A cross-cultural comparison of psychological distress among individuals living with HIV in Atlanta, Georgia, and Eldoret, Kenya.

Elevated psychological distress during HIV infection has been consistently correlated with negative HIV-related health outcomes in studies conducted in various regions of the world. This study was conducted to compare the nature and range of psychological distress among HIV-infected individuals who had sought mental health care as part of their HIV care in Kenya and the United States. The Brief Symptom Inventory (BSI) was completed by 234 individuals with HIV in Atlanta, Georgia, USA, and 284 in Eldoret, Kenya. The US-based sample expressed markedly higher levels of psychological distress symptoms on the anxiety, depression, interpersonal sensitivity, obsessive-compulsive, and psychoticism dimensions, as well as the overall global severity index. Substantial proportions of both the US and Kenya cohorts expressed higher levels of somatization and paranoid ideation that suggested further psychological evaluation. This study revealed psychological distress expression varied drastically among individuals who self-enrolled into HIV-related mental health care within two different care infrastructures.

Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya.

BACKGROUND: Depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings. OBJECTIVE: To assess the validity/reliability of PHQ-9 and PHQ-2. DESIGN: Observational, two occasions 7 days apart. PARTICIPANTS: A total of 347 patients attending psychosocial support groups. MEASUREMENTS: Demographics, PHQ-9, PHQ-2, general health perception rating and CD4 count. RESULTS: Rates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%, 21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 > or =3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18-35, 36-61) subgroups. CONCLUSIONS: PHQ-9 and PHQ-2 appear valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya.

Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, Kenya, 2018: a cross-sectional study.

INTRODUCTION: The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. METHODS: We conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UoN ERC), approval number P510/09/2017. We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis. RESULTS: We interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty-six (47.5%) of the patients had either stage G1 or G2, 17 (14.4%) had end-stage renal disease; 64 (54.2%) had haemoglobin below 10g/dl while 33 (28.0%) had sodium levels below 135 mmol/l. ). History of unexplained anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86); hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. CONCLUSION: Burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary.

Reduced renal function is associated with progression to AIDS but not with overall mortality in HIV-infected Kenyan adults not initially requiring combination antiretroviral therapy.

BACKGROUND: The World Health Organization (WHO) has recently recommended that antiretrovirals be initiated in all individuals with CD4 counts of less than 350 cells/mm3. For countries with resources too limited to expand care to all such patients, it would be of value to able to identify and target populations at highest risk of HIV progression. Renal disease has been identified as a risk factor for disease progression or death in some populations. METHODS: Times to meeting combination antiretroviral therapy (cART) initiation criteria (developing either a CD4 count < 200 cells/mm3 or WHO stage 3 or 4 disease) and overall mortality were evaluated in cART-naïve, HIV-infected Kenyan adults with CD4 cell counts ≥200/mm3 and with WHO stage 1 or 2 disease. Cox proportional hazard regression models were used to evaluate the associations between renal function and these endpoints. RESULTS: We analyzed data of 7383 subjects with a median follow-up time of 59 (interquartile range, 27-97) weeks. In Cox regression analyses adjusted for age, sex, WHO disease stage, CD4 cell count and haemoglobin, estimated creatinine clearance (CrCl) < 60 mL/min was significantly associated with shorter times to meeting cART initiation criteria (HR 1.34; 95% CI, 1.23-1.52) and overall mortality (HR 1.73; 95% CI, 1.19-2.51) compared with CrCl ≥60 mL/min. Estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 was associated with shorter times to meeting cART initiation criteria (HR 1.39; 95% CI, 1.22-1.58), but not with overall mortality. CrCl and eGFR remained associated with shorter times to cART initiation criteria, but neither was associated with mortality, in weight-adjusted analyses. CONCLUSIONS: In this large natural history study, reduced renal function was strongly associated with faster HIV disease progression in adult Kenyans not initially meeting cART initiation criteria. As such, renal function measurement in resource-limited settings may be an inexpensive method to identify those most in need of cART to prevent progression to AIDS. The initial association between reduced CrCl, but not reduced eGFR, and greater mortality was explained by the low weights in this population.

Characteristics of psychosocial support seeking during HIV-related treatment in western Kenya.

While the characteristics of those who seek psychosocial support following an HIV diagnosis have been well documented in western countries where linkages between HIV-related treatment and psychosocial support programs are well established, little is known about those who become engaged with such services in countries of the world where comprehensive HIV-related care and prevention systems are continuing to develop. Data were collected from 397 individuals who had enrolled in HIV-related psychosocial support groups in western Kenya in November 2005. Demographic and HIV-related characteristics, as well as assessments of psychological distress, were collected from each participant and analyzed by gender in order to document the characteristics of those seeking psychosocial care in conjunction with their participation in an HIV-related treatment and prevention program. Those seeking psychosocial support were primarily female (72%), living with HIV for an average of 2.5 years, and unemployed (70%). Women were younger and more likely to be either widowed or never married; while men were more likely to have advanced HIV disease, including lower CD4 counts and an AIDS diagnosis. Across all participants, HIV serostatus disclosure was rarely reported to sex partners, family members, and friends. Symptoms of psychological distress were more prevalent among women on multiple measures, including depression, anxiety, paranoid ideation, interpersonal sensitivity, and somatization. An increased understanding of the characteristics of those likely to seek psychosocial support groups will help HIV program managers to develop protocols necessary for facilitating linkages to psychosocial support for those enrolled in HIV-related treatment programs. Patient engagement in psychosocial support may facilitate improvements in psychological function and support an individual's maintenance of HIV treatment and prevention behaviors.