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Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa

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Abstract

Psychiatric comorbidity, the presence of two or more psychiatric disorders, leads to worse HIV outcomes in the United States; this relationship has not been studied in sub-Saharan Africa. We conducted a preliminary study to describe the prevalence of psychiatric comorbidity (unipolar mood, anxiety, and trauma disorders) among 363 adults prior to HIV testing at Witkoppen Health and Welfare Centre, a primary care clinic in Johannesburg, South Africa. We also examined whether psychiatric comorbidity predicted subsequent linkage to HIV care 3 months later. Prevalence of psychiatric comorbidity prior to HIV testing was approximately 5.5%. In the final HIV-positive subsample (n = 76), psychiatric comorbidity of unipolar mood, anxiety, and trauma disorders did not predict linkage to care [adjusted relative risk = 1.01 (0.59, 1.71)] or number of follow-up appointments (adjusted relative risk = 0.86 (0.40, 1.82)]. A similar psychiatric profile emerged for HIV-positive and HIV-negative individuals before becoming aware of their HIV status. The psychiatric burden typically seen in HIV-positive individuals may manifest over time.

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Notes

  1. Bipolar disorder was also assessed, but only two participants met diagnostic criteria (out of N= 348) so it was not included as a diagnostic category in the analysis.

  2. We also ran models for both outcomes using depressive symptoms as a predictor instead of psychiatric comorbidity and results were unchanged. Results of these analyses can be obtained from the first author.

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Funding

This work was supported by the National Institute of Mental Health Grant 5F30MH096664, and National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium comprised of the University of North Carolina, John Hopkins, Morehouse and Tulane (1R25TW009340-01) and the American Recovery and Reinvestment Act. Financial support for REDCAP was provided by Grant UL1RR025747 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health.

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Authors and Affiliations

  1. Department of Psychology, University of Maryland, College Park, MD, USA

    Jennifer M. Belus

  2. Department of Pediatrics, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Rushina Cholera

  3. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA

    William C. Miller

  4. Witkoppen Health and Welfare Centre, Johannesburg, South Africa

    Jean Bassett

  5. Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bradley N. Gaynes

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  1. Jennifer M. Belus
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Correspondence to Rushina Cholera.

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Belus, J.M., Cholera, R., Miller, W.C. et al. Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa. AIDS Behav 23, 3444–3451 (2019). https://doi.org/10.1007/s10461-019-02586-6

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