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BJPsych Open ; 6(5): e104, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32886056


BACKGROUND: Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. AIMS: This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). METHOD: A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10-24 years) in LMICs. RESULTS: Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver-adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. CONCLUSIONS: Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.

Curr HIV/AIDS Rep ; 17(5): 529-546, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32776179


PURPOSE OF REVIEW: We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. RECENT FINDINGS: ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

EClinicalMedicine ; 23: 100333, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32637890


Background: There is a lack of data from low- and middle-income countries on whether anxiety independently predicts a more chronic course for depression. Methods: We undertook secondary data analysis of a cluster randomised controlled trial in Zimbabwe which had tested the effectiveness of the Friendship Bench intervention for common mental disorders compared to enhanced usual care. Inclusion for the current study was participants from the trial who had probable major depression at baseline, defined as scoring => 11 on the locally validated Patient Health Questionnaire (PHQ9). This emerged to be 354 of the original 573 (61.78%) of the original trial sample. Anxiety was measured using the locally validated cut-point on the Generalised Anxiety Disorder scale (GAD-7). Persistent depression was defined as scoring => 11 on the PHQ-9 at six-months follow-up. Analysis in Stata 15 used random-effects logistic regression to adjust for clustering by clinic. Outcomes: Of the 354 participants who were eligible for treatment, 329 (92·9%) completed 6-month follow-up assessment. 37% of the trial sample had persistent depression at 6-months follow-up; 59% in the control arm and 17% in the intervention arm. Co-morbid anxiety present at trial baseline was independently associated with persistent depression after adjusting for age, gender and baseline depression severity (adjusted OR = 2·83, 95% CI 1·32-6·07). There was no evidence of effect modification by trial arm. Baseline depression severity also predicted persistent depression. Interpretation Treatment for depression in low and middle-income countries (LMIC) should be directed towards those with greatest need. This includes people with co-morbid anxiety and greater depression severity at initial assessment who are less likely to remit at six months. Advice on coping with anxiety, psychological treatments which target common anxiety symptoms such as fear, avoidance, excessive worry and intrusive thoughts, and Selective Serotonin Reuptake Inhibitors (SSRIs) should be made more widely available in LMIC and offered to those with persistent mixed depression and anxiety.

Brain Behav Immun ; 73: 261-273, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29768184


This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = -0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.

Depresión/terapia , Infecciones por VIH/inmunología , Infecciones por VIH/psicología , Adulto , África del Sur del Sahara , Fármacos Anti-VIH/uso terapéutico , Depresión/psicología , Trastorno Depresivo Mayor/inmunología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Intervención Médica Temprana/métodos , Femenino , VIH/inmunología , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Resultado del Tratamiento
Psychiatr Serv ; 59(3): 322-5, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18308916


OBJECTIVE: This study examined the association between socioeconomic deprivation and extended hospitalization in severe mental disorder, after taking account of confounding variables. METHODS: A representative sample of 660 inpatients from South Auckland, New Zealand, was followed for two years from their index admission. Additional data were collected during the index admission for a subsample of 291 patients. RESULTS: Greater levels of socioeconomic deprivation in the inpatient's neighborhood of residence was associated with extended hospitalization after adjustment for demographic factors and primary diagnosis but not after adjustment for comorbid diagnosis, chronicity, function, and severity. Most extended hospitalizations were related to poor illness recovery. CONCLUSIONS: People from more deprived areas are likely to need longer psychiatric admissions, mostly because of the association between deprivation and having more disabling symptoms and a comorbid psychiatric diagnosis. Interventions to prevent psychiatric hospitalization, reduce duration of stay, and enhance recovery must be tested among those with greater levels of socioeconomic deprivation.

Tiempo de Internación/estadística & datos numéricos , Esquizofrenia/rehabilitación , Adulto , Áreas de Influencia de Salud , Grupos Étnicos/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Índice de Severidad de la Enfermedad , Factores Socioeconómicos
Br J Psychiatry ; 188: 581-2, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16738350


Adults from South Auckland, New Zealand who required acute admission to hospital were followed from admission to discharge. After adjusting for demographic factors, diagnosis, chronicity, severity, consultant psychiatrist and involuntary admission, the length of stay for those from more deprived areas was significantly longer by 7 days than for those from less deprived areas. Information on socio-economic deprivation should be used in discharge planning and in optimising access to community care. Research is needed on group-level factors that may affect recovery from mental disorders.

Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/terapia , Áreas de Pobreza , Adulto , Femenino , Humanos , Masculino , Nueva Zelanda , Pobreza , Factores Socioeconómicos