RESUMO
Assuntos
Atenção à Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Tuberculose/terapia , Estudos Transversais , Atenção à Saúde/estatística & dados numéricos , Saúde Global , Infecções por HIV/epidemiologia , Humanos , Incidência , Programas de Rastreamento/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Tuberculose/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/terapiaRESUMO
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
Assuntos
Antituberculosos/uso terapêutico , Depressão/epidemiologia , Tuberculose/psicologia , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Efeitos Psicossociais da Doença , Depressão/complicações , Progressão da Doença , Farmacorresistência Bacteriana , Comportamentos Relacionados com a Saúde , Humanos , Adesão à Medicação/psicologia , Assistência Centrada no Paciente/organização & administração , Estigma Social , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologiaRESUMO
Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes' difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N=102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients' lives and thus warrant further assessment and treatment.
Assuntos
Depressão , Infecções por HIV , Inflamação , Interleucina-6/sangue , Monócitos , Carga Viral , Adulto , Biomarcadores/sangue , Depressão/sangue , Depressão/classificação , Depressão/imunologia , Depressão/fisiopatologia , Feminino , Infecções por HIV/sangue , Infecções por HIV/imunologia , Humanos , Inflamação/sangue , Inflamação/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
Excess drinking poses multiple substantial health risks to HIV-infected individuals. However, no published intervention studies have focused on drinking reduction as the main outcome in HIV primary care patients. An intervention in this setting must place minimal demands on pressured staff and resources. This pilot study tested such an intervention, which consisted of brief Motivational Interviewing (MI) and HealthCall, an automated daily telephone self-monitoring system based on Interactive Voice Response (IVR), designed to extend and enhance the effects of brief MI. Thirty-one patients entered the study, received a 30-minute MI and were instructed in daily use of the IVR system. They received graphical feedback on their daily drinking from the HealthCall database after 30 days. A statistically significant decrease in drinking was found over time, both as reported in daily IVR calls (beta = - 0.01, se 0.01, p=.03) and in follow-up interviews (beta = - 0.04, se 0.12, p=.02) at 60 days. The proportion of daily calls made supported the feasibility of the intervention. The results indicate that HealthCall is acceptable to a disadvantaged HIV patient population, and preliminary data support the efficacy of this intervention in reducing harmful drinking among HIV primary care patients.
Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Infecções por HIV/psicologia , Atenção Primária à Saúde/economia , Psicoterapia Breve/economia , Adulto , Consumo de Bebidas Alcoólicas/economia , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Projetos Piloto , Psicoterapia Breve/métodos , AutorrevelaçãoRESUMO
PURPOSE: The Columbia University HIV Mental Health Training Project, created to improve the mental health workforce's AIDS preparedness in New York and neighboring states, sought to compare the perceived HIV-related needs and capacities of mental health care providers in settings where clients with substance use disorders predominated versus those where clients with substance use disorders were the minority of the agencies' caseload. METHODS: The first consecutive 67 mental health care agencies that requested HIV/AIDS training between March 2000 and January 2001 completed a written needs assessment describing their HIV-related services and training needs. RESULTS: Agencies with higher substance abuse caseloads were significantly more likely than others to have large HIV/AIDS caseloads, to be currently providing condoms to clients, and to rate staff comfort with sexual identity issues as well as drug-related issues as good. Overall, agencies that had received previous training in specific topic areas (e.g., HIV risk assessment) were significantly more likely than others to provide those services. Even so, in all settings, significant gaps in service provision were found. IMPLICATIONS: Two decades into the AIDS epidemic, mental health care agencies, especially those treating smaller caseloads of patients with substance use disorders, may not be providing sufficient services to meet their clients' HIV-related needs.
Assuntos
Infecções por HIV/psicologia , Pessoal de Saúde/educação , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde Mental , Transtornos Relacionados ao Uso de Substâncias/psicologia , Atitude do Pessoal de Saúde , Preservativos , Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Educação em Saúde , Humanos , Capacitação em Serviço , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
New information about the life cycle of HIV, new HIV-specific laboratory tests, and newer antiretroviral medications have transformed the management of HIV illness. Knowledge about these changes will help mental health providers better understand the latest medical issues affecting their HIV-infected patients, which will assist them in providing better care.
Assuntos
Síndrome da Imunodeficiência Adquirida/psicologia , Infecções por HIV/psicologia , Serviços de Saúde Mental , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Capacitação em Serviço , Relações Profissional-PacienteRESUMO
Since the advent of highly active antiretroviral therapy, the issue of strict adherence has become increasingly important. This chapter examines how the mental health provider can employ a multimodal approach to promoting patient adherence, which increases the chances of success.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/psicologia , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente/psicologia , Participação do Paciente/psicologia , Síndrome da Imunodeficiência Adquirida/psicologia , Mecanismos de Defesa , Infecções por HIV/psicologia , Humanos , Recusa do Paciente ao Tratamento/psicologiaRESUMO
This presentation, relying both on personal experience and an array of studies, surveys the problems minorities face in trying to obtain adequate health care. From another viewpoint, these are problems that physicians have in trying to provide health care to persons they do not understand and cannot really see or hear. And the problems multiply when the patient is a minority in more than one sense. The gay, Hispanic, HIV+ patient, for example, is removed from the average physician's comprehension to a degree that is itself almost incomprehensible. Treating patients as they ought to be treated requires that physicians overcome many layers of prejudice and unfounded assumptions. Failure to overcome such prejudices distorts medical practice.