Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania

ABSTRACT

AIDS-related mortality among HIV-positive adolescents has risen by 50% despite the scale up of antiretroviral therapy (ART). ART maladherence likely plays a role in the increase of AIDS-related deaths among adolescents and has shown to be associated with psychosocial and mental health difficulties. Addressing the specific mental health needs of HIV-positive adolescents is critical to ending the HIV epidemic. This cross-sectional study prospectively enrolled HIV-positive adolescents (12–24 years) in Moshi, Tanzania. A structured questionnaire was administered that included questions about home, school, adherence, and measures of stigma (Berger Stigma Scale) and mental health. Mental health measures included depression (Patient Health Questionnaire-9), emotional/behavioral difficulties (Strengths and Difficulties Questionnaire), and traumatic experiences/post-traumatic stress symptoms (The University of California Los Angeles-post-traumatic stress disorder-Reaction Index). Mental health difficulties were prevalent among HIV-positive adolescents and were associated with incomplete adherence and stigma. Resources are needed to reduce HIV stigma and address mental health among HIV-positive adolescents in low-resource settings. This will improve not only mental health, but may also improve ART adherence and virologic suppression, improving overall health of the individual and reducing the risk of HIV transmission to others.

KEYWORDS:

• Pediatric HIV
• adolescent mental health
• depression
• trauma
• antiretroviral therapy adherence

Acknowledgements

The authors would like to thank the clinical staff and patients at the Kilimanjaro Christian Medical Centre Child Centered Family Care Clinic, and especially Eunice Chibanda and Elizabeth Amos for their dedication in interviewing and listening to the youth participating in the study. To Hedwiga Mrema, Elissiana Ndossa, and Gabriel Karia for their hard work in consenting, enrolling, providing medical records and phlebotomy during this ongoing project. A sincere thanks to the HIV-positive youth who gave their time and provided candid responses to the many difficult questions surrounding traumatic experiences and the mental health questionnaires.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by the Duke University Center for AIDS Research (CFAR), an NIH-funded program [P30 AI064518], the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) training grant to the Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center [T32 HD060558] and by NIH Research Training Grant R25 TW009337 and IRSDA K01 TW-009985 funded by the Fogarty International Center and the National Institute of Mental Health.