BACKGROUND: Depression greatly burdens subSaharan Africa, especially populations living with HIV/ AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dualpurpose 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 ≥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)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) 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. INTRODUCTIONMore than 70% of all deaths attributable to HIV/AIDS are in sub-Saharan Africa, with approximately 6.1% of adults living with HIV in Kenya in 2005 1 . The social, economic and health impact of depression in sub-Saharan Africa is also great, where depression is associated with mortality 2-5 , work disability 4-7 , lower quality of life 5,[8][9][10][11][12] , risk of heart disease 13 and high-risk behaviors for contracting HIV infection 14 . With one exception 15 , the sparse literature on depression among individuals living with HIV/AIDS in sub-Saharan Africa has shown elevated rates of depression relative to community samples 3,8,10,[16][17][18][19][20][21][22][23][24][25] , consistent with western countries [26][27][28][29] . Thus, there is an urgency to incorporating mental health into HIV/ AIDS treatment programs in sub-Saharan Africa, including western Kenya [30][31][32][33][34][35] .Depression in sub-Saharan Africa presents in forms (culturespecific idioms, somatic, based on interpersonal relationships or spiritual in nature) that may o...

BackgroundMore than two-thirds of the world's HIV-positive individuals live in sub-Saharan Africa, where genetic susceptibility to kidney disease is high and resources for kidney disease screening and antiretroviral therapy (ART) toxicity monitoring are limited. Equations to estimate glomerular filtration rate (GFR) from serum creatinine were derived in Western populations and may be less accurate in this population.MethodsWe compared results from published GFR estimating equations with a direct measure of GFR by iohexol clearance in 99 HIV-infected, ART-naïve Kenyan adults. Iohexol concentration was measured from dried blood spots on filter paper. The bias ratio (mean of the ratio of estimated to measured GFR) and accuracy (percentage of estimates within 30% of the measured GFR) were calculated.ResultsThe median age was 35 years, and 60% were women. The majority had asymptomatic HIV, with median CD4+ cell count of 355 cells/mm3. Median measured GFR was 115 mL/min/1.73 m2. Overall accuracy was highest for the Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equation. Consistent with a prior report, bias and accuracy were improved by eliminating the coefficient for black race (85% of estimates within 30% of measured GFR). Accuracy of all equations was poor in participants with GFR 60–90 mL/min/1.73 m2 (<65% of estimates within 30% of measured GFR), although this subgroup was too small to reach definitive conclusions.ConclusionsOverall accuracy was highest for the CKD-EPI equation. Eliminating the coefficient for race further improved performance. Future studies are needed to determine the most accurate GFR estimate for use in individuals with GFR <90 mL/min/1.73 m2, in whom accurate estimation of kidney function is important to guide drug dosing. Direct measurement of GFR by iohexol clearance using a filter paper based assay is feasible for research purposes in resource-limited settings, and could be used to develop more accurate GFR estimates in African populations.

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While researchers in many western countries have documented the nature of psychological distress that is commonly present among individuals living with HIV, there has been virtually no research on the same topic among other high prevalence areas of the world, particularly in countries like Kenya. This study sought to document the nature of psychological distress among 397 individuals living with HIV in western Kenya and who were participating in psychosocial support groups in conjunction with their enrollment in HIV-related treatment. Psychological distress was assessed using the Brief Symptom Inventory (BSI), a 53-item self-report psychological inventory that asks individuals to recall symptoms experienced in the prior seven days. The levels of psychological distress in this sample were moderate with a substantial proportion of participants meeting the criteria that suggested a need for further psychiatric evaluation. Findings support the need for further assessments of the range and nature of psychological distress among the diverse communities of countries like Kenya and the need for greater attention to the inclusion of mental health services in the rapidly developing treatment and prevention programs in this region of the world.

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.