title: Prevalence and Associations of Psychological Distress, HIV Infection and HIV Care Service Utilization in East Zimbabwe.
abstract: The correlation between mental health and sexual risk behaviours for HIV infection remains largely unknown in low and middle income settings. The present study determined the prevalence of psychological distress (PD) in a sub-Saharan African population with a generalized HIV epidemic, and investigated associations with HIV acquisition risk and uptake of HIV services using data from a cross-sectional survey of 13,252 adults. PD was measured using the Shona Symptom Questionnaire. Logistic regression was used to measure associations between PD and hypothesized covariates. The prevalence of PD was 4.5% (95% CI 3.9-5.1%) among men, and 12.9% (95% CI 12.2-13.6%) among women. PD was associated with sexual risk behaviours for HIV infection and HIV-infected individuals were more likely to suffer from PD. Amongst those initiated on anti-retroviral therapy, individuals with PD were less likely to adhere to treatment (91 vs. 96%; age- and site-type-adjusted odds ratio = 0.38; 95% CI 0.15, 0.99). Integrated HIV and mental health services may enhance HIV care and treatment outcomes in high HIV-prevalence populations in sub-Saharan Africa.
authors.affiliation: Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK. m.tlhajoane14@imperial.ac.uk.
authors.forename: Malebogo
authors.initials: M
authors.lastname: Tlhajoane
authors.affiliation: Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Eaton
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Albert
authors.initials: A
authors.lastname: Takaruza
authors.affiliation: Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rhead
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Rufurwokuda
authors.initials: R
authors.lastname: Maswera
authors.affiliation: Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schur
authors.affiliation: Institute of Epidemiology and Health, University College London, London, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.affiliation: Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.|Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.affiliation: Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.|Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Antiretroviral therapy; HIV/AIDS; Mental health; Treatment cascade