The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records
Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision...
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Veröffentlicht in: | Epidemiology and psychiatric sciences 2021-05, Vol.30, p.e37-e37, Article e37 |
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creator | Ruffieux, Y. Efthimiou, O. Van den Heuvel, L. L. Joska, J. A. Cornell, M. Seedat, S. Mouton, J. P. Prozesky, H. Lund, C. Maxwell, N. Tlali, M. Orrell, C. Davies, M.-A. Maartens, G. Haas, A. D. |
description | Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services.
We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.
In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes.
There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated. |
doi_str_mv | 10.1017/S2045796021000196 |
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We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.
In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes.
There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.</description><identifier>ISSN: 2045-7960</identifier><identifier>EISSN: 2045-7979</identifier><identifier>DOI: 10.1017/S2045796021000196</identifier><identifier>PMID: 33993900</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; AIDS ; Cohort analysis ; Cohort Studies ; Electronic Health Records ; HIV ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Mental disorders ; Mental Disorders - drug therapy ; Mental Disorders - epidemiology ; Middle Aged ; Original ; Original Article ; Psychiatry ; Psychotropic drugs ; South Africa - epidemiology ; Young Adult</subject><ispartof>Epidemiology and psychiatric sciences, 2021-05, Vol.30, p.e37-e37, Article e37</ispartof><rights>Copyright © The Author(s), 2021. Published by Cambridge University Press</rights><rights>Copyright © The Author(s), 2021. Published by Cambridge University Press. This work is licensed under the Creative Commons Attribution – Non-Commercial – Share Alike License http://creativecommons.org/licenses/by-nc-sa/4.0 (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2021 2021 The Author(s)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-dc33e94b6022cde42fccf7d4322ea2da68d417ce976b5929b763a014ce93e2243</citedby><cites>FETCH-LOGICAL-c401t-dc33e94b6022cde42fccf7d4322ea2da68d417ce976b5929b763a014ce93e2243</cites><orcidid>0000-0002-5159-8220 ; 0000-0002-0891-2448 ; 0000-0002-4849-181X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157506/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S2045796021000196/type/journal_article$$EHTML$$P50$$Gcambridge$$Hfree_for_read</linktohtml><link.rule.ids>164,230,314,724,777,781,861,882,23299,27905,27906,53772,53774,55609,55785</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33993900$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruffieux, Y.</creatorcontrib><creatorcontrib>Efthimiou, O.</creatorcontrib><creatorcontrib>Van den Heuvel, L. L.</creatorcontrib><creatorcontrib>Joska, J. A.</creatorcontrib><creatorcontrib>Cornell, M.</creatorcontrib><creatorcontrib>Seedat, S.</creatorcontrib><creatorcontrib>Mouton, J. P.</creatorcontrib><creatorcontrib>Prozesky, H.</creatorcontrib><creatorcontrib>Lund, C.</creatorcontrib><creatorcontrib>Maxwell, N.</creatorcontrib><creatorcontrib>Tlali, M.</creatorcontrib><creatorcontrib>Orrell, C.</creatorcontrib><creatorcontrib>Davies, M.-A.</creatorcontrib><creatorcontrib>Maartens, G.</creatorcontrib><creatorcontrib>Haas, A. D.</creatorcontrib><title>The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records</title><title>Epidemiology and psychiatric sciences</title><addtitle>Epidemiol Psychiatr Sci</addtitle><description>Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services.
We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.
In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes.
There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>AIDS</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Electronic Health Records</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Mental disorders</subject><subject>Mental Disorders - drug therapy</subject><subject>Mental Disorders - epidemiology</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Original Article</subject><subject>Psychiatry</subject><subject>Psychotropic drugs</subject><subject>South Africa - epidemiology</subject><subject>Young Adult</subject><issn>2045-7960</issn><issn>2045-7979</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>IKXGN</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kc1u1DAUhSMEolXpA7BBltiwGbj-STxmgVRV9EeqxKKFbeTYN4mLEw-2g9R34WHxtMNQQKxsX3_nXB_fqnpJ4S0FKt9dMxC1VA0wCgBUNU-qw21pJZVUT_f7Bg6q45RuCwNCwZo3z6sDzpXiCuCw-nEzIskRdZ5wzmTQG9KHSLYH7Yl1KUSLMRE3E20XnxPBOQbv0W5LF5dfHok3MQxRTxPe49dhySM56aMz-j3RxIQxxExSXuwdWZKbB-Ld_LUYoUeTY5idISNqX1QRTembXlTPeu0THu_Wo-rz2ceb04vV1afzy9OTq5URQPPKGs5Ria58BTMWBeuN6aUVnDHUzOpmbQWVBpVsulox1cmGa6CiVDgyJvhR9eHBd7N0E1pTwkTt2010k453bdCu_fNmdmM7hO_tmtayhqYYvNkZxPBtwZTbySWD3usZw5JaVrO14JKCKujrv9DbsMS5xLunoGYN0ELRB8rEkFLEfv8YCu12_O0_4y-aV49T7BW_hl0AvjPVUxedHfB37__b_gTUxbzK</recordid><startdate>20210517</startdate><enddate>20210517</enddate><creator>Ruffieux, Y.</creator><creator>Efthimiou, O.</creator><creator>Van den Heuvel, L. L.</creator><creator>Joska, J. A.</creator><creator>Cornell, M.</creator><creator>Seedat, S.</creator><creator>Mouton, J. P.</creator><creator>Prozesky, H.</creator><creator>Lund, C.</creator><creator>Maxwell, N.</creator><creator>Tlali, M.</creator><creator>Orrell, C.</creator><creator>Davies, M.-A.</creator><creator>Maartens, G.</creator><creator>Haas, A. 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L. ; Joska, J. A. ; Cornell, M. ; Seedat, S. ; Mouton, J. P. ; Prozesky, H. ; Lund, C. ; Maxwell, N. ; Tlali, M. ; Orrell, C. ; Davies, M.-A. ; Maartens, G. ; Haas, A. 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L.</au><au>Joska, J. A.</au><au>Cornell, M.</au><au>Seedat, S.</au><au>Mouton, J. P.</au><au>Prozesky, H.</au><au>Lund, C.</au><au>Maxwell, N.</au><au>Tlali, M.</au><au>Orrell, C.</au><au>Davies, M.-A.</au><au>Maartens, G.</au><au>Haas, A. D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records</atitle><jtitle>Epidemiology and psychiatric sciences</jtitle><addtitle>Epidemiol Psychiatr Sci</addtitle><date>2021-05-17</date><risdate>2021</risdate><volume>30</volume><spage>e37</spage><epage>e37</epage><pages>e37-e37</pages><artnum>e37</artnum><issn>2045-7960</issn><eissn>2045-7979</eissn><abstract>Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services.
We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.
In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes.
There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>33993900</pmid><doi>10.1017/S2045796021000196</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-5159-8220</orcidid><orcidid>https://orcid.org/0000-0002-0891-2448</orcidid><orcidid>https://orcid.org/0000-0002-4849-181X</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Acquired immune deficiency syndrome Adolescent Adult AIDS Cohort analysis Cohort Studies Electronic Health Records HIV HIV Infections - drug therapy HIV Infections - epidemiology Human immunodeficiency virus Humans Mental disorders Mental Disorders - drug therapy Mental Disorders - epidemiology Middle Aged Original Original Article Psychiatry Psychotropic drugs South Africa - epidemiology Young Adult |
title | The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records |
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