Impact of mental health service use on the HIV care cascade among women.

IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine Pub Date : 2025-03-04 DOI:10.1111/hiv.70008
Seerat Chawla, Angela Kaida, Marie-Josée Brouillette, Bluma Kleiner, Danièle Dubuc, Lashanda Skerritt, Ann N Burchell, Danielle Rouleau, Mona Loutfy, Alexandra de Pokomandy
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引用次数: 0

Abstract

Background: While the negative effects of mental health issues on HIV clinical outcomes have been well-documented, the impact of mental health treatment on the HIV care cascade is largely uncharacterized. The objective of this study was to describe the engagement of women with mental health conditions and symptoms, who reported using mental health services, across the HIV care cascade and to assess the relationship between mental health service use and HIV care steps.

Methods: Longitudinal data were analysed from participants enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013-2018) who had clinically significant depressive symptoms or reported a mental health diagnosis at baseline. Among this subset, four states of HIV care were defined at baseline, 18 months and 36 months: (1) unengaged in care (did not visit an HIV provider in the past year), (2) not on antiretroviral therapy (ART) (visited an HIV provider in the past year but did not report current ART use), (3) detectable (reported current ART use but a detectable viral load) and (4) optimal (reported current ART use and an undetectable viral load). Sankey diagrams were used to illustrate the engagement of women across the HIV care cascade over 3 years based on their self-reported use of mental health services at baseline. The association between mental health service use and care state at baseline was analysed using multinomial logistic regression models.

Results: Of the 898 women in the cohort with significant depressive symptoms or mental health conditions at baseline, 3.8% (n = 34) were unengaged in care, 10.9% (n = 98) were not on ART, 12.4% (n = 111) were detectable and 72.9% (n = 655) were optimal. Over the 36 months, 51.0% of women transitioned between states at least once. When stratified by service use, women who reported use of mental health services at baseline had better engagement across the care cascade and had fewer transitions between states over the 3 years, 37.2% of which were to better states of care. The use of mental health services at baseline was also significantly associated with greater odds of engagement in the optimal state compared with not on ART (adjusted odds ratio [aOR]: 1.72, 95% confidence interval [CI]: 1.07-2.77). A similar but statistically insignificant association was found with the detectable care state (aOR: 1.67, 95% CI: 0.92-3.03).

Conclusions: Our findings demonstrate that linkage to mental health care has a positive impact on HIV care outcomes among women. Accessible mental health services may serve to improve both mental well-being and progression of these patients along the HIV care cascade, thereby achieving individual and public health goals.

心理健康服务使用对妇女艾滋病毒护理级联的影响。
背景:虽然心理健康问题对艾滋病毒临床结果的负面影响已被充分记录,但心理健康治疗对艾滋病毒护理级联的影响在很大程度上是未知的。本研究的目的是描述报告使用心理健康服务的有心理健康状况和症状的妇女在整个艾滋病毒护理级联中的参与情况,并评估心理健康服务使用与艾滋病毒护理步骤之间的关系。方法:对加拿大HIV妇女性健康和生殖健康队列研究(CHIWOS)(2013-2018)参与者的纵向数据进行分析,这些参与者在基线时有临床显著的抑郁症状或报告有心理健康诊断。在这一子集中,在基线、18个月和36个月时定义了四种艾滋病毒护理状态:(1)未参与护理(过去一年中未访问艾滋病毒提供者),(2)未接受抗逆转录病毒治疗(ART)(过去一年中访问了艾滋病毒提供者,但未报告当前的抗逆转录病毒治疗),(3)可检测(报告当前的抗逆转录病毒治疗使用但可检测到病毒载量)和(4)最佳(报告当前的抗逆转录病毒治疗使用但无法检测到病毒载量)。桑基图被用来说明妇女在3年多的时间里参与艾滋病毒护理的程度,这是基于她们自我报告的基线心理健康服务的使用情况。使用多项逻辑回归模型分析心理卫生服务使用与基线护理状态之间的关系。结果:在基线时有显著抑郁症状或精神健康状况的898名女性中,3.8% (n = 34)未接受治疗,10.9% (n = 98)未接受抗逆转录病毒治疗,12.4% (n = 111)可检测到,72.9% (n = 655)最佳。在过去的36个月里,51.0%的女性至少在州之间转换过一次。当按服务使用情况分层时,报告在基线时使用精神卫生服务的妇女在整个护理级联中有更好的参与,并且在3年内状态之间的过渡较少,其中37.2%的人进入了更好的护理状态。基线时接受心理健康服务的患者与未接受抗逆转录病毒治疗的患者相比,更有可能处于最佳状态(调整后的优势比[aOR]: 1.72, 95%可信区间[CI]: 1.07-2.77)。与可检测的护理状态存在类似但统计学上不显著的关联(aOR: 1.67, 95% CI: 0.92-3.03)。结论:我们的研究结果表明,与精神卫生保健的联系对妇女的艾滋病毒护理结果有积极影响。无障碍的精神卫生服务可能有助于改善这些患者的精神健康和艾滋病毒护理级联的进展,从而实现个人和公共卫生目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HIV Medicine
HIV Medicine 医学-传染病学
CiteScore
5.10
自引率
10.00%
发文量
167
审稿时长
6-12 weeks
期刊介绍: HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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