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Common mental disorders and HIV status in the context of DREAMS among Adolescent Girls and Young Women in rural KwaZulu-Natal, South Africa

Common mental disorders and HIV status in the context of DREAMS among Adolescent Girls and Young Women in rural KwaZulu-Natal, South Africa
Common mental disorders and HIV status in the context of DREAMS among Adolescent Girls and Young Women in rural KwaZulu-Natal, South Africa
Background: HIV affects many adolescent girls and young women (AGYW) in South Africa. Given the bi-directional HIV and mental health relationship, mental health services may help prevent and treat HIV in this population. We therefore examined the association between common mental disorders (CMD) and HIV-related behaviours and service utilisation, in the context of implementation of the combination DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) HIV prevention programme in rural uMkhanyakude district, KwaZulu-Natal. DREAMS involved delivering a package of multiple interventions in a single area to address multiple sources of HIV risk for AGYW.

Methods: we analysed baseline data from an age-stratified, representative cohort of 13–22 year-old AGYW. We measured DREAMS uptake as a count of the number of individual-level or community-based interventions each participant received in the last 12 months. CMD was measured using the validated Shona Symptom Questionnaire, with a cut off score ≥ 9 indicating probable CMD. HIV status was ascertained through home-based serotesting. We used logistic regression to estimate the association between CMD and HIV status adjusting for socio-demographics and behaviours.

Results: probable CMD prevalence among the 2184 respondents was 22.2%, increasing steadily from 10.1% among 13 year-old girls to 33.1% among 22 year-old women. AGYW were more likely to report probable CMD if they tested positive for HIV (odds ratio vs. test negative: 1.88, 95% confidence interval: 1.40–2.53). After adjusting for socio-demographics and behaviours, there was evidence that probable CMD was more prevalent among respondents who reported using multiple healthcare-related DREAMS interventions.

Conclusion: we found high prevalence of probable CMD among AGYW in rural South Africa, but it was only associated with HIV serostatus when not controlling for HIV acquisition risk factors. Our findings highlight that improving mental health service access for AGYW at high risk for HIV acquisition might protect them. Interventions already reaching AGYW with CMD, such as DREAMS, can be used to deliver mental health services to reduce both CMD and HIV risks. There is a need to integrate mental health education into existing HIV prevention programmes in school and communities.
Adolescents, HIV prevention, Mental health, South Africa, Women
1471-2458
Mthiyane, Nondumiso
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Harling, Guy
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Chimbindi, Natsayi
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Baisley, Kathy
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Seeley, Janet
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Dreyer, Jaco
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Zuma, Thembelihle
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Birdthistle, Isolde
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Floyd, Sian
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Mcgrath, Nuala
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Tanser, Frank
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Shahmanesh, Maryam
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Sherr, Lorraine
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Mthiyane, Nondumiso
e47691b1-0dcc-4699-b77b-e3b13748fa77
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Chimbindi, Natsayi
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Baisley, Kathy
5fe8c276-d9d2-4bb6-91a3-8acd38a5151f
Seeley, Janet
f3106c01-ac91-4ffc-945a-6db3558fd8eb
Dreyer, Jaco
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Zuma, Thembelihle
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Birdthistle, Isolde
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Floyd, Sian
e9de12a7-bb1d-46c6-ab0e-12f30c6e8659
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Tanser, Frank
a7112c48-809b-4f7c-8662-eaef445891f4
Shahmanesh, Maryam
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Sherr, Lorraine
dcc07842-49e3-44fc-bf87-d56dd0f15323

Mthiyane, Nondumiso, Harling, Guy, Chimbindi, Natsayi, Baisley, Kathy, Seeley, Janet, Dreyer, Jaco, Zuma, Thembelihle, Birdthistle, Isolde, Floyd, Sian, Mcgrath, Nuala, Tanser, Frank, Shahmanesh, Maryam and Sherr, Lorraine (2021) Common mental disorders and HIV status in the context of DREAMS among Adolescent Girls and Young Women in rural KwaZulu-Natal, South Africa. BMC Public Health, 21 (478), [478]. (doi:10.1186/s12889-021-10527-z).

