Prevalence and Associations of Psychological Distress, HIV Infection and HIV Care Service Utilization in East Zimbabwe

Tlhajoane, Malebogo; Eaton, Jeffrey W.; Takaruza, Albert; Rhead, Rebecca; Maswera, Rufurwokuda; Schur, Nadine; Sherr, Lorraine; Nyamukapa, Constance; Gregson, Simon

doi:10.1007/s10461-017-1705-x

Cited by 17 publications

(25 citation statements)

References 37 publications

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“…Poor mental health, in the form of greater psychological distress, is associated with lower ART uptake in east Zimbabwe. 29 As in many previous studies, 37 we found that psychological distress was more common in sex workers but we did not find this was an important factor mediating uptake. FSWs in this study also reported higher levels of stigma linked to HIV than NSWs; however, unlike studies elsewhere in Zimbabwe, 38 we did not find stigma to be a significant deterrent to accessing healthcare.…”

Section: Discussioncontrasting

confidence: 49%

Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

et al. 2018

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ObjectiveGlobally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake.MethodsData from a household survey conducted in 2009–2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression.ResultsHIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02–2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03–5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs’ greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy.ConclusionFSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs’ need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake.

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Section: Discussioncontrasting

confidence: 49%

Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

et al. 2018

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“…Nevertheless, there were indications that CTs in Manicaland shifted distributions of reported symptoms of psychological distress and a qualitative study of the Trial found that children and guardians in households receiving CTs reported reduced levels of stress and anxiety [ 61 ]. A previous analysis of the study population found links between psychological distress and potentially risky sexual behaviour [ 46 ], so improved mental health may have contributed to reduced recent sexual activity, although reverse causality is possible. Similarly, the Kenyan CT evaluation found a mediating role of mental health [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Secondary outcomes, analysed for their potential in mediating effects on sexual behaviour (Fig. 3 ), included school enrolment [ 44 , 45 ], psychological distress [ 46 ], and consumption of alcohol, cigarettes, and drugs. See Additional file 2 (section 1) for information on data for measures.…”

Section: Methodsmentioning

confidence: 99%

“… Secondary outcomes Psychological distress ≥7 symptoms of psychological distress (25-item scale) M & F (15–29) M & F (30–54) Poverty and income inequality can lead to psychological distress, which may be alleviated with CTs. See [ 46 ] for details. School enrolment Currently enrolled in schoolb M & F (15–20) c CTs remove economic barriers to school enrolment.…”

Section: Methodsmentioning

confidence: 99%

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Spillover HIV prevention effects of a cash transfer trial in East Zimbabwe: evidence from a cluster-randomised trial and general-population survey

et al. 2020

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Background Benefits of cash transfers (CTs) for HIV prevention have been demonstrated largely in purposively designed trials, commonly focusing on young women. It is less clear if CT interventions not designed for HIV prevention can have HIV-specific effects, including adverse effects. The cluster-randomised Manicaland Cash Transfer Trial (2010–11) evaluated effects of CTs on children’s (2–17 years) development in eastern Zimbabwe. We evaluated whether this CT intervention with no HIV-specific objectives had unintended HIV prevention spillover effects (externalities). Methods Data on 2909 individuals (15–54 years) living in trial households were taken from a general-population survey, conducted simultaneously in the same communities as the Manicaland Trial. Average treatment effects (ATEs) of CTs on sexual behaviour (any recent sex, condom use, multiple partners) and secondary outcomes (mental distress, school enrolment, and alcohol/cigarette/drug consumption) were estimated using mixed-effects logistic regressions (random effects for study site and intervention cluster), by sex and age group (15–29; 30–54 years). Outcomes were also evaluated with a larger synthetic comparison group created through propensity score matching. Results CTs did not affect sexual debut but reduced having any recent sex (past 30 days) among young males (ATE: − 11.7 percentage points [PP] [95% confidence interval: -26.0PP, 2.61PP]) and females (− 5.68PP [− 15.7PP, 4.34PP]), with similar but less uncertain estimates when compared against the synthetic comparison group (males: -9.68PP [− 13.1PP, − 6.30PP]; females: -8.77PP [− 16.3PP, − 1.23PP]). There were no effects among older individuals. Young (but not older) males receiving CTs reported increased multiple partnerships (8.49PP [− 5.40PP, 22.4PP]; synthetic comparison: 10.3PP (1.27PP, 19.2PP). No impact on alcohol, cigarette, or drug consumption was found. There are indications that CTs reduced psychological distress among young people, although impacts were small. CTs increased school enrolment in males (11.5PP [3.05PP, 19.9PP]). Analyses with the synthetic comparison group (but not the original control group) further indicated increased school enrolment among females (5.50PP [1.62PP, 9.37PP]) and condom use among younger and older women receiving CTs (9.38PP [5.90PP, 12.9PP]; 5.95PP [1.46PP, 10.4PP]). Conclusions Non-HIV-prevention CT interventions can have HIV prevention outcomes, including reduced sexual activity among young people and increased multiple partnerships among young men. No effects on sexual debut or alcohol, cigarette, or drug consumption were observed. A broad approach is necessary to evaluate CT interventions to capture unintended outcomes, particularly in economic evaluations. Trial registration ClinicalTrials.gov, NCT00966849. Registered August 27, 2009.

