title: Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania.
abstract: AIDS-related mortality among HIV-positive adolescents has risen by 50% despite the scale up of antiretroviral therapy (ART). ART maladherence likely plays a role in the increase of AIDS-related deaths among adolescents and has shown to be associated with psychosocial and mental health difficulties. Addressing the specific mental health needs of HIV-positive adolescents is critical to ending the HIV epidemic. This cross-sectional study prospectively enrolled HIV-positive adolescents (12-24 years) in Moshi, Tanzania. A structured questionnaire was administered that included questions about home, school, adherence, and measures of stigma (Berger Stigma Scale) and mental health. Mental health measures included depression (Patient Health Questionnaire-9), emotional/behavioral difficulties (Strengths and Difficulties Questionnaire), and traumatic experiences/post-traumatic stress symptoms (The University of California Los Angeles-post-traumatic stress disorder-Reaction Index). Mental health difficulties were prevalent among HIV-positive adolescents and were associated with incomplete adherence and stigma. Resources are needed to reduce HIV stigma and address mental health among HIV-positive adolescents in low-resource settings. This will improve not only mental health, but may also improve ART adherence and virologic suppression, improving overall health of the individual and reducing the risk of HIV transmission to others.
authors.affiliation: a Division of Pediatric Infectious Diseases , Duke University Medical Center , Durham , NC , USA.|b Kilimanjaro Christian Medical Centre , Moshi , Tanzania.|c Duke Global Health Institute, Duke University , Durham , NC , USA.
authors.forename: Dorothy E
authors.initials: DE
authors.lastname: Dow
authors.affiliation: c Duke Global Health Institute, Duke University , Durham , NC , USA.|d Department of Biostatistics and Bioinformatics , Duke University , Durham , NC , USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Turner
authors.affiliation: b Kilimanjaro Christian Medical Centre , Moshi , Tanzania.
authors.forename: Aisa M
authors.initials: AM
authors.lastname: Shayo
authors.affiliation: b Kilimanjaro Christian Medical Centre , Moshi , Tanzania.
authors.forename: Blandina
authors.initials: B
authors.lastname: Mmbaga
authors.affiliation: a Division of Pediatric Infectious Diseases , Duke University Medical Center , Durham , NC , USA.|c Duke Global Health Institute, Duke University , Durham , NC , USA.
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.affiliation: e Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.|f Center for Child and Family Health , Duke University Medical Center , Durham , NC , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008603:Mental Health / Q000706:statistics & numerical data; D020380:Needs Assessment; D015995:Prevalence; D057545:Social Stigma; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring
keywords: Pediatric HIV; adolescent mental health; antiretroviral therapy adherence; depression; trauma
references.citation: JAMA. 2014 Aug 27;312(8):809-16
references.pmid: 25157724
references.citation: AIDS Care. 2012;24(7):836-42
references.pmid: 22292795
references.citation: AIDS Patient Care STDS. 2007 Jul;21(7):501-8
references.pmid: 17651031
references.citation: Psychiatry Res. 2013 Dec 15;210(2):653-61
references.pmid: 23972787
references.citation: J Trauma Stress. 2012 Feb;25(1):64-70
references.pmid: 22354509
references.citation: J Adolesc Health. 2008 Apr;42(4):410-7
references.pmid: 18346667
references.citation: Pediatrics. 2014 Aug;134(2):e464-72
references.pmid: 25049342
