Challenges in Delivering Effective Mental Health Services to People with HIV Infection in Custodial Setting

People with HIV have higher prevalence in the custodial settings as compared to the general population. HIV infection in many countries has been closely related to the use of illicit drugs via intravenous route. In Malaysia there are significant proportion of HIV infection are transmitted via this way. There was around 95% of HIV infected prisoners were heroin addict who injected themselves This is even more important when the use of illicit drugs has been criminalised. The criminalisation of illicit drug which has been the primary approach in tackling drug problems results in the difficulties in delivering health service to those have been detained due to the use of illicit drugs. There are growing positive evidence which shows medical and psychosocial modes of treatment for tackling drug related harms resulted in better outcomes. Issues of co-morbidity in those who use drug are also important consideration when providing mental health service to individuals with HIV infection. It is even more complex when these people are incarcerated These issues are discussed in this presentation. This will be based on researches (HARAPAN Project) which are undertaken in one of the prison facilities.

Evaluation of the dried blood spot (DBS) collection method as a tool for detection of HIV Ag/Ab, HBsAg, anti-HBs and anti-HCV in a Malaysian tertiary referral hospital

<p><b>INTRODUCTION</b>Dried blood spot (DBS) collection is an appealing alternative to whole blood or plasma sampling, as it has technical and economic advantages over the latter.</p><p><b>MATERIALS AND METHODS</b>A prospective cross-sectional study was conducted at a Malaysian tertiary referral hospital from November 2009 to March 2010. One hundred and fifty paired specimens of DBS and plasma were analysed by the standard assays for HIV Ag/Ab, HBsAg, anti-HBS and anti-HCV, separately (total 600 paired specimens). DBS sample titres were then compared to the results of plasma testing, which was used as the gold standard.</p><p><b>RESULTS</b>For the HIV Ag/Ab assay with a cut-off point of 0.35 Relative Light Units (RLUs), the sensitivity and specificity were both 100%. For the HBsAg assay, the sensitivity was 96.5% and the specificity was 97.8%, with a cut-off point of 1.72 RLUs. Sensitivity for the anti-HBs test was 74.2% and the specificity was 86.9%, using a cut-off point of 0.635 RLUs. For the anti-HCV assay, the sensitivity was 97.3% and the specificity was 100%, with a cut-off point of 0.10 RLUs.</p><p><b>CONCLUSION</b>DBS is an ideal choice to be used as a screening tool for the detection of HIV, Hepatitis B and Hepatitis C virus infections. However, different cut-off values need to be used for the validation of test positivity in DBS samples because the small amount of blood in the DBS specimens leads to lower assay titres.</p>

Identifying Depression Among The Human Immunodeficiency Virus (HIV) Patients In University Malaya Medical Centre, Kuala Lumpur, Malaysia

Objective: The aim of this study was to identify depression among HIV- infected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIV- infected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Socio- demographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, non- alcoholic drinkers and females were more likely to be depressed (P<0.05). All clinical characteristics showed no statistical differences. Conclusion: The depression rate was lower compared to those from the studies in western countries. The risk factors for depression were different from those found in other studies as well.