Anxiety and Associated Factors Among Clients on Highly Active Antiretroviral Therapy (HAART) in Public Hospitals of Southern Ethiopia: A Multi-Center Cross-Sectional Study

Abstract

Background

Anxiety is an unpleasant feeling of fear, apprehension, and nervousness without any apparent stimulus. Anxiety is one of the co-morbidities that are often overlooked in treating patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Anxiety is worse among people with HIV/AIDS than the general population. Few studies have been conducted on prevalence of anxiety in people receiving antiretroviral treatment and limited evidence is available on its associated factors. Therefore, the objective of this study was to investigate the magnitude and associated factors of anxiety among clients on highly active antiretroviral therapy in public hospitals of Southern Ethiopia.

Methods

An institution-based cross-sectional study was conducted in public hospitals of Southern Ethiopia. Simple random sampling method was used to recruit study participants. Data collection was done by using a structured questionnaire regarding medical data related to HIV/AIDS. Seven items of the Hospital Anxiety and Depression Scale (HADS) were also used to measure the anxiety level. Oslo social support scale and perceived stigma scale were used to measure social support and stigma respectively. Bivariate and multivariate logistic regression analyses were computed with 95% CI to identify different explanatory variables. Significance was declared at p<0.05. Multi-collinearity was checked by variance inflation factors and Hosmer-Lemeshow test was used to check model fitness.

Results

Prevalence of anxiety among clients on HAART in selected public hospitals of Southern Ethiopia was found to be 25.6%. Females (AOR=3.24, 95% CI [1.32, 7.97]), being widowed (AOR=5.47, 95% CI [1.08, 29.72], monthly income 1425–2280 Ethiopian birr (AOR=7.29, 95% CI [2.55, 20.88]), comorbid conditions (AOR=5.47, 95% CI [1.92, 15.62]), perceived stigma (AOR=8.34, 95% CI [3.49, 19.91]) were factors associated with anxiety.

Conclusion

Approximately one-fourth of participants living with HIV/AIDS had anxiety. Being female, widowed, medium income, comorbid conditions, and perceived stigma were significantly associated with anxiety. This finding highlights the importance of mental health assessment, early detection and treatment of anxiety as an integral component of HIV/AIDS care.

Keywords:

• anxiety
• HAART
• antiretroviral therapy
• HIV/AIDS
• Ethiopia

Abbreviations

AOR, Adjusted Odds Ratio; COR, Crude Odds Ratio; CI, Confidence Interval; AIDS, Acquired Immune Deficiency Syndrome; APA, American Psychiatric Association; ART, Anti-Retroviral Treatment; BGH, Butajira General Hospital; GAD, Generalized Anxiety Disorder; HAART, Highly Active Anti-Retroviral Treatment; HADS, Hospital Anxiety and Depression Scale; HIV, Human Immune Deficiency Virus; MHS, Moderate to High Risk for Suicide; OR, Odds Ratio; OSSS, Oslo Social Support Scale; PLWHA, People Living With HIV/AIDS; SNNPR, Southern Nations Nationalities and People Ethiopia; WCSH, Worabe Comprehensive Specialized Hospital; WHO, World Health Organization; WUNEMMSH, Wachemo University Nigist Elleni Mohammed Memorial Specialized Hospital.

Data Sharing Statement

The datasets used and analyzed in the current study are included within the article.

Ethics Approval and Consent to Participate

Ethical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) Haramaya University, College of Health and Medical Sciences with Ethics approval number of IHRERC/074/2021. In addition, support letter was written to the hospitals. The objective and purpose of the study were explained briefly to the study participants and confidentiality was assured. Finally, written informed consent was obtained from study participants before conducting the interview. This study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

We acknowledge the entire staff of the hospitals for their cooperation in making this study a success. We also appreciate the study participants for their cooperation in providing the necessary information.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

Funding for this study was provided by Haramaya University. The funder has no direct contribution to the study except funding the research work. Award/Grant numbers are not applicable.