references.citation: AIDS Patient Care STDS. 2015 Feb;29(2):86-94
references.pmid: 25607900
references.citation: Prev Sci. 2014 Jun;15(3):318-28
references.pmid: 23868419
references.citation: Res Nurs Health. 2001 Dec;24(6):518-29
references.pmid: 11746080
references.citation: PLoS One. 2013 Oct 04;8(10):e74771
references.pmid: 24124455
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2013 Apr;48(4):595-611
references.pmid: 22961287
references.citation: BMC Psychiatry. 2011 Aug 04;11(1):127
references.pmid: 21816045
references.citation: J Child Psychol Psychiatry. 2013 Apr;54(4):423-44
references.pmid: 22943414
references.citation: BMC Infect Dis. 2014 Nov 07;14:567
references.pmid: 25373425
references.citation: East Afr Med J. 2009 Jan;86(1):16-24
references.pmid: 19530544
references.citation: J Adolesc Health. 2012 Sep;51(3):242-51
references.pmid: 22921134
references.citation: AIDS Behav. 2014 Jun;18(6):1174-85
references.pmid: 24623068
references.citation: J Gen Intern Med. 2009 Feb;24(2):189-97
references.pmid: 19031037
references.citation: J Int AIDS Soc. 2015 Feb 26;18(2 Suppl 1):19429
references.pmid: 25724505
references.citation: PLoS One. 2012;7(12):e52856
references.pmid: 23285204
references.citation: Acta Paediatr. 2002;91(4):459-65
references.pmid: 12061364
references.citation: J Int Assoc Provid AIDS Care. 2014 Jul-Aug;13(4):346-52
references.pmid: 24114726
references.citation: Lancet. 2011 Oct 22;378(9801):1515-25
references.pmid: 22008427
references.citation: Lancet. 2012 Mar 17;379(9820):1056-67
references.pmid: 22305766
references.citation: AIDS Care. 2001 Feb;13(1):27-40
references.pmid: 11177463
references.citation: J Child Psychol Psychiatry. 2008 Mar;49(3):313-34
references.pmid: 18093112
references.citation: J Child Adolesc Ment Health. 2011 Jan 1;23(1):17-28
references.pmid: 22685483
references.citation: Vulnerable Child Youth Stud. 2010 Jun;5(2):174-187
references.pmid: 20808733
references.citation: J Affect Disord. 2014;167:160-6
references.pmid: 24972364
references.citation: Int J Ment Health Syst. 2011 Sep 24;5(1):24
references.pmid: 21943178
references.citation: AIDS Care. 2014;26(8):947-51
references.pmid: 24666226
references.citation: AIDS. 2015 Jan 28;29(3):361-71
references.pmid: 25686684
references.citation: J Acquir Immune Defic Syndr. 2007 Nov 1;46(3):349-54
references.pmid: 17721397
references.citation: J Am Acad Child Adolesc Psychiatry. 2001 Nov;40(11):1337-45
references.pmid: 11699809
references.citation: Ann Behav Med. 2011 Dec;42(3):352-60
references.pmid: 21818528
references.citation: J Int AIDS Soc. 2015 Feb 26;18(2 Suppl 1):19393
references.pmid: 25724503
references.citation: Lancet HIV. 2014 Dec;1(3):e104-11
references.pmid: 26424119
references.citation: Lancet. 2007 Apr 14;369(9569):1302-1313
references.pmid: 17434406
references.citation: PLoS One. 2013 Jul 23;8(7):e70254
references.pmid: 23894625
references.citation: Lancet. 2011 Jun 18;377(9783):2093-102
references.pmid: 21652063
references.citation: Arch Pediatr Adolesc Med. 2005 Aug;159(8):764-70
references.pmid: 16061785
references.citation: Am J Orthopsychiatry. 2008 Jul;78(3):290-9
references.pmid: 19123748
references.citation: AIDS Behav. 2015 Feb;19(2):380-92
references.pmid: 25577026
references.citation: J Int AIDS Soc. 2015 Jan 13;18:19358
references.pmid: 25591915
references.citation: AIDS Care. 2012;24(6):722-7
references.pmid: 22292411
references.citation: AIDS Care. 2013;25(10):1245-52
references.pmid: 23398282
references.citation: J Adolesc. 2014 Feb;37(2):197-203
references.pmid: 24439625
references.citation: Lancet. 2014 Apr 12;383(9925):1355-1357
references.pmid: 24529338
references.citation: JAMA. 2006 Aug 9;296(6):679-90
references.pmid: 16896111