Impact of COVID-19-Related Stress and Lockdown on Mental Health Among People Living With HIV in Argentina.

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.

[Looking back but facing ahead: implementing lessons learned from the 2nd Lebanon War].

The medical system utilizes a structured culture for learning lessons in order to improve the supply of services. Various tools are utilized to evaluate performance. The aim of the article is to describe the processes for learning lessons which were carried out following the Second Lebanon War and the major lessons that were identified and implemented. Three processes were performed: a process of learning Lessons of the heaLthcare system, initiated and led by the Supreme HeaLth Authority (SHA); After action review (AAR), initiated and led by the military Medical Corps and; at a later stage, a critique, initiated and led by the State Comptroller, that examined the performance of the medical system, as part of a critique on the preparedness of the home front. The following elements were defined as highly prioritized for improvement to elevate the preparedness for a future war: (1) deployment of unified clinics in conflict areas; (2) supply of medical services to the population in shelters; (3) deploying emergency medicine services, including the relationship between the Ministry of Health (MOH) and the Home Front Command (HFC); (4) defining the relationships between the MOH and HFC in deploying the community health services in emergencies; (5) protecting medical facilities and personal protection equipment for medical teams and; (6) treating acute stress reactions. The AAR, critique and learning lessons signify three different processes that can sometimes be contradictory. Nevertheless, it is possible to achieve organizational improvement white integrating between these three processes, as was displayed by the SHA.