Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho

Abstract

SUMMARY SETTING Limited data exist on the prevalence and correlates, including stigma, of mental health conditions, including depressive symptoms and alcohol use, among patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) in sub-Saharan Africa, despite their negative impact on health outcomes. OBJECTIVE To assess the prevalence and correlates of depressive symptoms and hazardous/harmful alcohol use among TB-HIV patients in the Start TB patients on ART and Retain on Treatment (START) study. DESIGN START, a mixed-methods cluster-randomized trial, evaluated a combination intervention package vs. standard of care (SOC) to improve treatment outcomes in TB-HIV co-infected patients in Lesotho. Moderate/ severe depressive symptoms and hazardous/harmful alcohol use were measured using baseline questionnaire data collected from April 2013 to March 2015. Demographic, psychosocial, and TB- and HIV-related knowledge and attitudes, including stigma, were assessed for association with both conditions using generalized linear mixed models. RESULTS Among 371 participants, 29.8% reported moderate/severe depressive symptoms, and 24.7% reported hazardous/harmful alcohol use; 7% reported both. Depressive symptoms were significantly associated with less education, more difficulty understanding written medical information, non-disclosure of TB, greater TB stigma, and the SOC study arm. Hazardous/harmful alcohol use was significantly associated with male sex, as well as greater TB and external HIV stigma. CONCLUSION Prevalence of depressive symptoms and hazardous/harmful alcohol use were high, suggesting a need for routine screening for, and treatment of, mental health disorders in TB-HIV patients.

Prevalence and Associated Factors for Alcohol Use Disorder Among Tuberculosis Patients: A Systematic Review and Meta-analysis.

“…Among twenty-seven studies (11,14,15,17,25, included in the present meta-analysis, only eight (11,14,25,36,37,39,45,49) reported about the associated factors for alcohol use disorder among tuberculosis patients. Our qualitative synthesis for the socio-demographic factors associated with AUD in tuberculosis patients revealed that male gender (14,25,36,39,49), age older than 35 years (14), being single, divorced or widowed (11,14), being unemployed (11), being black American (36), colored ethnicity (49), low level of education (14,49), no educational background (39), low level of income (< Rs 5000 per month) (14) and poverty (49).…”

“…The average prevalence of alcohol use disorder in tuberculosis patients was higher in Asia and Europe;37% (14, 17, 25, 35-39, 42-45, 48, 53) than the prevalence in US ; 24% (36,39) and Africa ; 24% (11,15,33,34,40,41,46,47,(49)(50)(51)(52)54) (Figure 3). The average prevalence of AUD was 36% in studies that do not report the assessment tool for AUD (35,36,38,(41)(42)(43)(44)51) which is higher than the prevalence in studies that utilized AUDIT (26%) (14,15,17,25,34,39,(45)(46)(47)(48)(49)(50)(52)(53)(54) (Figure 4). Besides, studies which were case-control (15,40,42) provided higher prevalence of AUD (39%) than cross-sectional (11,14,17…”

“…Considering the regional setting where the included studies were done; six (17,25,35,37,38,48), ve (41,46,47,49,50) and another ve studies were from Russia, South Africa (33,34,51,52,54) and Ethiopia (33,34,51,52,54) respectively. The remaining studies were from United States (US) (36,39), Estonia (42,43), India (14,44,53), Thailand (45), Nigeria (40), Botswana (15) and Zambia (11). Most of the studies in the present analysis were Cohort (25,35,38,41,45,47,49,(52)(53)(54) and cross-sectional (11,14,17,33,34,36,37,42,…”

“…One -third of the studies included (14,15,17,25,34,39,(45)(46)(47)(48)(49)(50)(52)(53)(54) used Alcohol use disorder identi cation test (AUDIT) to measure alcohol use disorder in tuberculosis patients. Besides two studies (11, 40) measured AUD with mini-international neuropsychiatric-interview(MINI), one (33) with alcohol, smoking, and substance involvement screening test(ASSIST)and another one used DSM-IV (37).…”

“…Our qualitative synthesis for the socio-demographic factors associated with AUD in tuberculosis patients revealed that male gender (14,25,36,39,49), age older than 35 years (14), being single, divorced or widowed (11,14), being unemployed (11), being black American (36), colored ethnicity (49), low level of education (14,49), no educational background (39), low level of income (< Rs 5000 per month) (14) and poverty (49). Besides, being on category-II tuberculosis treatment(relapse and treatment failure) (14), TB retreatment patient status and nonadherence to anti-TB medication (49), patients with chronic/relapsing form of tuberculosis (37), patients with perceived TB stigma (39), patients who feel ashamed of having TB (39), people close to you would avoid you because of TB (39), HIV-co-infection and low HIV CD4-count (39), having cavitary lesions on chest radiographic examination (36), and smear-positive and culture-positive types of TB (36) were also the reported clinical and tuberculosis related factors for (1,2,6,11,16) Age older than years (11) Being single, divorced or widowed (11,19) Being unemployed (19) Being black American 1Coloured ethnicity (16) Low level of education (11,16) No educational background (2) Low level of income (< Rs 500...…”