Virtually no screening and treatment for mental health disorders in many HIV clinics across the world

The proportion of HIV treatment clinics screening for depression, anxiety, and post-traumatic stress disorder (PTSD) is 50%, 14%, and 12%, respectively, in many world regions, reported Dr. Angela Parcesepe of the University of North Carolina at 24th International AIDS Conference (AIDS 2022) in Montreal this week. Additionally, both screening tests and medications for the treatment of depression, anxiety, and PTSD are only available at 36%, 11%, and 8% of sites, respectively.

Common mental disorders, such as depression, anxiety, and PTSD, are highly prevalent among people living with HIV and associated with poor HIV treatment outcomes. Integrating your screening and treatment into HIV care can improve mental health, HIV treatment outcomes, and quality of life. However, data on the availability of mental health screening and treatment in HIV clinics remains sparse.

Using data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, the 2020 survey captured information on HIV clinics in Asia, the Caribbean, Latin America, sub-Saharan Africa, North America, and Australia, and reported on the availability of screening tests and treatment. for depression, anxiety and PTSD.

A total of 223 HIV treatment centers from 41 countries participated in the survey. 67% were in urban settings, 50% cared for adults and children, 38% cared for adults only, and 12% cared for children only. The majority of sites (78%) were located in low- and middle-income countries.

In clinical settings: Urban clinics were more likely to report screening and treatment than rural clinics. Similarly, more clinics in high-income countries offered mental health services.

Across Populations Served: Clinics serving both adults and children rated more for depression (53%) than clinics for children only (31%). However, clinics for children only assessed more anxiety (23%) compared to clinics for adults and children (13%).

Across global regions: Clinics in Latin America and the Caribbean offered screening for depression (63%) and anxiety (13%), but no sites reported screening for PTSD. In African cohorts, East Africa screened more for depression (53%) and PTSD (14%) than other African regions, but had the least screening for anxiety (7%). West Africa had minimal screening for depression, anxiety, and PTSD in only 7%, 14%, and 7% of sites, respectively. North America outperformed all regions, testing for depression, anxiety, and PTSD in 93%, 24%, and 28% of HIV treatment sites.

Dr. Parcesepe explained to AIDS 2022 that they previously conducted this survey between 2016 and 2017 at 68 clinics in 27 low- and middle-income countries. They compared those results to current (2020) numbers from the same 68 clinics and found that depression and PTSD screening was now available at 31% and 24% of clinics that did not offer it in 2016/2017. However, 15% to 12% of clinics that detected depression and PTSD in the first survey stopped offering those services in 2020.

It highlighted the lack of screening and treatment for mental health disorders in many rural and pediatric HIV treatment settings, especially in low-income countries. He emphasized the need to identify and implement practical and sustainable services.

A limitation of the study was that the availability of services was reported by center staff and not independently verified. He also clarified that the 2020 data was collected before COVID-19, so the reported numbers do not reflect decreases in services caused by the pandemic.

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