Do common mental disorders decline over time in TB/HIV co-infected and HIV patients without TB who are on antiretroviral treatment?

BACKGROUND: The relationship between TB/HIV co-infection and common mental disorders (CMD) is not well investigated. A follow up study was conducted to assess the change in CMD over a 6-months period and its predictors among TB/HIV co-infected and HIV patients without TB in Ethiopia. METHODS: A longitudinal study was conducted in 2009. A total of 465 HIV/AIDS patients without TB and 124 TB/HIV co-infected patients from four antiretroviral treatment (ART) centers in Ethiopia were recruited to assess CMD and quality of life (QoL). CMD and QoL were assessed at baseline and at six month using the Kessler-10 scale and the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV-Bref) respectively. Multivariate analysis was conducted using generalized estimating equations (GEE) using STATA to assess change in CMD and its predictors. RESULTS: At the 6 month, 540 (97 TB/HIV co-infected and 455 HIV/AIDS patients without TB) patients completed the follow up and 8.6% (21% among TB/HIV co-infected and 2.2% among HIV patients without TB) lost to follow-up.At baseline, 54.4% of TB/HIV co-infected patients had mild to severe mental disorder compared to 41.2% among HIV patients without TB. At the six month follow up, 18.1% of TB/HIV co-infected patients had mild to severe mental disorder compared to 21.8% among HIV patients without TB. The decline of the prevalence of any form of metal disorder was 36.3% among TB/HIV co-infected patients compared to 19.4% among HIV patients without TB (P<0.001).QoL was strongly associated with CMD in TB/HIV co-infected patients and HIV patients without TB (ß = -0.04, P<0.001) after controlling the effect of several confounding variables such as sex, income, WHO disease stage, duration on ART, CD4 lymphocyte count, adherence to ART and social support. CONCLUSION: The prevalence of CMD has significantly reduced particularly among TB/HIV co-infected patients over a 6 months period. Poor QoL is the major independent predictors of CMD. We recommend integration of mental health services in TB/HIV programs. Training of health care providers at TB/HIV clinics could help to screen and treat CMD among TB/HIV co-infected patients.

Change in quality of life: a follow up study among patients with HIV infection with and without TB in Ethiopia.

BACKGROUND: There is a dearth of literature on the impact of TB/HIV co-infection on quality of life (QoL). We conducted a study to assess the change in QoL over a 6-months period and its predictors among HIV-infected patients with and without TB in Ethiopia. METHODS: 465 HIV-infected patients without TB and 124 TB/HIV co-infected patients were enrolled in a prospective study in February, 2009. 455 (98%) HIV-infected and 97 (78%) TB/HIV co-infected patients were followed for 6 months. Data on QoL at baseline and 6th month were collected by trained nurses through face to face interviews using the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV-Brief). Common Mental Disorder (CMD) was assessed using a validated version of the Kessler-10 scale. Multivariate analysis was conducted using generalized estimating equations (GEE) using STATA to assess change in QoL and its predictors. RESULTS: There was a statistically significant improvement of the physical, psychological, social, environmental and spiritual QoL at the 6th months follow up compared to the baseline for both groups of patients (P < 0.0001). The change in QoL in all dimension were more marked for TB/HIV co-infected patients compared to HIV-infected patients without TB.A severe form of CMD was strongly associated with poorer physical QoL among TB/HIV co-infected individuals (ß = -2.84; P = 0.000) and HIV clients without TB (ß = -2.34; P = 0.000). CONCLUSION: This study reveals that ART and anti-TB treatment significantly improve the QoL particularly among TB/HIV co-infected patients. We recommend that the ministry of health in collaboration with partners shall integrate mental health services into the TB/HIV programs and train health care providers to timely identify and treat CMD to improve QoL.

Common mental disorders in TB/HIV co-infected patients in Ethiopia.

BACKGROUND: The relationship between TB/HIV co-infection and common mental disorders (CMD) has been scarcely investigated. In this study, we compared the occurrence of CMD in TB/HIV co-infected and non-co-infected HIV patients in Ethiopia. METHODS: We conducted a cross sectional study in three hospitals in Ethiopia from February to April, 2009. The study population consisted of 155 TB/HIV co-infected and 465 non-co-infected HIV patients. CMD was assessed through face to face interviews by trained clinical nurses using the Kessler 10 scale. Several risk factors for CMD were assessed using a structured questionnaire. RESULTS: TB/HIV co-infected patients had significantly (p = 0.001) greater risk of CMD (63.7%) than the non-co-infected patients (46.7%). When adjusted for the effect of potential confounding variables, the odds of having CMD for TB/HIV co-infected individuals was 1.7 times the odds for non-co-infected patients [OR = 1.7, (95%CI: 1.0, 2.9)]. Individuals who had no source of income [OR = 1.7, (95%CI: 1.1, 2.8)], and day labourers [OR = 2.4, 95%CI: 1.2, 5.1)] were more likely to have CMD as compared to individuals who had a source of income and government employees respectively. Patients who perceived stigma [OR = 2.2, 95%CI: 1.5, 3.2)] and who rate their general health as "poor" [OR = 10.0, 95%CI: 2.8, 35.1)] had significantly greater risk of CMD than individual who did not perceive stigma or who perceived their general health to be "good". CONCLUSION: TB/HIV control programs should develop guidelines to screen and treat CMD among TB/HIV co-infected patients. Screening programs should focus on individuals with no source of income, jobless people and day labourers.

Tuberculosis and HIV co-infection: its impact on quality of life.

BACKGROUND: Very little is known about the quality of life of tuberculosis (TB) and HIV co-infected patients. In this study in Ethiopia, we compared the quality of life HIV positive patients with and without TB. METHODS: A cross sectional study was conducted from February to April, 2009 in selected hospitals in Oromiya Regional state, Ethiopia. The study population consisted of 467 HIV patients and 124 TB/HIV co-infected patients. Data on quality of life was collected by trained nurses through face to face interviews using the short Amharic version of the World Health Organization Quality of Life Instrument for HIV clients (WHOQOL HIV). Depression was assessed using a validated version of the Kessler scale. Data was collected by trained nurses and analyzed using SPSS 15.0 statistical software. RESULTS: TB/HIV co-infected patients had a lower quality of life in all domains as compared to HIV infected patients without active TB. Depression, having a source of income and family support were strongly associated with most of the Quality of life domains. In co-infected patients, individuals who had depression were 8.8 times more likely to have poor physical health as compared to individuals who had no depression, OR = 8.8(95%CI: 3.2, 23). Self-stigma was associated with a poor quality of life in the psychological domain. CONCLUSION: The TB control program should design strategies to improve the quality of life of TB/HIV co-infected patients. Depression and self-stigma should be targeted for intervention to improve the quality of life of patients.