CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

919 TREATED MENTAL DISORDERS IN PRIMARY AND TERTIARY HIV CARE PROGRAMS IN CAPE TOWN Andreas D. Haas 1 , Yann Ruffieux 1 , Nicki Tiffin 2 , Hans Prozesky 3 , Catherine Orrell 2 , Mpho Tlali 2 , Andrew Boulle 2 , Mary-Ann Davies 2 , Matthias Egger 1 , for the IeDEA Southern Africa Collaboration 1 University of Bern, Bern, Switzerland, 2 University of Cape Town, Cape Town, South Africa, 3 Stellenbosch University, Tygerberg, South Africa Background: The adult 12-month prevalence of common mental disorders in the Western Cape, South Africa is 20% and lifetime prevalence is 40% (South African Stress and Health study 2009). Untreated mental disorders may lead to suboptimal antiretroviral therapy (ART) outcomes. We describe the incidence of treated mental disorders among adults on ART in Cape Town. Methods: Routinely collected data from two HIV care programs in Cape Town were linked to available province-wide pharmacy dispensing and hospital discharge data using national identifiers. We included adults who initiated ART between 2004 and 2017 at the Tygerberg Academic Hospital, a tertiary care facility and the Gugulethu Community Health Center, a primary care facility. We used the Kaplan-Meier method to estimate the cumulative incidence of pharmacological treatments with psychiatric medication and hospital admissions for mental disorders (i.e. admissions for a mental, behavioral or substance use disorder [ICD10 F00-F99] or admission to a psychiatric ward) after ART initiation. Results: We included 4,051 patients from Tygerberg and 11,312 patients from Gugulethu. Out of a total of 15,363 patients, 939 (6.1%) received pharmacological treatments: 645 (4.3%) received antipsychotics, 568 (3.7%) antidepressants, and 297 (1.9%) anxiolytics. 197 patients (1.3%) had been admitted to a hospital for a mental disorder: 48 patients (0.3%) for a schizophrenic disorder (ICD10 F20-F29), 44 (0.3%) for a mood disorder (F30-F39), 34 (0.2%) for an organic mental disorder (F01-F09), 27 (0.2%) for a substance use disorder (F10-F19), 32 (0.2%) for other/unspecified mental disorders, and 84 patients (0.5%) had been admitted to psychiatric wards without a documented ICD10 diagnosis. Cumulative incidence of pharmacologic mental health treatment (solid lines) at 10 years after ART initiation was 28.6% (95%-CI 26.4-31) at Tygerberg and 6.9% (95%-CI 6.2-7.6) at Gugulethu (Figure). Cumulative incidence of hospital admissions for mental disorders (dashed lines) at 10 years was 5.4%(95%-CI 4.3-6.8) at Tygerberg and 1.7%(95%-CI 1.4-2.1) at Gugulethu (Figure). Conclusion: While it is expected that not all mental health conditions would be diagnosed and treated, an appreciable burden of mental health disorders could be ascertained in these cohorts of patients on ART. The higher incidence of ascertained mental health disorders in the hospital settings likely reflects a combination of differences in underlying incidence, diagnosis and ascertainment of diagnoses.

918 KNOWLEDGE OF HIV STATUS DECREASES DEPRESSIVE SYMPTOMS AMONG FEMALE SEX WORKERS

Katrina F. Ortblad 1 , Daniel Kibuuka Musoke 2 , Michael M. Chanda 3 , Thomson Ngabirano 4 , Jennifer Velloza 1 , Margaret McConnell 5 , Catherine E. Oldenburg 6 , Till Bärnighausen 7 1 University of Washington, Seattle, WA, USA, 2 International Research Consortium, Kampala, Uganda, 3 John Snow, Inc, Lusaka, Zambia, 4 Uganda Health Marketing Group, Kampala, Uganda, 5 Harvard University, Boston, MA, USA, 6 University of California San Francisco, San Francisco, CA, USA, 7 Heidelberg University, Heidelberg, Germany Background: The causal effect of knowledge of HIV status on depression is not well understood. It is thus a major worry that knowledge of HIV-positive status may result in depression, which may be a barrier to scaling innovative HIV testing interventions that move testing outside the health system and away from the support of trained counselors (i.e., HIV self-testing). Methods: To estimate the relationship between HIV status and depression, we employ a quasi-experimental approach, individual fixed effects analysis – which controls for all observed and unobserved individual level confounders that do not vary over time. We use longitudinal data from two female sex worker (FSW) cohorts, constructed from randomized controlled trials of HIV self-testing delivery models in urban Ugandan and Zambian transit towns. Participants were provided access to free standard of care HIV testing services and two HIV self-tests (intervention arms only) over the course of four months. Participants completed quantitative surveys at months 0, 1, and 3. At each survey, participants self-reported their knowledge of HIV status. We used the PHQ-9 depression scale (range 0-27 points) to measure the severity of participants’ depressive symptoms (continuous scores) and prevalence of likely depression (scores ≥10 indicate clinical depression in this and other setting). To capture time-varying confounders shared by the participants, we controlled for calendar month and survey round. Results: The majority of the 1,965 enrolled participants (960 Uganda; 965 Zambia) changed their knowledge of HIV status over four months (57% Uganda; 67% Zambia). Knowledge of HIV status significantly decreased the severity of depressive symptom among participants in both Uganda and Zambia and significantly decreased the prevalence of likely depression in Zambia (Figure 1). In Zambia, the prevalence of likely depression (45.7% at enrollment) decreased by 14.1% (95% CI -22.1% to -6.0%, p=0.001) with knowledge of HIV-negative status and decreased by 14.3% (95% CI -23.9% to -4.5%, p=0.002) with knowledge of HIV-positive status. Conclusion: Knowledge of HIV status, be it positive or negative, significantly decreased depressive symptoms in two diverse populations of FSWs. This is finding is consistent with literature suggesting that certainty about a health condition is less stressful that uncertainty, even if the results are unwanted. Expansion of HIV testing programs could have mental health benefits for FSWs.

Poster Abstracts

CROI 2019 359