Living with severe depression or an anxiety disorder can have a similar impact on patients’ promptness in seeking care following an HIV diagnosis as living far from a clinic, according to study looking at mental health factors among patients diagnosed more than 90 days before their arrival at a South Africa clinic for further testing and evaluation.
The study, reported in Clinical Infectious Diseases, evaluated factors associated with treatment delays among 1,271 people diagnosed with HIV at an urban township clinic in KwaZulu-Natal, where rates of infection rank among the highest in the world. Shortening the time between diagnosis and initiation of antiretroviral treatment — that both protects patients’ health and reduces risks of transmission — is critical to attaining the “90-90-90″* goals that UNAIDS has projected must be reached worldwide by 2020 to control the pandemic and end its global public health impacts by 2030, the authors of a report on the study note. In 2016 South Africa adopted universal test and start guidelines for HIV treatment — that all people diagnosed with the virus have access to immediate treatment — in the interest of reaching the goals.
But the authors note, distance from clinics, low perception of risk, and high perception of stigma, continue to rank high among factors that hinder access to treatment. At the same time, the authors write, while treatment lapses or interruptions, as well as suboptimal treatment outcomes have been linked to depression and anxiety, studies have not identified the specific impacts of mental health factors on diagnosis and treatment. Enrolling patients who came to an Umlazi township clinic for HIV testing, researchers administered questionnaires commonly used to evaluate depression and anxiety prior to testing. Patients who tested positive for HIV were evaluated for symptoms and CD4 — or immune cell — depletion. Patients who had already tested positive for the virus more than three months prior to their visit to the Umlazi clinic and enrollment in the study were classified as “delayed presenters,” while participants who tested positive upon their enrollment or within the previous three months and had a CD4 count lower than 200, were classified as “late testers.” Patients with questionnaire scores indicating severe depression were more than three times likelier than patients without depression to be delayed presenters, and patients with scores indicating generalized anxiety disorder were more than twice as likely than patients without anxiety to delay presenting for care, the authors write. Patients with severe depression also were more than twice as likely to test for the virus later.
The findings, the authors write indicate that including basic screening for anxiety and depression into HIV testing programs, and encouraging same-day treatment initiation, could strengthen links to care.
* 90 percent of people living with the virus being aware of their infection, 90 percent of people diagnosed with the virus accessing antiretroviral treatment, and treatment suppressing the virus in 90 percent of those receiving it.