Investigating the Barriers and Facilitators to Using Antiretroviral Therapy among Women Living with HIV in Plateau State, Nigeria.

BACKGROUND: Women and girls account for more than 50% of the global HIV population. In Nigeria, the proportion of women living with HIV on long-term antiretroviral therapy (ART) has been on the rise. Despite this, little research exists on their experiences regarding antiretroviral therapy use, especially for women living with HIV (WLHIV) in Plateau State, Nigeria. This study investigates the barriers and facilitators influencing antiretroviral therapy use among women living with HIV. METHODS: This study employed a qualitative research design, using focus groups, and included women (female sex workers, pregnant and non-pregnant women living with HIV) and the male partners of serodiscordant couples. Eligibility criteria were being 18 years of age or older, on antiretroviral therapy for more than one year/on pre-exposure prophylaxis (PrEP) for more than one month, and speaking English, Hausa, or both. Data coding utilized both inductive and deductive approaches, and standard content analysis was applied to develop emerging themes. RESULTS: Of the 106 participants, 88 were women living with HIV, and 18 were men in serodiscordant couples. The first facilitator shared by the participants was feeling healthier and stronger due to the antiretroviral therapy, which was also expressed by the male participants on PrEP as feeling good while taking the drug. Additional facilitators shared by the participants included weight gain and having a more positive outlook on life. Participants also disproportionately described barriers to using antiretroviral therapy, including experiences with emotional challenges, physical discomfort, and side effects of ART. Such barriers were linked to feelings of past regret, frustration, and disappointment. CONCLUSION: This study underscores the significance of maintaining a positive perspective on ART use, demonstrated by the connection between a positive outlook and weight gain, and highlights the hurdles that Plateau State's women living with HIV face in adhering to antiretroviral therapy. Policymakers and healthcare providers can utilize these findings to formulate targeted strategies aimed at minimizing identified barriers and enhancing antiretroviral therapy utilization among this population via peer- support groups, economic empowerment, and psychosocial support.

Integrated services for neglected tropical diseases and mental health: pilot study assessing acceptability, feasibility and attitudes in Benue State, Nigeria.

