Mental Health Diagnoses, Symptoms, and Service Utilization in US Youth with Perinatal HIV Infection or HIV Exposure

Smith, Renee; Huo, Yanling; Tassiopoulos, Katherine; Rutstein, Richard M.; Kapetanovic, Suad; Mellins, Claude A.; Kacanek, Deborah; Malee, Kathleen

doi:10.1089/apc.2018.0096

Cited by 28 publications

(18 citation statements)

References 45 publications

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“… 28 Adopting innovative approaches like the provision of community ART services and creating youth-friendly services might reduce a high attrition rate, which was supported by studies conducted in Mozambique and systematic review including Sub Saharan Africa. 26 , 27 , 29 …”

Section: Discussionmentioning

confidence: 99%

Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

Dejen¹,

Jara²,

Yeshanew³

et al. 2021

HIV

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Introduction There is an expansion and advancement of antiretroviral therapy. However, attrition of patients from HIV care is one of the major drivers of poor performance of HIV/AIDS programs, which leads to drug resistance, morbidity and mortality. The study aimed to assess the incidence of attrition and its predictors among adults receiving first-line antiretroviral therapy. Methods An institution-based retrospective cohort study was conducted among 634 adults receiving antiretroviral therapy, and study participants were selected using a simple random sampling technique. Data were cleaned and entered into Epi Data version 3.1 and exported to STATA 14.1 for further analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models; then, variables at a p-value of less than 0.25 and 0.05 were included in the multivariable analysis and statistically significant, respectively. Results The total time observed was found to be 1807.08 person-years of observation with a median follow-up time of 2.67 years (IQR 1.25−4.67). The incidence rate of attrition was 8.36 (95% CI: 7.12−9.80) per 100 person-years. Significant predictors of attrition were being young age [adjusted hazard ratio (AHR) =2.0, 95% CI, (1.11−3.58)], nearest calendar year of ART initiation [AHR =2.32, 95% CI, (1.08–5.01)], bedridden functional status [AHR=3.25, 95% CI, (1.33−7.96)], WHO stage III [AHR=3.57, 95% CI, (1.58−8.06)] and stage IV [AHR=5.46, 95% CI, (1.97−15.13)], viral load result of ≤1000 [AHR=0.11, 95% CI, (0.06−0.23)], disclosure status [AHR=2.03, 95% CI, (1.22−3.37)] and adherence level of poor [AHR=3.19, 95 CI, (1.67−6.09)]. Conclusion The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. However, as a standard, every client who started antiretroviral therapy should be retained. Positive predictors of attrition were young age (15–24), recent year of ART initiation, baseline functional status, advanced WHO stage III and IV, no disclosure status, fair/poor adherence whereas, viral load result of ≤1000 copies/mL had a preventive effect on attrition.

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Section: Discussionmentioning

confidence: 99%

Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

Dejen¹,

Jara²,

Yeshanew³

et al. 2021

HIV

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“…It incorporates group and home-based family activities as well as community events to promote parent-child communication and improve AYAAH self-esteem and reduce any problem behaviour [57]. Group differences were noted in self-esteem for children 6 to 12 years of age at three months, but not at six months, and not for adolescents [13][14][15][16][17][18]. Both age groups showed significant group differences in the level of parental care at six months.…”

Section: Group and Family Strengthening Interventionsmentioning

confidence: 99%

“…Mental health challenges are a critical barrier to ending the HIV epidemic across contexts and populations, given that they increase the risk of non-adherence to ART, poor engagement in care and sexual and substance use risk behaviours for HIV transmission [6][7][8][9]. Studies from multiple countries increasingly show high rates of various mental health problems in AYALH ranging from psychosocial distress and symptoms of emotional and behavioural problems to actual psychiatric disorders [7,[9][10][11][12][13][14], with some studies finding higher rates of mental health problems in youth compared to those with PHIV [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…Studies of AYALH have often utilized comparison groups of AYA affected by HIV (AYAAH) ‐ including those who lost one or both parents to AIDS, or who are living in households with caregivers or family members living with HIV, and those who were perinatally HIV exposed, but uninfected (PHEU) as they share many of the same psychosocial and contextual vulnerabilities. Results show that AYAAH are also at increased risk for mental health problems [23,24], with some studies suggesting that they are at even greater risk than AYALH [11,14,16]. For example, in one study, AYAAH were more likely to be depressed, anxious and report internalized stigma, suicidal ideation and excessive substance use than AYALH [16].…”

Section: Introductionmentioning

confidence: 99%

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Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

et al. 2021

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Introduction Adolescents and young adults (AYA) remain vulnerable to HIV‐infection and significant co‐morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence‐based mental health interventions for AYALH and AYAAH to inform future work. Methods The review, targeting work between 2014 and 2020, initially included studies of evidence‐based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes. Results and discussion We identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub‐Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence‐based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group‐based and family strengthening interventions, economic empowerment combined with family strengthening, group‐based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group‐based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health. Conclusions Despite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence‐based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.

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“…Behavioral problems and symptoms of depression are not uncommon among children, adolescents and young adults with perinatal HIV infection (AYA-PHIV) in low-, middle-, and high-income countries. 1–3 Among school-age children living with HIV in Thailand, for example, 42% had abnormal Child Behavior Checklist scores by parent report, suggesting significant behavioral and/or emotional problems. 4 Among Thai youth and young adults with HIV, ages 16–25 years, 53% reported a clinically significant mental health problem (e.g., depression, anxiety, social impairment, and/or somatic complaints).…”

Section: Introductionmentioning

confidence: 99%

HIV-related enacted stigma and increase frequency of depressive symptoms among Thai and Cambodian adolescents and young adults with perinatal HIV

et al. 2020

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HIV-related enacted stigma and social problems may increase risk for depression and/or behavioral problems among adolescents and young adults with perinatal HIV(AYA-PHIV), yet few studies have explored stigma in AYA-PHIV residing in low-to-middle income regions, including Southeast Asia. We assessed HIV-related enacted stigma and social problems in AYA-PHIV who participated in the RESILIENCE study (clinicaltrials.gov identification: U19AI53741) in Thailand and Cambodia using specific questions during structured in-person interviews. Depression was measured by the Child Depression Inventory for children <15 years, or the Center for Epidemiologic Studies Depression Scales for youth ≥15 years); behavioral problems were measured by the Child Behavior Checklist (CBCL-caregiver report). Among 195 AYA-PHIV (median age 16.9 years), 25.6% reported a lifetime experience of enacted stigma, while 10.8% experienced social problems due to HIV infection. The frequency of depressive symptoms was nearly two-fold higher among AYA-PHIV with compared to those without HIV-related enacted stigma (34.7% vs. 16.0%, p = 0.005). Caregiver-reported behavioral problems were detected in 14.6% of all AYA-PHIV, with no differences between those with and without HIV-related enacted stigma. Low household income and caregiver mental health problems were independent risk factors for depressive symptoms; HIV-related enacted stigma was also associated with increased risk, warranting targeted services to support AYA-PHIV.

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Mental Health Diagnoses, Symptoms, and Service Utilization in US Youth with Perinatal HIV Infection or HIV Exposure

Cited by 28 publications

References 45 publications

Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

HIV-related enacted stigma and increase frequency of depressive symptoms among Thai and Cambodian adolescents and young adults with perinatal HIV

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