Accuracy of alternative PHQ-9 scoring algorithms to screen for depression in people living with HIV in Sub-Saharan Africa.

BACKGROUND: Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The nine-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH. SETTING: five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal and the Republic of Congo. METHODS: Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity, and area under the curve (AUC)) of the traditional PHQ-9 scoring (positive screening - score≥10) was compared to alternative scoring algorithms including: i) the presence of ≥1 mood symptom (PHQ-9 items 1&2) combined with ≥2 other symptoms listed in the PHQ-9, and ii) a simplified recoding of each 4-response item into two categories (absence/presence). RESULTS: A total of 735 participants were included (54% female, median age 42 years [IQR 34-50]). Depression was diagnosed by a psychiatrist in 95(13%) participants. Alternative scoring sensitivities (0.59 to 0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC were significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability. CONCLUSION: As a primary screening test, new scoring algorithms appeared to improve the PHQ-9 sensitivity in identifying depression and reduce heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.

PrEP in the key population community: a qualitative study of perspectives on pre-exposure prophylaxis by men who have sex with men and female sex workers in Kigali, Rwanda.

Background: Men who have sex with men (MSM) and female sex workers (FSW) are increasingly and disproportionately impacted by HIV in sub-Saharan Africa, yet current PrEP care models in this region are not optimized for these communities. Limited data exist describing experiences and preferences of MSM and FSW with respect to accessing and using PrEP. Methods: We conducted qualitative, semi-structured interviews with MSM and FSW recruited from three health centers and seven community organizations in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive approach to describe key themes related to initiating and adhering to PrEP. Results: Participants included 18 MSM and 14 FSW; 12 were using PrEP at the time of interview, 9 had previously used PrEP, and 11 had never used it. Participants highlighted the central role of their social networks as key sources of information about and support for PrEP use, and described a strong motivation to use PrEP as a way to protect both themselves and their communities from HIV. While stigma and discrimination were pervasive, these were experienced differently by MSM and FSW. Participants suggested community access points that allowed more discreet and less frequent contact with health care workers as important and desired strategies to improve engagement. Conclusions: These findings suggest that leveraging community resources for disseminating information about HIV prevention and delivering PrEP could contribute to successful implementation of PrEP for MSM and FSW in Rwanda and other settings in SSA.

Accuracy of nine-item Patient Health Questionnaire against psychiatric diagnosis for depression among people with HIV.

OBJECTIVE: The aim of this study was to assess the performance of the nine-item Patient Health Questionnaire (PHQ-9) against psychiatrist diagnosis in people with HIV (PWH). DESIGN: Cross-sectional analysis of data collected between January 2018 and July 2022 across five sites in Cameroon, Cote d'Ivoire, Kenya, Senegal, and the Republic of Congo. Participants were ≥18 years and receiving HIV care at the participating site. PHQ-9 was administered by study staff followed by a psychiatrist's evaluation within 3 days. RESULTS: Overall, 778 participants with complete data were included: 297 (38.2%) in Cameroon, 132 (17.0%) in Congo, 148 (19.0%) in Cote d'Ivoire, 98 (12.6%) in Kenya, and 103 (13.2%) in Senegal. The area under the curve for PHQ-9 score was generally high ranging from 0.935 [95% confidence interval (CI): 0.893, 0.977] in Cote d'Ivoire to 0.768 (95% CI: 0.589, 0.947) in Congo. However, for the common cut-off score ≥10, sensitivity was low: 50% or lower in Cameroon, Congo and Senegal, 66.7% in Kenya and 70.6% in Cote d'Ivoire. But negative predictive values (NPV) were high: 98.9% (95% CI: 96.9%, 99.8%) in Cameroon, 96.1 (95% CI: 91.1, 98.7) in Cote d'Ivoire, 96.3% (95% CI: 89.7%, 99.2%) in Kenya, 95.7% (95% CI: 90.2%, 98.6%) in Congo, and 89.0% (95% CI: 81.2%, 94.4%) in Senegal. INTERPRETATION: Across all countries, PHQ-9 score ≥10 performed very poorly (low sensitivity) as a tool to identify psychiatrist diagnosed depression. However, the observed high NPV suggests it can be used to rule out depression.

The Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA): protocol for a prospective cohort study in Africa, Southeast Asia and Latin America.