BACKGROUND: The World Health Organization recommends person-centred and integrated care for mental health of people with Neglected Tropical Diseases. This study assesses the feasibility and acceptability of mental health care for people with NTDs, which integrated mental health care into primary health care services, in central Nigeria. METHODS: People affected by NTDs were screened for depression and anxiety, and those identified referred to the integrated service. Following their use of the service, Focus Group Discussions were held with service users and carers, and Key Informant Interviews with health service providers. Service providers were also interviewed on attitudes, before and after training with the WHO mhGAP Intervention Guide. RESULTS: In general service users reported satisfaction with the services, which they found to be dignified and accessible. They expressed concern about affordability, and waiting times. Providers also felt the service was acceptable. System gaps were identified, for example in health information systems and supervision. Poor political will threatened sustainability. CAMI scores did not change with mhGAP training. CONCLUSION: Locally designed services that support mental health of people with NTDs can be integrated into primary care. Weak basic infrastructure and lack of investment are barriers to sustainability and potential effectiveness. CONTEXTE: L'Organisation mondiale de la santé recommande des soins centrés sur la personne et intégrés pour la santé mentale des personnes atteintes de maladies tropicales négligées. Cette étude évalue la faisabilité et l'acceptabilité des soins de santé mentale pour les personnes atteintes de MTN, qui ont intégré les soins de santé mentale dans les services de soins de santé primaires, dans le centre du Nigeria. Cette étude évalue la faisabilité et l'acceptabilité des soins de santé mentale pour les personnes atteintes de MTN, qui intègrent les soins de santé mentale dans les services de soins de santé primaires, au centre du Nigeria. MÉTHODES UTILISÉES: Les personnes atteintes de MTN ont fait l'objet d'un dépistage de la dépression et de l'anxiété, et celles qui ont été identifiées ont été orientées vers le service intégré. Après leur utilisation du service, des discussions de groupe ont été organisées avec les utilisateurs du service et les soignants, et des entretiens avec des informateurs clés avec des prestataires de services de santé. Les prestataires de services ont également été interrogés sur leurs attitudes, avant et après la formation au guide d'intervention mhGAP de l'OMS. RÉSULTATS: En général, les utilisateurs des services se sont déclarés satisfaits des services, qu'ils ont trouvés dignes et accessibles. Ils ont exprimé des inquiétudes quant à l'accessibilité financière et aux temps d'attente. Les prestataires ont également estimé que le service était acceptable. Des lacunes ont été identifiées dans le système, par exemple dans les systèmes d'information sanitaire et la supervision. Le manque de volonté politique a menacé la viabilité des services. Les scores CAMI restent inchangés suite à la formation au mhGAP. CONCLUSION: Des services de santé mentale conçus localement pour venir en aide aux personnes atteintes de MTN peuvent être intégrés aux soins primaires. La qualité de l'infrastructure de base et le manque d'investissement sont les obstacles principaux à la durabilité et à l'efficacité potentielle de ces interventions. ANTECEDENTES: La Organización Mundial de la Salud recomienda una atención centrada en la persona e integrada para la salud mental de las personas con Enfermedades Tropicales Desatendidas. Este estudio evalúa la viabilidad y aceptabilidad de la atención a la salud mental de las personas con ETD, que integra la atención a la salud mental en los servicios de atención primaria, en Nigeria central. MÉTODOS: Las personas afectadas por ETD fueron examinadas para detectar depresión y ansiedad, y las identificadas fueron derivadas al servicio integrado. Tras su utilización del servicio, se celebraron debates de grupos focales con los usuarios y cuidadores del servicio, y entrevistas a informantes clave con los proveedores de servicios sanitarios. También se entrevistó a los proveedores de servicios sobre sus actitudes, antes y después de la formación con la Guía de Intervención mhGAP de la OMS. RESULTADOS: En general, los usuarios se mostraron satisfechos con los servicios, que consideraron dignos y accesibles. Expresaron su preocupación por la asequibilidad y los tiempos de espera. Los proveedores también consideraron que el servicio era aceptable. Se detectaron deficiencias en el sistema, por ejemplo en los sistemas de información sanitaria y la supervisión. La escasa voluntad política amenazaba la sostenibilidad. Las puntuaciones CAMI no cambiaron con la formación mhGAP. CONCLUSIÓN: Los servicios diseñados localmente para apoyar la salud mental de las personas con ETD pueden integrarse en la atención primaria. La debilidad de la infraestructura básica y la falta de inversión son obstáculos para la sostenibilidad y la eficacia potencial.

Integration of services for Neglected Tropical Diseases and mental health in Nigeria: development of a practical model informed by international recommendations, contextual factors and service-user perspectives.