Record type: Article

Abstract

Background: HIV affects many adolescent girls and young women (AGYW) in South Africa. Given the bi-directional HIV and mental health relationship, mental health services may help prevent and treat HIV in this population. We therefore examined the association between common mental disorders (CMD) and HIV-related behaviours and service utilisation, in the context of implementation of the combination DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) HIV prevention programme in rural uMkhanyakude district, KwaZulu-Natal. DREAMS involved delivering a package of multiple interventions in a single area to address multiple sources of HIV risk for AGYW.

Methods: we analysed baseline data from an age-stratified, representative cohort of 13–22 year-old AGYW. We measured DREAMS uptake as a count of the number of individual-level or community-based interventions each participant received in the last 12 months. CMD was measured using the validated Shona Symptom Questionnaire, with a cut off score ≥ 9 indicating probable CMD. HIV status was ascertained through home-based serotesting. We used logistic regression to estimate the association between CMD and HIV status adjusting for socio-demographics and behaviours.

Results: probable CMD prevalence among the 2184 respondents was 22.2%, increasing steadily from 10.1% among 13 year-old girls to 33.1% among 22 year-old women. AGYW were more likely to report probable CMD if they tested positive for HIV (odds ratio vs. test negative: 1.88, 95% confidence interval: 1.40–2.53). After adjusting for socio-demographics and behaviours, there was evidence that probable CMD was more prevalent among respondents who reported using multiple healthcare-related DREAMS interventions.

Conclusion: we found high prevalence of probable CMD among AGYW in rural South Africa, but it was only associated with HIV serostatus when not controlling for HIV acquisition risk factors. Our findings highlight that improving mental health service access for AGYW at high risk for HIV acquisition might protect them. Interventions already reaching AGYW with CMD, such as DREAMS, can be used to deliver mental health services to reduce both CMD and HIV risks. There is a need to integrate mental health education into existing HIV prevention programmes in school and communities.

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PUBH-D-20-03172 Revised manuscript 03102020 - Accepted Manuscript
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Accepted/In Press date: 28 February 2021
e-pub ahead of print date: 10 March 2021
Published date: 10 March 2021
Additional Information: Funding The impact evaluation of DREAMS was funded by the Bill and Melinda Gates Foundation (Grant number OPP1136774 and OPP1171600, http://www. gatesfoundation.org). This research is also supported by the National Institute of Mental Health (R01 MH114560). Africa Health Research Institute is supported by a grant from the Wellcome Trust (082384/Z/07/Z). The AHRI population surveillance is partially funded by DSI-MRC South Africa Population Research Network. GH is supported by a fellowship from the Royal Society and the Wellcome Trust (210479/Z/18/Z). NuM is a recipient of an NIHR Research Professorship award (Ref: RP-2017-08-ST2–008). The funders played no role in the design of the study, data collection and analysis, decision to publish, or preparation of the manuscript.
Keywords: Adolescents, HIV prevention, Mental health, South Africa, Women

Identifiers

Local EPrints ID: 449240
URI: http://eprints.soton.ac.uk/id/eprint/449240
ISSN: 1471-2458
PURE UUID: 9e7b66c0-e685-4026-bbad-c845afcc769a
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 20 May 2021 16:32
Last modified: 10 Jan 2022 03:01

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Contributors

Author: Nondumiso Mthiyane
Author: Guy Harling
Author: Natsayi Chimbindi
Author: Kathy Baisley
Author: Janet Seeley
Author: Jaco Dreyer
Author: Thembelihle Zuma
Author: Isolde Birdthistle
Author: Sian Floyd
Author: Nuala Mcgrath ORCID iD
Author: Frank Tanser
Author: Maryam Shahmanesh
Author: Lorraine Sherr

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