Screening for depression among adult patients on antiretroviral therapy for human immunodeficiency virus (HIV) attending primary health care facilities in the Rustenburg District

Abstract

Depression commonly Occurs in chronic diseases such as HIV-AIDS and "Depression makes chronic disease worse: WHO", depression is expected to become the second-leading cause of disease burden by the year 2020, after heart disease. Depression can exacerbate chronic disease (WHO, 2007, Kerr L.K. & Kerr L.D., 2001). From the University of New Mexico Health Sciences Center (2009), it has been confirmed that depression is very common in people living with HIV/AIDS and the rate of depression among them was estimated as high as 60%. This was previously confirmed by Moosa and Jeenah (2007).' In Tanzania life events were found to be part in the aetiology of depression and that the rates had increased in recent years (Mbatia et aI., 2009).The authors recommend the strengthening of training of primary health care workers to detect depression and provide pharmacological and psychological treatment. The South African Journal of Psychiatry, states that depression in the world is exceedingly common in the general population. The lifetime prevalence rates are between nine to 20%. In chronic diseases the rate of depression is between 15 to 360/0,which is high. (Moosa & Jeenah, 2007). Untreated depression can lead to missing medication doses and lower the patient's quality of life (aidsinfonet.org, 2009). It has also been established that depression is linked to poor Highly Anti¬retroviral Therapy (HAART) adherence (Kacanek D., Jacobson D.L., Spiegelman D., Wanke c., Isaac R. & Wilson LB., 2010). Primary care based aualitv improvement programs for depression have shown to improve the quality of care, satisfaction with care and health outcomes, functioning, economic productivity and household wealth at reasonable cost (WHO 2010, Kumar & Encinosa W., 2009, Hoberg M.A. et aI., 2008).

Study setting

The study was conducted in the Rustenburg district of North West province. The comprehensive management of HIV/AIDS is part of the district health system that is implemented in this province. Voluntary Counselling and Testing (VCT) is offered to patients at the clinics or health centre (Primary Health care facilities). A positive rapid test, done in the clinic or health centre, is followed by collection of blood for confirmation, using a second rapid test and two Enzyme linked immuno sorbent assay (ELISA) and assessing CD4 levels at the h.ospital's laboratory.

Patients with two rapid tests and two ELISA positives, and a CD4 of less than 200 or clinical stage three, according to revised World Health Organisation (WHO) clinical staging of HIV/AIDS (J.G. Barlett, J.E. Gallant & F.M. Conradie, 2008) are referred to wellness clinic / Job Shimankana Tabane (JST) hospital, for initiation of Anti¬Retroviral Therapy (ART). Once stable on treatment for more than six months, patients are referred down to the nearest clinic or health centre for follow up.

Why is the study necessary?

As a medical officer at one of the down referral primary health care facilities, the researcher encountered patients who were on antiretroviral therapy, that frequently presented with symptoms consistent with depression but these patients were not aware of the depression. x

The researcher became concerned about the lack of identification of depression among adult patients on antiretroviral therapy for human immunodeficiency virus (HIV) in my district, with subsequent lack of appropriate management. After conducting an informal enquiry from some of the patients about symptoms that could be attributed to depression, the researcher became convinced that most of the patients were depressed, although they were not aware of it.

The magnitude of the problem had not been explored in Rustenburg before. This is when the researcher decided to conduct a study on screening for depression amongst adult patients on antiretroviral therapy for human immunodeficiency virus in my district. The result of this study will inform the development of protocols used in the provision of comprehensive care to these patients.

Methodoloav

A descriptive cross-sectional study was conducted amongst adult patients on antiretroviral therapy for Human Immunodeficiency Virus (HIV) who attended one clinic and two health centres, all three accredited in terms of HIV management, in Rustenburg district (South Africa) during December 2009.

A hundred and seventeen (117) adult patients, who consulted three Health Centres and agreed to participate in the study were sequentially selected for inclusion in the study.

A questionnaire, adapted from the World Health Organization's (WHOs), Zung self-rating depression score by a trained nurse, was used to evaluate depression among the participants. Descriptive analysis of the data was done. The Medical Research, Ethics and Publications Committee (MREC) of the University of Limpopo/ Medunsa campus approved the intended study (Registration Number: MREC/M/29/2009).

Results

Amongst the 117 participants 81(69.2 %) had mild depression, 2 (1.7%) had moderate depression, 1(0.9 %) had severe depression and 33 (28.2%) did not have depression. Depression was equally common amongst males and females, 77.1% for males and 69.5% for females. Depression was most common on patients taking a regimen that contains efavirens, lamivudine and stavudine.

Conclusion

Depression is common among adult patients on antlretroviral therapy for Human Immunodeficiency Virus (HIV) attending primary health care facilities in Rustcenburg District. Most of the patients are mildly depressed, as demonstrated by this study research.