BACKGROUND: Mental health care is now recognised as essential for people affected by NTDs, but accessible services are rare. This paper presents results of a prevalence study for depression and anxiety among people living with leprosy and lymphatic filariasis, and collation of user perspectives on needs and priorities for a new service. METHODS: Prevalence of mental conditions was carried out with 141 people living with leprosy and lymphatic filariasis and matched controls. Those who screened positive for depression or anxiety were interviewed in a qualitative study to understand their experiences of living with the conditions, and what their priorities would be for services and support. Results contributed to the process of developing a contextually adapted collaborative care model for implementation in the primary care system in Nigeria, using a Theory of Change approach. RESULTS: We found high rates of depression, anxiety, and reduced wellbeing, with strong correlation across measures. The qualitative study revealed experiences of stigma and exclusion, and concern for financial and economic needs, and a desire for provision of free services and support for livelihoods. CONCLUSION: Services should be designed with good understanding of local needs and service user priorities. CONTEXTE: Les soins de santé mentale sont désormais reconnus comme essentiels pour les personnes touchées par les MTN, mais les services accessibles sont rares. Cet article présente les résultats d'une étude de prévalence de la dépression et de l'anxiété chez les personnes vivant avec la lèpre et la filariose lymphatique, ainsi que la collecte des points de vue des utilisateurs sur les besoins et les priorités d'un nouveau service. MÉTHODES UTILISÉES: Une étude de prévalence des troubles mentaux a été menée auprès de 141 personnes vivant avec la lèpre et la filariose lymphatique et de témoins appariés. Celles qui ont été dépistées positives pour la dépression ou l'anxiété ont été interrogées dans le cadre d'une étude qualitative afin de comprendre leur expérience de la vie avec ces maladies et leurs priorités en matière de services et de soutien. Les résultats ont contribué au processus d'élaboration d'un modèle de soins collaboratifs adapté au contexte et destiné à être mis en œuvre dans le système de soins primaires au Nigeria, à l'aide d'une approche fondée sur la théorie du changement. RÉSULTATS: Nous avons constaté des taux élevés de dépression, d'anxiété et de diminution du bien-être, avec une forte corrélation entre les mesures. L'étude qualitative a révélé des expériences de stigmatisation et d'exclusion, des préoccupations concernant les besoins financiers et économiques, ainsi qu'un désir de services gratuits et de soutien aux moyens de subsistance. CONCLUSION: Les services doivent être conçus en tenant compte des besoins locaux et des priorités des utilisateurs. ANTECEDENTES: Actualmente se reconoce que la atención de salud mental es esencial para las personas afectadas por ETD, pero los servicios accesibles son escasos. los servicios accesibles son escasos. Este documento presenta los resultados de un estudio de prevalencia de depresión y ansiedad entre las personas que viven con lepra y filariasis linfática, y las perspectivas de los usuarios sobre las necesidades y prioridades de un nuevo servicio. MÉTODOS: Se realizó un estudio de prevalencia de trastornos mentales con 141 personas que vivían con lepra y filariasis linfática y controles emparejados. Los que dieron positivo en depresión o ansiedad fueron entrevistados en un estudio cualitativo para conocer sus de vivir con estas enfermedades y cuáles serían sus prioridades en cuanto a servicios y apoyo. servicios y apoyo. Los resultados contribuyeron al proceso de desarrollo de un modelo de atención para su aplicación en el sistema de atención primaria de Nigeria, utilizando un enfoque basado en la Teoría del Cambio. RESULTADOS: Encontramos altas tasas de depresión, ansiedad y reducción del bienestar, con una fuerte correlación entre las medidas. correlación entre las medidas. El estudio cualitativo reveló experiencias de estigmatización y de estigmatización y exclusión, preocupación por las necesidades financieras y servicios gratuitos y apoyo a los medios de subsistencia. CONCLUSIÓN: Los servicios deben diseñarse teniendo en cuenta las necesidades locales y las prioridades de los usuarios de los usuarios.

A comparative study of posttraumatic stress disorder in two post-conflict communities in Benue state Nigeria.

Background: The attendant long-term mental health consequence of the conflict of various kinds in Nigeria is yet to be thoroughly investigated. The Tiv-Fulani farmer-herdsmen crisis is one such conflict that occurred in 2013/2014 in Guma local government in Benue state. Aims: This study seeks to find out some years after the crisis, the prevalence difference in posttraumatic stress disorder (PTSD) between a community (Uikpiam) with direct exposure to the conflict and another (Daudu) with indirect exposure, the pattern of distribution of PTSD symptoms and the associate factors of PTSD. Methods: It is a cross-sectional one that employed a multi-stage cluster sampling method to select 413 participants; 135 from Uikpiam and 278 from Daudu. The study instruments administered included a questionnaire with some socio-demographic variables and an extract from the PTSD module of the Composite International Diagnostic Interview. Results: The prevalence rate of PTSD was higher in Uikpiam (16.3%) when compared to Daudu (4.3%). A high proportion of sub-threshold symptoms of PTSD was recorded in both communities. An association was found between a lower educational qualification and PTSD (χ2 = 8.373; p = 0.039). Conclusion: PTSD can be a prolonged mental ill-effect of crisis and proximity to trauma sites increases vulnerability including lower education. This study looked at PTSD only as an outcome of this crisis, but mental health adverse outcomes of the crisis may not be limited to this alone, hence the need for further investigations for relevant stakeholders to act.

