Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 4 de 4
Filtrar
1.
J Health Psychol ; 22(10): 1265-1276, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-26893295

RESUMEN

Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n=4) and patients (n=15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6months.


Asunto(s)
Antirreumáticos/uso terapéutico , Terapia Cognitivo-Conductual/métodos , Asistencia Sanitaria Culturalmente Competente/métodos , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/etnología , Evaluación de Procesos y Resultados en Atención de Salud , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Zimbabwe/etnología
2.
JAMA ; 316(24): 2618-2626, 2016 12 27.
Artículo en Inglés | MEDLINE | ID: mdl-28027368

RESUMEN

Importance: Depression and anxiety are common mental disorders globally but are rarely recognized or treated in low-income settings. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap. Objective: To evaluate the effectiveness of a culturally adapted psychological intervention for common mental disorders delivered by LHWs in primary care. Design, Setting, and Participants: Cluster randomized clinical trial with 6 months' follow-up conducted from September 1, 2014, to May 25, 2015, in Harare, Zimbabwe. Twenty-four clinics were randomized 1:1 to the intervention or enhanced usual care (control). Participants were clinic attenders 18 years or older who screened positive for common mental disorders on the locally validated Shona Symptom Questionnaire (SSQ-14). Interventions: The Friendship Bench intervention comprised 6 sessions of individual problem-solving therapy delivered by trained, supervised LHWs plus an optional 6-session peer support program. The control group received standard care plus information, education, and support on common mental disorders. Main Outcomes and Measures: Primary outcome was common mental disorder measured at 6 months as a continuous variable via the SSQ-14 score, with a range of 0 (best) to 14 and a cutpoint of 9. The secondary outcome was depression symptoms measured as a binary variable via the 9-item Patient Health Questionnaire, with a range of 0 (best) to 27 and a cutpoint of 11. Outcomes were analyzed by modified intention-to-treat. Results: Among 573 randomized patients (286 in the intervention group and 287 in the control group), 495 (86.4%) were women, median age was 33 years (interquartile range, 27-41 years), 238 (41.7%) were human immunodeficiency virus positive, and 521 (90.9%) completed follow-up at 6 months. Intervention group participants had fewer symptoms than control group participants on the SSQ-14 (3.81; 95% CI, 3.28 to 4.34 vs 8.90; 95% CI, 8.33 to 9.47; adjusted mean difference, -4.86; 95% CI, -5.63 to -4.10; P < .001; adjusted risk ratio [ARR], 0.21; 95% CI, 0.15 to 0.29; P < .001). Intervention group participants also had lower risk of symptoms of depression (13.7% vs 49.9%; ARR, 0.28; 95% CI, 0.22 to 0.34; P < .001). Conclusions and Relevance: Among individuals screening positive for common mental disorders in Zimbabwe, LHW-administered, primary care-based problem-solving therapy with education and support compared with standard care plus education and support resulted in improved symptoms at 6 months. Scaled-up primary care integration of this intervention should be evaluated. Trial Registration: pactr.org Identifier: PACTR201410000876178.


Asunto(s)
Agentes Comunitarios de Salud , Asistencia Sanitaria Culturalmente Competente , Trastornos Mentales/terapia , Atención Primaria de Salud , Solución de Problemas , Psicoterapia , Adulto , Distribución por Edad , Ansiedad/epidemiología , Ansiedad/terapia , Agentes Comunitarios de Salud/educación , Depresión/epidemiología , Depresión/terapia , Femenino , Estudios de Seguimiento , Seropositividad para VIH/epidemiología , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Cooperación del Paciente/estadística & datos numéricos , Selección de Paciente , Grupo Paritario , Distribución por Sexo , Evaluación de Síntomas , Resultado del Tratamiento , Adulto Joven , Zimbabwe/epidemiología
3.
J Affect Disord ; 198: 50-5, 2016 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-27011359

RESUMEN

BACKGROUND: In low income countries in Sub-Saharan Africa there are few validated tools to screen for common disabling mental disorders such as depression and general anxiety disorder (GAD). OBJECTIVES: We validated three screening tools: the Shona Symptom Questionnaire for common mental disorders (SSQ-14), the Patient Health Questionnaire for depression (PHQ-9), and the Generalized Anxiety Disorder questionnaire (GAD-7). The study participants were attendees at a primary health care clinic in Harare, Zimbabwe. METHODS: Consecutive adults aged 18 and above attending the clinic were enrolled over a two-week period in September 2013. Trained research assistants administered the screening tools to eligible participants after obtaining written consent. Participants were then interviewed by one of four psychiatrists using the Structured Clinical Interview of the DSM-IV (SCID). Performance characteristics were calculated for each tool, against the SCID as the gold standard. RESULTS: A total of 264 participants were enrolled, of whom 52 (20%) met the SCID criteria for depression alone, 97 (37%) for mixed depression and anxiety and 9 (3%) for anxiety alone. Of the 237 where HIV status was known, 165 (70%) were HIV positive. With the optimal cutoff of ≥9, the sensitivity and specificity for the SSQ-14 against a diagnosis of either depression and/or general anxiety were 84% (95%CI:78-89%) and 73% (95%CI:63-81%) respectively. Internal reliability was high (Cronbach α=0.74). The optimal cutoff for PHQ-9 was ≥11, which provided a sensitivity of 85% (95%CI:78-90%) and specificity of 69% (95%CI:59-77%) against a SCID diagnosis of depression (Cronbach α=0.86). The GAD-7 (optimal cutoff ≥10) had sensitivity and specificity of 89% (95%CI:81-94%) and 73% (95%CI:65-80%) respectively against a SCID diagnosis of GAD (Cronbach α=0.87). CONCLUSION: Screening tools for depression and GAD had good performance characteristics in a primary health care population in Zimbabwe with a high prevalence of HIV. These can be used for research and also in clinical care to screen patients who may benefit from treatment.


Asunto(s)
Trastornos de Ansiedad/diagnóstico , Depresión/diagnóstico , Infecciones por VIH/epidemiología , Pobreza/estadística & datos numéricos , Atención Primaria de Salud , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adolescente , Adulto , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/epidemiología , Depresión/complicaciones , Depresión/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Psicometría , Reproducibilidad de los Resultados , Adulto Joven , Zimbabwe/epidemiología
4.
Trop Med Int Health ; 20(7): 903-13, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25754063

RESUMEN

OBJECTIVE: To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. METHODS: In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. RESULTS: The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care. CONCLUSIONS: Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , Cumplimiento de la Medicación , Trastornos Mentales/complicaciones , Estrés Psicológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Cultura , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Necesidades y Demandas de Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Pobreza , Prevalencia , Estigma Social , Apoyo Social , Esposos , Estrés Psicológico/etiología , Pensamiento , Zimbabwe
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...