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Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National ‘Treat All’ Policy

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Abstract

Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.

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Data Availability

The dataset contains sensitive information and is not publicly available. However, it could be made available from the first author (AMP) on reasonable request, with approval from the IRB at the University of North Carolina at Chapel Hill to maintain confidentiality.

Code Availability

All analyses were conducted using SAS. SAS code could be made available from the first author (AMP) on reasonable request.

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Funding

This research was supported by NIMH Grant K01 MH114721, NICHD Grant P2C HD050924 (Carolina Population Center), NIAID Grant P30 AI050410 (UNC Center for AIDS Research), and NIAID Grant U01AI096299. This work is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.

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Authors and Affiliations

  1. Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA

    Angela M. Parcesepe

  2. Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Angela M. Parcesepe

  3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lindsey M. Filiatreau & Brian Pence

  4. Clinical Research Education Networking and Consultancy, Yaounde, Cameroon

    Peter Vanes Ebasone, Anastase Dzudie & Rogers Ajeh

  5. Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA

    Milton Wainberg

  6. Jamot Hospital, Yaounde, Cameroon

    Eric Pefura-Yone

  7. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Marcel Yotebieng

  8. Bamenda Regional Hospital, Bamenda, Cameroon

    Denis Nsame

  9. Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Kathryn Anastos

  10. Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA

    Denis Nash

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  1. Angela M. Parcesepe
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  2. Lindsey M. Filiatreau
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  11. Kathryn Anastos
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  12. Denis Nash
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Contributions

AP: Conceptualization, funding, analysis, Writing—original draft; LF: Analysis; Writing—review & editing; PVE: Project administration; Writing—review & editing; AD: Project administration; Supervision; Writing—review & editing; RA: Writing—review & editing; MW: Conceptualization; Writing—review & editing; BP: Conceptualization; Writing—review & editing; EP: Project administration; Writing—review & editing; MY: Writing—Review & editing; DNsame: Writing—Review & editing; KA: Writing—review & editing; DNash: Conceptualization; Writing—review & editing.

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Correspondence to Angela M. Parcesepe.

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This study was approved by the Institutional Review Board at the University of North Carolina at Chapel Hill and the National Ethical Committee of Research for Human Health in Cameroon.

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All participants provided written informed consent.

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Parcesepe, A.M., Filiatreau, L.M., Ebasone, P.V. et al. Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National ‘Treat All’ Policy. AIDS Behav 25, 4018–4028 (2021). https://doi.org/10.1007/s10461-021-03328-3

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