Undetected psychiatric morbidity among HIV/AIDS patients attending Comprehensive Care Clinic (CCC) in Nairobi Kenya: towards an integrated mental health care

Abstract

BackgroundPsychiatric morbidity is commonly associated with HIV disease and may have adverse effects. This aspect may be overlooked at comprehensive HIV care centers in Low and Middle-Income Countries.ObjectivesThe aim of this study was to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre in a semi-urban clinic, in Nairobi, Kenya.DesignDescriptive cross-sectional study of adult HIV patients not receiving any psychiatric treatment was conducted.Participants/methodsThe participants consisted of consecutive sample of adults (n = 245) attending HIV Comprehensive Care Clinic at Kangemi Health Centre, Nairobi. The Mini International Neuropsychiatric Interview (MINI) was administered to screen for undetected psychiatric morbidity. Socio-demographic characteristics were recorded in a questionnaire. Sample descriptive analysis was performed and prevalence of undetected psychiatric morbidity calculated. Chi-square test for independence was used to examine the associations between patient characteristics and undetected morbidity. Multivariable logistic regression analysis was performed to determine independent predictors of undetected psychiatric morbidity.ResultsThe mean age of our participants was 37.3 years (SD 9.2) Three-quarters (75.9%) of participants were females and median duration of HIV illness was 5 years. The prevalence of (previously undetected) psychiatric morbidity was 71.4% (95% CI 65.3–77). The leading psychiatric disorders were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). Overall psychiatric morbidity was associated with low income (<USD 30), p = 0.035. MDD was associated with older age and female gender. There were no statistically significant associations between overall psychiatric morbidity and social determinants such as gender, marital status, level of education, religious affiliation, and occupation or employment status.ConclusionThe burden of psychiatric morbidity in Kenyan HIV patients remains high and is most significantly associated with lower socioeconomic status. There is need to provide holistic care including screening for mental well-being all through the treatment of HIV patients in low-income settings.

A systematic review and meta-analysis of epidemiology of depression in people living with HIV in east Africa

“…Among the total of nineteen studies included in our analysis ten of them were done in Uganda [ 5 , 7 , 8 , 10 , 11 , 20 , 26 , 37 – 39 ], whereas five of the studies were conducted in Ethiopia [ 2 , 3 , 9 , 16 , 17 ] and the other studies were conducted in Kenya [ 18 ], Tanzania [ 15 ], Rwanda [ 14 ] and Sudan [ 40 ]. The publication year of those studies ranged from 2006 to 2017.…”

“…All of the included studies used cross-sectional study design. One study used community samples [ 11 ] and eighteen studies used samples from institution [ 2 , 3 , 5 , 7 – 10 , 14 – 18 , 20 , 26 , 37 – 40 ]. Regarding the instrument used, four studies used diagnostic instrument [ 5 , 10 , 15 , 38 ], fourteen studies used screening instrument [ 2 , 3 , 7 – 9 , 14 , 16 , 17 , 26 , 37 , 39 , 40 ] and one study used self-report questionnaire to assess depression in PLWHIV [ 11 ].…”

“…al. (2015) [ 15 ] Cross sectional study (institution setting) 740 PHQ-9 97% Ethiopia Systematic random sampling Adults 45.8%( n =339) MB.ChB.PW (2011) [ 18 ] Cross sectional study (institution setting) 400 BDI Not reported Kenya Systematic random sampling 47.25%( n =189) Marwick KF. et.…”

“…For the rest of east African countries, there is limited data for subgroup analysis. We found only one study conducted in each of the other four east African countries such as Kenya [ 18 ], Tanzania [ 15 ], Rwanda [ 14 ] and Sudan [ 40 ].…”

“…We also performed subgroup analysis based on the instrument used to assess depression. Four studies used diagnostic instrument (DSM or ICD) and [ 1 , 4 , 6 , 18 , 20 ] and fourteen studies used screening instrument (PHQ-9, HADS, BDI, CES-D, or HSC-D) to assess depression in people living with HIV in east Africa [ 1 , 5 , 7 – 17 , 19 ]. The pooled prevalence of depression in people living with HIV was 12.40% (95% CI 4.0-32.80) and 46% (95% CI 36.90-55.38 ) for the studies conducted using diagnostic and screening instrument respectively (see Table 2 ).…”