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“…People living with HIV (PLHIV) show elevated rates of depression, anxiety and trauma [ 12 – 14 ], which may be due to HIV-related stigma [ 15 , 16 ], the direct disease burden, or the impact of an HIV diagnosis on quality of life and relationships. People with mental health challenges are also at greater risk of HIV exposure and acquisition [ 17 – 19 ]. A recent survey of adults in Zimbabwe found that psychological distress was associated with increased sexual risk behaviour among seronegative individuals, and with reduced adherence to treatment for PLHIV [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Common mental disorders and HIV status in the context of DREAMS among adolescent girls and young women in rural KwaZulu-Natal, South Africa

et al. 2021

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Background HIV affects many adolescent girls and young women (AGYW) in South Africa. Given the bi-directional HIV and mental health relationship, mental health services may help prevent and treat HIV in this population. We therefore examined the association between common mental disorders (CMD) and HIV-related behaviours and service utilisation, in the context of implementation of the combination DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) HIV prevention programme in rural uMkhanyakude district, KwaZulu-Natal. DREAMS involved delivering a package of multiple interventions in a single area to address multiple sources of HIV risk for AGYW. Methods We analysed baseline data from an age-stratified, representative cohort of 13–22 year-old AGYW. We measured DREAMS uptake as a count of the number of individual-level or community-based interventions each participant received in the last 12 months. CMD was measured using the validated Shona Symptom Questionnaire, with a cut off score ≥ 9 indicating probable CMD. HIV status was ascertained through home-based serotesting. We used logistic regression to estimate the association between CMD and HIV status adjusting for socio-demographics and behaviours. Results Probable CMD prevalence among the 2184 respondents was 22.2%, increasing steadily from 10.1% among 13 year-old girls to 33.1% among 22 year-old women. AGYW were more likely to report probable CMD if they tested positive for HIV (odds ratio vs. test negative: 1.88, 95% confidence interval: 1.40–2.53). After adjusting for socio-demographics and behaviours, there was evidence that probable CMD was more prevalent among respondents who reported using multiple healthcare-related DREAMS interventions. Conclusion We found high prevalence of probable CMD among AGYW in rural South Africa, but it was only associated with HIV serostatus when not controlling for HIV acquisition risk factors. Our findings highlight that improving mental health service access for AGYW at high risk for HIV acquisition might protect them. Interventions already reaching AGYW with CMD, such as DREAMS, can be used to deliver mental health services to reduce both CMD and HIV risks. There is a need to integrate mental health education into existing HIV prevention programmes in school and communities.

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Prevalence and Associations of Psychological Distress, HIV Infection and HIV Care Service Utilization in East Zimbabwe

Cited by 17 publications

References 37 publications

Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe

Spillover HIV prevention effects of a cash transfer trial in East Zimbabwe: evidence from a cluster-randomised trial and general-population survey

Common mental disorders and HIV status in the context of DREAMS among adolescent girls and young women in rural KwaZulu-Natal, South Africa

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