INTRODUCTION: Tuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity and mortality. Following TB treatment, surviving individuals may be at risk for post-TB lung disease. The TB Sentinel Research Network (TB-SRN) provides a platform for coordinated observational TB research within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS AND ANALYSIS: This prospective, observational cohort study will assess treatment and post-treatment outcomes of pulmonary TB (microbiologically confirmed or clinically diagnosed) among 2600 people aged ≥15 years, with and without HIV coinfection, consecutively enrolled at 16 sites in 11 countries, across 6 of IeDEA's global regions. Data regarding clinical and sociodemographic factors, mental health, health-related quality of life, pulmonary function, and laboratory and radiographic findings will be collected using standardised questionnaires and data collection tools, beginning from the initiation of TB treatment and through 12 months after the end of treatment. Data will be aggregated for proposed analyses. ETHICS AND DISSEMINATION: Ethics approval was obtained at all implementing study sites, including the Vanderbilt University Medical Center Human Research Protections Programme. Participants will provide informed consent; for minors, this includes both adolescent assent and the consent of their parent or primary caregiver. Protections for vulnerable groups are included, in alignment with local standards and considerations at sites. Procedures for requesting use and analysis of TB-SRN data are publicly available. Findings from TB-SRN analyses will be shared with national TB programmes to inform TB programming and policy, and disseminated at regional and global conferences and other venues.

Low birth weight among infants and pregnancy outcomes among women living with HIV and HIV-negative women in Rwanda.

Introduction: In utero exposure to HIV and/or triple antiretroviral therapy (ART) have been shown to be associated with preterm births and low birth weight (LBW), but data from low-resources settings with high burden of HIV remain limited. This study utilized retrospective data to describe pregnancy outcomes among Rwandan women living with HIV (WLHIV) and HIV-negative women and to assess the association of HIV and ART with LBW. Methods: This study used data from a large cohort of WLHIV and HIV-negative women in Rwanda for a cross-sectional analysis. Retrospective data were collected from antenatal care (ANC), delivery, and Prevention of Mother to Child Transmission (PMTCT) registries within the Central Africa International Epidemiology Databases to Evaluate AIDS (CA-IeDEA) in Rwanda. Data from women with documented HIV test results and known pregnancy outcomes were included in the analysis. Analyses for predictors of LBW (< 2,500 g) were restricted to singleton live births. Logistic models were used to identify independent predictors and estimate the odd ratios (OR) and 95% confidence intervals (CI) measuring the strength of their association with LBW. Results and discussion: Out of 10,608 women with known HIV status and with documented pregnancy outcomes, 9.7% (n = 1,024) were WLHIV. We restricted the sample to 10,483 women who had singleton live births for the analysis of the primary outcome, LBW. Compared with HIV-negative women, WLHIV had higher rates of stillbirth, preterm births, and LBW babies. Multivariable model showed that WLHIV and primigravidae had higher odds of LBW. Lower maternal weight and primigravidae status were associated with greater odds of LBW. Among WLHIV, the use of ART was associated with significantly lower odds of LBW in a bivariate analysis. Even in a sample of relatively healthier uncomplicated pregnancies and women who delivered in low-risk settings, WLHIV still had higher rates of poor pregnancy outcomes and to have LBW infants compared to women without HIV. Lower maternal weight and primigravidae status were independently associated with LBW. Given that supplementary nutrition to malnourished pregnant women is known to decrease the incidence of LBW, providing such supplements to lower-weight WLHIV, especially primigravidae women, might help reduce LBW.

Techniques for Increasing Educational Motivation and the Need to Assess Students' Knowledge: The Effectiveness of Educational Digital Games in Learning English Grammatical Material.

Educational digital games can be an effective way to teach English grammatical material because they provide an interactive and engaging learning experience. The purpose of this study is to clarify how playing digital games affects students' motivation and performance in university-level English grammar classes. [The North-Eastern Federal Institute of MK Ammosova in Neryungri] used a quasi-experimental study, testing, respondent survey, and statistical data analysis method for this purpose. 114 Fourth-year students were the participants, and they were split into the experimental and control groups at random. Students in the experimental group were given a learning format that included the use of digital games designed to teach English grammar (Quizlet and Kahoot!). The traditional teaching strategies offered by the university curriculum were used with the students in the control group (written assignments, textbooks, presentations, and tests). The post-test revealed that the control group's results were nearly identical to those of the pre-test. The students in the experimental group performed better. The proportion of students scoring "poor" fell from 30 to 10%, while the proportion scoring "moderate" fell from 42 to 27%. The "good" score increased from 17 to 40%, and the "excellent" score increased from 11 to 23%. These results suggest that digital games are a more productive and effective tool for teaching English grammar than traditional games. Students were also highly motivated, as they found digital games to be both entertaining and effective for language acquisition. Academic performance did not significantly improve. Based on this, future research might create electives or courses that teach English grammar more successfully using gamification techniques. These results can also be used to guide future research in education, language acquisition, and modern technology.

HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross-sectional study in the Democratic Republic of Congo.

INTRODUCTION: Disclosure of one's HIV status may decrease depression and improve the quality of life among people living with HIV. However, there is mixed evidence on the impact of disclosure to partners for pregnant women living with HIV (WLHIV) in areas of intersecting social concerns over disclosure and high prevalence of intimate partner violence (IPV). We assessed the association between HIV disclosure and depressive symptoms among pregnant WLHIV in the Democratic Republic of Congo (DRC) and examined whether the knowledge of partner's status or recent IPV modified this association. METHODS: We utilized data from participants enrolled in a trial to evaluate the effect of continuous quality interventions on long-term therapy outcomes among HIV-positive pregnant and breastfeeding women in DRC (NCT03048669). Only pregnant women (n = 1392) were included in this cross-sectional analysis. Between November 2016 and June 2019, enrolled participants completed a survey that included the Patient Health Questionnaire-9 (PHQ-9) to screen recent depressive symptoms, questions about disclosure, knowledge of partner's status and IPV. We used linear models to calculate crude and adjusted mean differences (MDs) between disclosure and depressive symptoms. All analyses were stratified by timing of HIV diagnosis. RESULTS: Disclosure was higher among participants diagnosed prior to current pregnancy (41% to their partners and 24% to family, friends or others) relative to those diagnosed during current pregnancy (21% to partners and 12% to family). About one-quarter of women reported any type of IPV in the past 12 months. Disclosure to a partner was associated with lower depressive symptoms among women diagnosed prior to current pregnancy (MD -0.55; 95% CI: -1.06, -0.04) but the opposite was observed among those diagnosed during current pregnancy (MD 0.5; 95% CI: -0.4, 1.4). Adjustment for IPV, knowledge of partner's status, age, number of living children and primigravidae did not change MDs substantially. CONCLUSIONS: Women in our sample mostly disclosed to partners despite high IPV burden. The observed association between disclosure to partners and lower depressive symptoms among women diagnosed prior to current pregnancy is consistent with cross-national evidence. A prospective study among pregnant WLHIV is needed to examine longitudinal effects of HIV status disclosure.

Worry, work, discrimination: Socioecological model of psychological distress among Central Asian immigrant women in Russia.

The Russian Federation is a major immigrant-receiving nation and hosts large immigrant populations from post-Soviet countries including Central Asia. However, there is yet little research on their health needs, and especially on mental health of immigrant women. This study uses qualitative data from 72 interviews with women from Kyrgyzstan, Tajikistan, and Uzbekistan conducted in two large cities in Central Russia, Kazan and Nizhny Novgorod, from April 2014 to February 2017. This study examines psychological distress among immigrant women and applies a gendered socioecological lens to understand its causes. We have identified intersecting factors that operate at different levels and cause distress in Central Asian immigrant women in Russia. Gendered vulnerabilities, persistent worry about their families' well-being, separation from loved ones, and limited sources of social support are key individual and interpersonal level of distress factors. Poor working and housing conditions along with economic hardships and concerns over their ability to reach the goals that guided their decisions to move to Russia reinforce experienced distress among immigrant women. Discrimination against Central Asian nationals and structural racism amplify challenges for immigrants' psychological well-being and mental health in Russia. By investigating underlying factors of psychological distress among an understudied immigrant population, this study defines configurations of Russia's risk environment and contributes to an understanding of migration as an important determinant of mental health.

Integral estimation of systemic inflammatory response under sepsis.

Currently, the most significant mediators of the systemic inflammatory response (SIR), specific to the development of critical states in sepsis, have the chaotic changes of concentrations in the blood. The solution to the problem is using integral indicators. A scoring scale of the SIR (0-16 points) is proposed based on the determination in the blood plasma of CRP, TNF-α, IL-6, IL-8 and IL-10. The scale was used in the survey of 167 patients with a diagnosis of sepsis (43 patients with sepsis according to definitions of "Sepsis-1 or 2" and 124 patients with sepsis according to the criteria of "Sepsis-3"); septic shock was verified in 31 cases and in 48 cases lethal outcomes were recorded. The association of SIR with critical complications of sepsis was revealed, especially under acute septic shock and in cases of a "second wave" (days 5-7) of critical complications. In contrast, prolonged/subacute sepsis (more than 14 days) under tertiary peritonitis is characterised by a lesser dependence of the criticality of the state on the severity of SIR. The proposed scale is an open system and allows you to modify the range of used particular indicators that are compatible by pathogenetic and diagnostic significance.

