title: Psychological predictors for attendance of post-HIV test counselling and linkage to care: the Umeed cohort study in Goa, India.
abstract: BACKGROUND
  Successful linkage to care is increasingly recognised as a potentially important factor in determining the success of Antiretroviral Therapy treatment programmes. However, the role of psychological factors during the early part of the continuum of care has so far been under-investigated. The objective of the Umeed study was to evaluate the impact of Common Mental Disorder (CMD), hazardous alcohol use and low cognitive functioning upon attendance for post-test counselling and linkage to care among people attending for HIV-testing in Goa, India.
  
  
  METHODS
  The study was a prospective cohort design. Participants were recruited at the time of attending for testing and were asked to complete a baseline interview covering sociodemographic characteristics and mental health exposures. HIV status, post-test counselling (PTC) and Antiretroviral Treatment (ART) Centre data were extracted from clinical records.
  
  
  RESULTS
  Among 1934 participants, CMD predicted non-attendance for PTC (adjusted OR = 0.51, 0.21-0.82). There was tentative evidence of an association between hazardous alcohol use and non-attendance for PTC (adjusted OR = 0.69, 0.45-1.02). There was no evidence of an association between CMD caseness and attendance for ART. However, post-hoc analyses showed an association between increasing symptoms of CMD and non-attendance.
  
  
  CONCLUSIONS
  Although participation rates were high (86%), non-participation was a possible source of bias. Cognitive tests had not been previously validated in a young population in Goa. The context in which cognitive testing took place may have contributed to the high prevalence of low scores. Findings suggest the need to move towards a broader conceptualisation of the interrelationship between mental health and HIV. It may be important to consider the impact of symptoms of depression and anxiety at every stage of the continuum of care, including immediately after diagnosis and when initiating contact with treatment services.
authors: Health Service & Population Research Department, Institute of Psychiatry, Kings College London, London SE5 8AF, UK. rosie.mayston@kcl.ac.uk.
authors: Rosie
authors: R
authors: Mayston
authors: Vikram
authors: V
authors: Patel
authors: Melanie
authors: M
authors: Abas
authors: Priya
authors: P
authors: Korgaonkar
authors: Ramesh
authors: R
authors: Paranjape
authors: Savio
authors: S
authors: Rodrigues
authors: Martin
authors: M
authors: Prince
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D003071:Cognition; D015331:Cohort Studies; D003376:Counseling; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult