Open AccessScreening and management of mental health and substance use disorders in HIV treatment settings in low‐ and middle‐income countries within the global Ie DEA consortium
Author(s) -
Parcesepe Angela M,
Mugglin Catrina,
Nalugoda Fred,
Bernard Charlotte,
Yunihastuti Evy,
Althoff Keri,
Jaquet Antoine,
Haas Andreas D,
Duda Stephany N,
Wester C William,
Nash Denis
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25101
Subject(s) - medicine , mental health , depression (economics) , psychiatry , substance abuse , public health , epidemiology , environmental health , family medicine , nursing , economics , macroeconomics
Integration of services to screen and manage mental health and substance use disorders ( MSD s) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV / AIDS ( PLWHA ) in low‐ and middle‐income countries ( LMIC s). Data on the extent to which HIV treatment sites in LMIC s screen and manage MSD s are limited. The objective of this study was to assess practices for screening and treatment of MSD s at HIV clinics in LMIC s participating in the International epidemiology Databases to Evaluate AIDS (Ie DEA ) consortium. Methods We surveyed a stratified random sample of 95 HIV clinics in 29 LMIC s in the Caribbean, Central and South America, Asia‐Pacific and sub‐Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post‐traumatic stress disorder ( PTSD ), substance use disorders ( SUD s) and other mental health disorders. Results Most sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD , 55% for SUD s and 29% for other mental health disorders. Depression, PTSD , SUD s and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on‐site management of depression, PTSD , and SUD s, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On‐site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUD s was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children. Conclusions Significant gaps exist in the management of MSD s in HIV care settings in LMIC s, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSD s and HIV care is needed.