Relationship between quality of life and postpartum depression among women in North-Central, Nigeria

Background: Postpartum depression is a problem of public health interest and impacts negatively on the perception of quality of lifer of sufferers. Quality of life' (QoL) as an outcome measure, is scantly used on women with postpartum depression in Nigeria. The current study was designed to assess the QoL of women with postpartum depression (PPD) in a tertiary hospital in North-Central, Nigeria.Method: A two-stage cross sectional procedure was used to recruit 550 participants 6 to 8 weeks postpartum in Jos, Northcentral, Nigeria. The Edinburgh Postnatal Depression Scale (EPDS), the World Health Organization Quality of Life-BREF-26 (WHOQoL-BREF-26) questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis (SCID) were used.Results: The studied participants were 531 out which 21.8% with postpartum depression had significantly poor perception in all the four domains of the WHOQoL-BREF-26 i.e., in the physical health (p<0.001), psychological (p<0.001), social relationships (p<0.001) and environmental (p<0.001) domains. On the whole, the overall rating of quality of life (p=0.002) and satisfaction with general health (p<0.001) were also perceived to be poor when compared to those without depression. However, regression model analysis showed that the presence of postpartum depression in a participant predicts a significant negative perception on physical and environmental domains of quality of life, but a positive prediction on the general satisfaction with health. Conclusion: Postpartum depression as a disorder of public health importance impacts on the perception of quality of life of women who suffer from it. Early detection and treatment will improve the quality of life of women with postpartum depression

Nigerian medical students' opinions about the undergraduate curriculum in psychiatry.

OBJECTIVE: The number of psychiatrists in Nigeria is inadequate to meet the treatment needs for neuropsychiatric disorders. Developing mental health competency in the future Nigerian physician workforce is one approach to filling the treatment gap. The authors aimed to assess medical students' attitudes to this training and its relevance to their future practice and to assess whether they are getting adequate or relevant training. METHOD: A cross-sectional, questionnaire-based survey was undertaken among a sample (N=375) of 5th- and 6th-year students across four medical schools in Nigeria. RESULTS: Over one-tenth (12%) chose psychiatry as a future career choice. Most expressed positive attitudes toward psychiatry and its relevance to their future careers. A majority were enthusiastic about receiving training in psychiatry in primary-care settings and welcomed a curriculum that emphasized the learning and management of common psychiatric disorders seen in general practice. CONCLUSION: Medical students surveyed would welcome an undergraduate curriculum that integrates the learning of psychiatry with other specialties and skills-training relevant for primary care. Efforts to modify the current curriculum in psychiatry in Nigerian medical schools should be encouraged.

Management of suicidal cut throat injuries in a developing nation: three case reports.

INTRODUCTION: Suicidal cut throat injuries are either unreported or fortunately rare in our country. The management of these injuries requires a multi-disciplinary approach. CASE PRESENTATIONS: This paper presents our experiences with managing three unemployed adult Nigerian males - two of Hausa ethnicity and one from the Tiv ethnic group presenting with cut throat injuries following suicidal attempts. CONCLUSION: The purpose of these reports is to emphasize that suicidal cut throat injuries do occur in our environment and there is a need for the collaboration of the otorhinolaryngologist, anesthesiologist and psychiatrist in the effective management of these patients. We recommend the socioeconomic improvement of individuals as a way of reducing the incidence of these injuries as unemployment was cited as a motivating factor for suicide in our patients. Ways must also be found to identify the many people in society without mental disorders who are at risk of suicidal behaviors.

Depression in patients with irritable bowel syndrome in Jos, Nigeria.

AIM: To study the brain-gut interaction and the effect of behavioral or psychiatric conditions on irritable bowel syndrome (IBS) in an African population. METHODS: IBS was diagnosed using the Rome II diagnostic criteria. The entry of each patient was confirmed following detailed explanations of the questions. Four hundred and eighteen patients were studied. Subjects satisfying the Rome II criteria for IBS were physically examined and stool microscopy was done to identify the presence of "alarm factors". Depression was diagnosed using the symptom-check list adapted from the Research Diagnostic Criteria (DSM-IV) of the American Psychiatric Association. RESULTS: Seventy-five (56.8%) of the 132 IBS patients were depressed whereas only 54 (20.1%) of the 268 non-IBS patients were depressed. There was a significant relationship between IBS and depression (chi2 = 54.29, Odds ratio = 5.21, 56.8 +/- 8.4 vs 20.1 +/- 5.2, P = 0.001). Even though constipation predominant IBS patients were more likely to be depressed, no significant relationship was found between the subtype of IBS and depression (chi2 = 0.02, OR = 0.95, P = 0.68). CONCLUSION: IBS is significantly associated with major depression but not gender and bowel subtypes of the patients. Patients with IBS need to be evaluated for depression due to the highly significant relationship between the two conditions.