCLUSION: in this Cameroonian population, the STOPBANG diagnostic performance did not differ from the original Caucasian one. It could therefore be proposed on a larger scale, since obesity and other OSA risk factors are increasing in SSA.