Integrating Depression Screening into HIV-care in Southern India.

将抑郁症筛查纳入印度南部的艾滋病毒护理。

• 批准号: 7944025
• 负责人: Lisa E Manhart
• 金额: $ 15.95万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7944025
• 关键词: Address; Adherence; Affect; Anxiety; CD4 Lymphocyte Count; Caring; Clinic; Cognitive; Comorbidity; Country; Data; Depressed mood; Depression screen; Diagnosis; Disease Progression; Enrollment; Epidemiologic Studies; Evaluation; Face; Focus Groups; HIV; Health; Healthcare; Hospitals; India; Individual; Intervention; Interview; Life; Link; Measures; Medical; Mental Depression; Mental Health; Modeling; Monitor; Mood Disorders; Outcome; Outcome Study; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Population Study; Predictive Value; Prevalence; Prevention; Professional counselor; Provider; Psychiatric Diagnosis; Psychiatrist; Psychometrics; Psychotherapy; Quality of life; Questionnaires; Recruitment Activity; Relative (related person); Research; Research Design; Research Infrastructure; Risk Behaviors; Risk-Taking; Screening procedure; Secondary Prevention; Sensitivity and Specificity; Series; Services; Social support; Specialized Center; Stigmata; System; Testing; Training; Translating; Viral Load result; adverse outcome; antiretroviral therapy; base; care seeking; clinical Diagnosis; coping; coping mechanism; depressive symptoms; experience; instrument; mental health personnel; primary care setting; psychosocial; public health relevance; sex risk; social stigma; statistics; tool; transmission process

DESCRIPTION (provided by applicant): UNAIDS estimates that over 33 million people are currently living with the human immunodeficiency virus (HIV); 2.5 million of these persons live in India and Southern India has among the highest HIV rates in the country. HIV-positive individuals suffer a host of co-morbidities that impact quality of life and disease progression, not the least of which is depression. Limited data are available on depression among HIV-positive persons in India, although small studies suggest the prevalence ranges from 20-47%, indicating it is likely to affect a large number of people. In addition to the psychosocial suffering that accompanies depressive mood disorders, depression has been associated with reduced adherence to antiretroviral therapy and increased sexual risk taking in some cases, although the evidence for the latter is mixed. Depression is also associated with poor biologic outcomes, including lower CD4 counts, higher viral load, more rapid disease progression and shortened survival. Screening for and treating depression therefore should be an integral part of HIV care services. Effective medications and psychotherapies for treating depression are available in urban centers in India where HIV care is delivered, but there is currently no system to screen and refer depressed HIV-positive individuals to trained mental health personnel. Therefore, we propose a series of studies designed to determine the feasibility of integrating a screening and referral system for depression into HIV care settings, with the following specific aims: (1) Compare 3 depression scales to psychiatric diagnoses of depression to identify the most appropriate tool to screen HIV-positive individuals in South India for depression; (2) Estimate the prevalence and correlates of depression among HIV- patients seeking care in an urban HIV clinic to identify modifiable factors; and (3) Identify barriers and facilitators to integrating depression screening into existing HIV-care services through focus groups and in-depth interviews. PUBLIC HEALTH RELEVANCE: Depression can result in significant psychosocial suffering and has been associated with numerous adverse outcomes among HIV-positive persons, including reduced adherence and poor biologic outcomes. Screening for and treating depression would contribute to primary HIV prevention by reducing viral load and thus transmission, and secondary prevention by reducing the psychosocial suffering and increasing quality of life among HIV-positive individuals in India.

描述（由申请人提供）：联合国艾滋病规划署估计，目前有超过 3300 万人感染人类免疫缺陷病毒 (HIV)；其中 250 万人生活在印度，而印度南部是该国艾滋病毒感染率最高的地区之一。 HIV 阳性个体患有许多影响生活质量和疾病进展的并发症，其中最重要的是抑郁症。尽管小型研究表明印度艾滋病毒阳性者抑郁症的患病率在 20-47% 之间，但有关印度艾滋病毒阳性者抑郁症的数据有限，这表明它可能会影响很多人。除了伴随抑郁情绪障碍带来的心理社会痛苦外，抑郁症还与抗逆转录病毒治疗依从性降低和某些情况下性风险增加有关，尽管后者的证据不一。抑郁症还与不良的生物学结果相关，包括 CD4 计数较低、病毒载量较高、疾病进展更快和生存期缩短。因此，抑郁症的筛查和治疗应该成为艾滋病毒护理服务的一个组成部分。印度提供艾滋病毒护理的城市中心提供治疗抑郁症的有效药物和心理疗法，但目前没有系统可以筛查抑郁症艾滋病毒阳性者并将其转诊给训练有素的心理健康人员。因此，我们提出了一系列研究，旨在确定将抑郁症筛查和转诊系统纳入艾滋病毒护理机构的可行性，具体目标如下：（1）将 3 种抑郁量表与抑郁症的精神病学诊断进行比较，以确定最合适的量表用于筛查印度南部艾滋病毒阳性者是否患有抑郁症的工具； (2) 估计在城市艾滋病毒诊所就诊的艾滋病毒患者中抑郁症的患病率和相关性，以确定可改变的因素； (3) 通过焦点小组和深入访谈，确定将抑郁症筛查纳入现有艾滋病毒护理服务的障碍和促进因素。 公共卫生相关性：抑郁症可导致严重的社会心理痛苦，并与艾滋病毒阳性者的许多不良后果相关，包括依从性降低和生物学结果不佳。筛查和治疗抑郁症将通过减少病毒载量和传播来促进艾滋病毒一级预防，并通过减少印度艾滋病毒阳性者的社会心理痛苦和提高生活质量来促进二级预防。