title: Validating the Children's Depression Inventory in the context of Rwanda.
abstract: BACKGROUND
  Depression is often co-morbid with chronic conditions, and when combined with HIV it can increase progression and reduce survival. A brief and accurate screening tool for depression among children living with HIV is necessary to increase access to mental health care and improve HIV-related outcomes in the long-term.
  
  
  METHODS
  A validation study was conducted, comparing the Children's Depression Inventory (CDI) with a structured clinical assessment as the gold standard among children living with HIV ages 7-14 years in Rwanda. The response rate was 87 % and the analysis was performed among 100 study participants.
  
  
  RESULTS
  Twenty-five percent of children had a diagnosis of depression based on the clinical interview. Sensitivity of the CDI ranged from 44 to 76 % and specificity was 92 to 100 % for cut-off scores from 5 to 9. The area under the curve (AUC) for receiver operating characteristic analysis, an estimate of overall accuracy, was 0.87 (95 % confidence interval: 0.77 - 0.97).
  
  
  CONCLUSIONS
  The significant prevalence of depression among children living with HIV in Rwanda reflects a critical need to advance mental health care in this population. Although overall accuracy of the CDI is reasonable in this context, further research needs to be done to develop a more sensitive measure of depression in this vulnerable population. Development of a highly sensitive screening measure will be a fundamental step towards improving access to mental health care among children living with HIV, potentially improving health outcomes and quality of life in the long-term as this vulnerable population transitions into adulthood.
authors.affiliation: Ministry of Health of Rwanda, P.O. Box 84, Kigali, Rwanda. agnes_binagwaho@hms.harvard.edu.|Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. agnes_binagwaho@hms.harvard.edu.|University of Global Health Equity, 260 Blvd de l'Umuganda, P.O. Box 6955, Kigali, Rwanda. agnes_binagwaho@hms.harvard.edu.|Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA. agnes_binagwaho@hms.harvard.edu.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Mary C Smith
authors.initials: MCS
authors.lastname: Fawzi
authors.affiliation: University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD, 21201, USA.
authors.forename: Mawuena
authors.initials: M
authors.lastname: Agbonyitor
authors.affiliation: Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda.
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.affiliation: Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda.
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.affiliation: Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda.
authors.forename: Eric
authors.initials: E
authors.lastname: Remera
authors.affiliation: Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mutabazi
authors.affiliation: University Teaching Hospital of Butare, Butare, Rwanda.
authors.forename: Cyprien
authors.initials: C
authors.lastname: Shyirambere
authors.affiliation: University Teaching Hospital of Butare, Butare, Rwanda.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cyamatare
authors.affiliation: Partners In Health, 641 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Nutt
authors.affiliation: Dana-Farber Cancer Institute Center for Global Cancer Medicine, 450 Brookline Avenue, Boston, MA, 02115, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Wagner
authors.affiliation: School of Public Health, University of Rwanda, P.O. Box 5229, Kigali, Rwanda.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Condo
authors.affiliation: Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda.
authors.forename: Nancy
authors.initials: N
authors.lastname: Misago
authors.affiliation: Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kayiteshonga
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012432:Rwanda; D012680:Sensitivity and Specificity
chemical_list: D019380:Anti-HIV Agents