Professional Longevity as a Problem of the Value-Semantic Regulation of Teacher Activity.

The aim of this research is to establish proper external and internal conditions for conducting pedagogical activity that reveal the value basis of professional education. The research justifies the need to analyse the guidelines of a person's professional self-identity, contents of professional activity motivation, peculiarities of maintaining the mental and physical health of a person, and the capacity of an educational institution's organisational culture. A number of indicators of value mechanisms of a teacher's professional longevity is revealed. A diagnostic program of the project, aimed at studying the value content of a teacher's behaviour strategies during the process of professional activity, was designed. The content of the hypothesis is connected with the assumption of value-semantic inter-conditionality of professional longevity. The research revealed significant interrelations of professional longevity with some psychological factors of value-semantic nature. Analysis of the organisational culture of an educational institution as a factor providing (preventing) the professional longevity of a teacher was carried out. The dominant tendency of describing the interconnection between an educational institution's organisational culture and the level of emotional burnout syndrome of teachers working within certain cultural models is revealed.

Cellular Stress and General Pathological Processes.

From the viewpoint of the general pathology, most of the human diseases are associated with a limited number of pathogenic processes such as inflammation, tumor growth, thrombosis, necrosis, fibrosis, atrophy, pathological hypertrophy, dysplasia and metaplasia. The phenomenon of chronic low-grade inflammation could be attributed to non-classical forms of inflammation, which include many neurodegenerative processes, pathological variants of insulin resistance, atherosclerosis, and other manifestations of the endothelial dysfunction. Individual and universal manifestations of cellular stress could be considered as a basic element of all these pathologies, which has both physiological and pathophysiological significance. The review examines the causes, main phenomena, developmental directions and outcomes of cellular stress using a phylogenetically conservative set of genes and their activation pathways, as well as tissue stress and its role in inflammatory and para-inflammatory processes. The main ways towards the realization of cellular stress and its functional blocks were outlined. The main stages of tissue stress and the classification of its typical manifestations, as well as its participation in the development of the classical and non-classical variants of the inflammatory process, were also described. The mechanisms of cellular and tissue stress are structured into the complex systems, which include networks that enable the exchange of information with multidirectional signaling pathways which together make these systems internally contradictory, and the result of their effects is often unpredictable. However, the possible solutions require new theoretical and methodological approaches, one of which includes the transition to integral criteria, which plausibly reflect the holistic image of these processes.

Financial and Emotional Support in Close Personal Ties among Central Asian Migrant Women in Russia.

This study advances research on the role of personal networks as sources of financial and emotional support in immigrants' close personal ties beyond the immediate family. Because resource scarcity experienced by members of immigrant communities is likely to disrupt normatively expected reciprocal support, we explored multi-level predictors of exchange processes with personal network members that involve (1) only receiving support, (2) only providing support, and (3) reciprocal support exchanges. We focus on an understudied case of Central Asian migrant women in the Russian Federation using a sample of 607 women from three ethnic groups-Kyrgyz, Tajik, Uzbek-who were surveyed in two large Russian cities-Nizhny Novgorod and Kazan. The survey collected information on respondents' demographic, socioeconomic, and migration-related characteristics, as well as characteristics of up to five individuals with whom they had a close relationship. Multi-level multinomial regression analyses were used to account for the nested nature of the data. Our results revealed that closer social relationships (siblings and friends) and greater levels of resources (income and regularized legal status) at both ego and alter levels were positively related to providing, receiving, and reciprocally exchanging financial and emotional support. Egos were more likely to provide financial assistance to transnational alters, whereas they were more likely to engage in mutual exchanges of emotional support with their network members from other countries. Personal network size and density showed no relationship with support exchanges. These findings provide a nuanced picture of close personal ties as conduits for financial and emotional support in migrant communities in a major, yet understudied, migrant-receiving context.

Kinetic and mechanistic studies of proline-mediated direct intermolecular aldol reactions.

Reaction progress kinetic analysis of the proline-mediated intermolecular aldol reaction shows that the rate depends on the concentrations of both the donor ketone1 and the electrophilic aldehyde 2, implying that enamine formation cannot be rate-determining. The observed kinetics and deuterium isotope effects are consistent with formation of the product iminium species as the rate-determining step.